H. R. 1319—205 
‘‘(D) INAPPLICABILITY OF PAYMENT LIMITATION.— Sec-
tion 1108(a) shall not apply with respect to any amount 
paid under this paragraph. 
‘‘(E) TERRITORY.—In this paragraph, the term ‘territory’ 
means the Commonwealth of Puerto Rico, the United States 
Virgin Islands, Guam, American Samoa, and the Common-
wealth of the Northern Mariana Islands.’’. 
Subtitle J—Medicaid 
SEC. 9811. MANDATORY COVERAGE OF COVID–19 VACCINES AND 
ADMINISTRATION AND TREATMENT UNDER MEDICAID. 
(a) COVERAGE.— 
(1) IN GENERAL.—Section 1905(a)(4) of the Social Security 
Act (42 U.S.C. 1396d(a)(4)) is amended by striking the semi-
colon at the end and inserting ‘‘; and (E) during the period 
beginning on the date of the enactment of the American Rescue 
Plan Act of 2021 and ending on the last day of the first 
calendar quarter that begins one year after the last day of 
the emergency period described in section 1135(g)(1)(B), a 
COVID–19 vaccine and administration of the vaccine; and (F) 
during the period beginning on the date of the enactment 
of the American Rescue Plan Act of 2021 and ending on the 
last day of the first calendar quarter that begins one year 
after the last day of the emergency period described in section 
1135(g)(1)(B), testing and treatments for COVID–19, including 
specialized equipment and therapies (including preventive 
therapies), and, without regard to the requirements of section 
1902(a)(10)(B) (relating to comparability), in the case of an 
individual who is diagnosed with or presumed to have COVID– 
19, during the period such individual has (or is presumed 
to have) COVID–19, the treatment of a condition that may 
seriously complicate the treatment of COVID–19, if otherwise 
covered under the State plan (or waiver of such plan);’’. 
(2) MAKING COVID–19 VACCINE AVAILABLE TO ADDITIONAL 
ELIGIBILITY
GROUPS
AND
TREATMENT
AVAILABLE
TO
CERTAIN 
UNINSURED.—Section 1902(a)(10) of such Act (42 U.S.C. 
1396a(a)(10)) is amended in the matter following subparagraph 
(G)— 
(A) by striking ‘‘and to other conditions which may 
complicate pregnancy, (VIII)’’ and inserting ‘‘, medical 
assistance for services related to other conditions which 
may complicate pregnancy, and medical assistance for vac-
cines described in section 1905(a)(4)(E) and the administra-
tion of such vaccines during the period described in such 
section, (VIII)’’; 
(B) by inserting ‘‘and medical assistance for vaccines 
described in section 1905(a)(4)(E) and the administration 
of such vaccines during the period described in such sec-
tion’’ after ‘‘(described in subsection (z)(2))’’; 
(C) by inserting ‘‘and medical assistance for vaccines 
described in section 1905(a)(4)(E) and the administration 
of such vaccines during the period described in such sec-
tion’’ after ‘‘described in subsection (k)(1)’’; 
(D) by inserting ‘‘and medical assistance for vaccines 
described in section 1905(a)(4)(E) and the administration
H. R. 1319—206 
of such vaccines during the period described in such sec-
tion’’ after ‘‘family planning setting’’; 
(E) by striking ‘‘and any visit described in section 
1916(a)(2)(G) that is furnished during any such portion’’ 
and 
inserting 
‘‘, 
any 
service 
described 
in 
section 
1916(a)(2)(G) that is furnished during any such portion, 
any vaccine described in section 1905(a)(4)(E) (and the 
administration of such vaccine) that is furnished during 
any such portion, and testing and treatments for COVID– 
19, 
including 
specialized 
equipment 
and 
therapies 
(including preventive therapies), and, in the case of an 
individual who is diagnosed with or presumed to have 
COVID–19, during the period such individual has (or is 
presumed to have) COVID–19, the treatment of a condition 
that may seriously complicate the treatment of COVID– 
19, if otherwise covered under the State plan (or waiver 
of such plan)’’; and 
(F) by striking the semicolon at the end and inserting 
‘‘, and (XIX) medical assistance shall be made available 
during the period described in section 1905(a)(4)(E) for 
vaccines described in such section and the administration 
of such vaccines, for any individual who is eligible for 
and receiving medical assistance under the State plan or 
under a waiver of such plan (other than an individual 
who is eligible for medical assistance consisting only of 
payment of premiums pursuant to subparagraph (E) or 
(F) or section 1933), notwithstanding any provision of this 
title or waiver under section 1115 impacting such individ-
ual’s eligibility for medical assistance under such plan or 
waiver to coverage for a limited type of benefits and serv-
ices that would not otherwise include coverage of a COVID– 
19 vaccine and its administration;’’. 
(3) PROHIBITION OF COST SHARING.— 
(A) IN GENERAL.—Subsections (a)(2) and (b)(2) of sec-
tion 1916 of the Social Security Act (42 U.S.C. 1396o) 
are each amended— 
(i) in subparagraph (F), by striking ‘‘or’’ at the 
end; 
(ii) in subparagraph (G), by striking ‘‘; and’’; and 
(iii) by adding at the end the following subpara-
graphs: 
‘‘(H) during the period beginning on the date of the 
enactment of this subparagraph and ending on the last 
day of the first calendar quarter that begins one year 
after the last day of the emergency period described in 
section 1135(g)(1)(B), a COVID–19 vaccine and the adminis-
tration of such vaccine (for any individual eligible for med-
ical assistance for such vaccine (and administration)); or 
‘‘(I) during the period beginning on the date of the 
enactment of this subparagraph and ending on the last 
day of the first calendar quarter that begins one year 
after the last day of the emergency period described in 
section 1135(g)(1)(B), testing and treatments for COVID– 
19, 
including 
specialized 
equipment 
and 
therapies 
(including preventive therapies), and, in the case of an 
individual who is diagnosed with or presumed to have 
COVID–19, during the period during which such individual
H. R. 1319—207 
has (or is presumed to have) COVID–19, the treatment 
of a condition that may seriously complicate the treatment 
of COVID–19, if otherwise covered under the State plan 
(or waiver of such plan); and’’. 
(B) APPLICATION TO ALTERNATIVE COST SHARING.—Sec-
tion 1916A(b)(3)(B) of the Social Security Act (42 U.S.C. 
1396o–1(b)(3)(B)) is amended— 
(i) in clause (xi), by striking ‘‘any visit’’ and 
inserting ‘‘any service’’; and 
(ii) by adding at the end the following clauses: 
‘‘(xii) During the period beginning on the date of 
the enactment of this clause and ending on the last 
day of the first calendar quarter that begins one year 
after the last day of the emergency period described 
in section 1135(g)(1)(B), a COVID–19 vaccine and the 
administration of such vaccine (for any individual 
eligible for medical assistance for such vaccine (and 
administration)). 
‘‘(xiii) During the period beginning on the date 
of the enactment of this clause and ending on the 
last day of the first calendar quarter that begins one 
year after the last day of the emergency period 
described in section 1135(g)(1)(B), testing and treat-
ments for COVID–19, including specialized equipment 
and therapies (including preventive therapies), and, 
in the case of an individual who is diagnosed with 
or presumed to have COVID–19, during the period 
during which such individual has (or is presumed to 
have) COVID–19, the treatment of a condition that 
may seriously complicate the treatment of COVID– 
19, if otherwise covered under the State plan (or waiver 
of such plan).’’. 
(4) INCLUSION IN THE MEDICAID DRUG REBATE PROGRAM 
OF
COVERED
OUTPATIENT
DRUGS
USED
FOR
COVID–19
TREAT-
MENT.— 
(A) IN GENERAL.—The requirements of section 1927 
of the Social Security Act (42 U.S.C. 1396r–8) shall apply 
to any drug or biological product to which subparagraph 
(F) of section 1905(a)(4) of such Act, as added by paragraph 
(1), applies or to which the subclause (XVIII) in the matter 
following subparagraph (G) of section 1902(a)(10) of such 
Act, as added by paragraph (2), applies that is— 
(i) furnished as medical assistance in accordance 
with section 1902(a)(10)(A) of such Act and such 
subparagraph (F) or subclause (XVIII) and section 
1902(a)(10)(A) of such Act, as applicable, for the treat-
ment, or prevention, of COVID–19, as described in 
such subparagraph or subclause, respectively; and 
(ii) a covered outpatient drug (as defined in section 
1927(k) of such Act, except that, in applying paragraph 
(2)(A) of such section to a drug to which such subpara-
graph (F) or such subclause (XVIII) applies, such drug 
shall be deemed a prescribed drug for purposes of 
section 1905(a)(12) of such Act). 
(B) CONFORMING AMENDMENT.—Section 1927(d)(7) of 
the Social Security Act (42 U.S.C. 1396r–8(d)(7)) is
H. R. 1319—208 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) Drugs and biological products to which section 
1905(a)(4)(F) and subclause (XVIII) in the matter following 
subparagraph (G) of section 1902(a)(10) apply that are 
furnished as medical assistance in accordance with such 
section or clause, respectively, for the treatment or preven-
tion, of COVID–19, as described in such subparagraph 
or subclause, respectively, and section 1902(a)(10)(A).’’. 
(5) ALTERNATIVE BENEFIT PLANS.—Section 1937(b) of the 
Social Security Act (42 U.S.C. 1396u–7(b)) is amended by 
adding at the end the following new paragraph: 
‘‘(8) COVID–19 VACCINES, TESTING, AND TREATMENT.—Not-
withstanding the previous provisions of this section, a State 
may not provide for medical assistance through enrollment 
of an individual with benchmark coverage or benchmark- 
equivalent coverage under this section unless, during the period 
beginning on the date of the enactment of the American Rescue 
Plan Act of 2021 and ending on the last day of the first 
calendar quarter that begins one year after the last day of 
the emergency period described in section 1135(g)(1)(B), such 
coverage includes (and does not impose any deduction, cost 
sharing, or similar charge for)— 
‘‘(A) COVID–19 vaccines and administration of the vac-
cines; and 
‘‘(B) testing and treatments for COVID–19, including 
specialized equipment and therapies (including preventive 
therapies), and, in the case of such an individual who 
is diagnosed with or presumed to have COVID–19, during 
the period such individual has (or is presumed to have) 
COVID–19, the treatment of a condition that may seriously 
complicate the treatment of COVID–19, if otherwise cov-
ered under the State plan (or waiver of such plan).’’. 
(b) TEMPORARY INCREASE IN FEDERAL PAYMENTS FOR COVERAGE 
AND ADMINISTRATION OF COVID–19 VACCINES.—Section 1905 of 
the Social Security Act (42 U.S.C. 1396d) is amended— 
(1) in subsection (b), by striking ‘‘and (ff)’’ and inserting 
‘‘(ff), and (hh)’’; 
(2) in subsection (ff), in the matter preceding paragraph 
(1), by inserting ‘‘, subject to subsection (hh)’’ after ‘‘or (z)(2)’’ 
and 
(3) by adding at the end the following new subsection: 
‘‘(hh) TEMPORARY INCREASED FMAP FOR MEDICAL ASSISTANCE 
FOR COVERAGE AND ADMINISTRATION OF COVID–19 VACCINES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other provision of 
this title, during the period described in paragraph (2), the 
Federal medical assistance percentage for a State, with respect 
to amounts expended by the State for medical assistance for 
a vaccine described in subsection (a)(4)(E) (and the administra-
tion of such a vaccine), shall be equal to 100 percent. 
‘‘(2) PERIOD DESCRIBED.—The period described in this para-
graph is the period that— 
‘‘(A) begins on the first day of the first quarter begin-
ning after the date of the enactment of this subsection; 
and
H. R. 1319—209 
‘‘(B) ends on the last day of the first quarter that 
begins one year after the last day of the emergency period 
described in section 1135(g)(1)(B). 
‘‘(3) EXCLUSION
OF
EXPENDITURES
FROM
TERRITORIAL 
CAPS.—Any payment made to a territory for expenditures for 
medical assistance under subsection (a)(4)(E) that are subject 
to the Federal medical assistance percentage specified under 
paragraph (1) shall not be taken into account for purposes 
of applying payment limits under subsections (f) and (g) of 
section 1108.’’. 
SEC. 9812. MODIFICATIONS TO CERTAIN COVERAGE UNDER MEDICAID 
FOR PREGNANT AND POSTPARTUM WOMEN. 
(a) STATE OPTION.—Section 1902(e) of the Social Security Act 
(42 U.S.C. 1396a(e)) is amended by adding at the end the following 
new paragraph: 
‘‘(16) EXTENDING CERTAIN COVERAGE FOR PREGNANT AND 
POSTPARTUM WOMEN.— 
‘‘(A) IN GENERAL.—At the option of the State, the State 
plan (or waiver of such State plan) may provide, that 
an individual who, while pregnant, is eligible for and has 
received medical assistance under the State plan approved 
under this title (or a waiver of such plan) (including during 
a period of retroactive eligibility under subsection (a)(34)) 
shall, in addition to remaining eligible under paragraph 
(5) for all pregnancy-related and postpartum medical assist-
ance available under the State plan (or waiver) through 
the last day of the month in which the 60-day period 
(beginning on the last day of her pregnancy) ends, remain 
eligible under the State plan (or waiver) for medical assist-
ance for the period beginning on the first day occurring 
after the end of such 60-day period and ending on the 
last day of the month in which the 12-month period (begin-
ning on the last day of her pregnancy) ends. 
‘‘(B) FULL BENEFITS DURING PREGNANCY AND THROUGH-
OUT
THE
12-MONTH
POSTPARTUM
PERIOD.—The medical 
assistance provided for a pregnant or postpartum indi-
vidual by a State making an election under this paragraph, 
without regard to the basis on which the individual is 
eligible for medical assistance under the State plan (or 
waiver), shall— 
‘‘(i) include all items and services covered under 
the State plan (or waiver) that are not less in amount, 
duration, or scope, or are determined by the Secretary 
to be substantially equivalent, to the medical assist-
ance available for an individual described in subsection 
(a)(10)(A)(i); and 
‘‘(ii) be provided for the individual while pregnant 
and during the 12-month period that begins on the 
last day of the individual’s pregnancy and ends on 
the last day of the month in which such 12-month 
period ends. 
‘‘(C) COVERAGE UNDER CHIP.—A State making an elec-
tion under this paragraph that covers under title XXI child 
health assistance for targeted low-income children who are 
pregnant or targeted low-income pregnant women, as
H. R. 1319—210 
applicable, shall also make the election under section 
2107(e)(1)(J) of such title.’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall apply with respect to State elections made under paragraph 
(16) of section 1902(e) of the Social Security Act (42 U.S.C. 1396a(e)), 
as added by subsection (a), during the 5-year period beginning 
on the 1st day of the 1st fiscal year quarter that begins one 
year after the date of the enactment of this Act. 
SEC. 9813. STATE OPTION TO PROVIDE QUALIFYING COMMUNITY- 
BASED MOBILE CRISIS INTERVENTION SERVICES. 
Title XIX of the Social Security Act is amended by adding 
after section 1946 (42 U.S.C. 1396w–5) the following new section: 
‘‘SEC. 1947. STATE OPTION TO PROVIDE QUALIFYING COMMUNITY- 
BASED MOBILE CRISIS INTERVENTION SERVICES. 
‘‘(a) IN GENERAL.—Notwithstanding section 1902(a)(1) (relating 
to Statewideness), section 1902(a)(10)(B) (relating to comparability), 
section 1902(a)(23)(A) (relating to freedom of choice of providers), 
or section 1902(a)(27) (relating to provider agreements), a State 
may, during the 5-year period beginning on the first day of the 
first fiscal year quarter that begins on or after the date that 
is 1 year after the date of the enactment of this section, provide 
medical assistance for qualifying community-based mobile crisis 
intervention services. 
‘‘(b) QUALIFYING COMMUNITY-BASED MOBILE CRISIS INTERVEN-
TION SERVICES DEFINED.—For purposes of this section, the term 
‘qualifying community-based mobile crisis intervention services’ 
means, with respect to a State, items and services for which medical 
assistance is available under the State plan under this title or 
a waiver of such plan, that are— 
‘‘(1) furnished to an individual otherwise eligible for medical 
assistance under the State plan (or waiver of such plan) who 
is— 
‘‘(A) outside of a hospital or other facility setting; and 
‘‘(B) experiencing a mental health or substance use 
disorder crisis; 
‘‘(2) furnished by a multidisciplinary mobile crisis team— 
‘‘(A) that includes at least 1 behavioral health care 
professional who is capable of conducting an assessment 
of the individual, in accordance with the professional’s per-
mitted scope of practice under State law, and other profes-
sionals or paraprofessionals with appropriate expertise in 
behavioral health or mental health crisis response, 
including nurses, social workers, peer support specialists, 
and others, as designated by the State through a State 
plan amendment (or waiver of such plan); 
‘‘(B) whose members are trained in trauma-informed 
care, de-escalation strategies, and harm reduction; 
‘‘(C) that is able to respond in a timely manner and, 
where appropriate, provide— 
‘‘(i) screening and assessment; 
‘‘(ii) stabilization and de-escalation; and 
‘‘(iii) coordination with, and referrals to, health, 
social, and other services and supports as needed, and 
health services as needed; 
‘‘(D) that maintains relationships with relevant 
community partners, including medical and behavioral
H. R. 1319—211 
health providers, primary care providers, community health 
centers, crisis respite centers, and managed care organiza-
tions (if applicable); and 
‘‘(E) that maintains the privacy and confidentiality of 
patient information consistent with Federal and State 
requirements; and 
‘‘(3) available 24 hours per day, every day of the year. 
‘‘(c) PAYMENTS.—Notwithstanding section 1905(b) or 1905(ff) 
and subject to subsections (y) and (z) of section 1905, during each 
of the first 12 fiscal quarters occurring during the period described 
in subsection (a) that a State meets the requirements described 
in subsection (d), the Federal medical assistance percentage 
applicable to amounts expended by the State for medical assistance 
for qualifying community-based mobile crisis intervention services 
furnished during such quarter shall be equal to 85 percent. In 
no case shall the application of the previous sentence result in 
the Federal medical assistance percentage applicable to amounts 
expended by a State for medical assistance for such qualifying 
community-based mobile crisis intervention services furnished 
during a quarter being less than the Federal medical assistance 
percentage that would apply to such amounts expended by the 
State for such services furnished during such quarter without 
application of the previous sentence. 
‘‘(d) REQUIREMENTS.—The requirements described in this sub-
section are the following: 
‘‘(1) The State demonstrates, to the satisfaction of the Sec-
retary that it will be able to support the provision of qualifying 
community-based mobile crisis intervention services that meet 
the conditions specified in subsection (b). 
‘‘(2) The State provides assurances satisfactory to the Sec-
retary that— 
‘‘(A) any additional Federal funds received by the State 
for qualifying community-based mobile crisis intervention 
services provided under this section that are attributable 
to the increased Federal medical assistance percentage 
under subection (c) will be used to supplement, and not 
supplant, the level of State funds expended for such serv-
ices for the fiscal year preceding the first fiscal quarter 
occurring during the period described in subsection (a); 
‘‘(B) if the State made qualifying community-based 
mobile crisis intervention services available in a region 
of the State in such fiscal year, the State will continue 
to make such services available in such region under this 
section during each month occurring during the period 
described in subsection (a) for which the Federal medical 
assistance percentage under subsection (c) is applicable 
with respect to the State. 
‘‘(e) FUNDING FOR STATE PLANNING GRANTS.—There is appro-
priated, out of any funds in the Treasury not otherwise appro-
priated, $15,000,000 to the Secretary for purposes of implementing, 
administering, and making planning grants to States as soon as 
practicable for purposes of developing a State plan amendment 
or section 1115, 1915(b), or 1915(c) waiver request (or an amend-
ment to such a waiver) to provide qualifying community-based 
mobile crisis intervention services under this section, to remain 
available until expended.’’.
H. R. 1319—212 
SEC. 9814. TEMPORARY INCREASE IN FMAP FOR MEDICAL ASSISTANCE 
UNDER STATE MEDICAID PLANS WHICH BEGIN TO 
EXPEND AMOUNTS FOR CERTAIN MANDATORY INDIVID-
UALS. 
Section 1905 of the Social Security Act (42 U.S.C. 1396d), 
as amended by section 9811 of this subtitle, is further amended— 
(1) in subsection (b), in the first sentence, by striking 
‘‘and (hh)’’ and inserting ‘‘(hh), and (ii)’’; 
(2) in subsection (ff), by striking ‘‘subject to subsection 
(hh)’’ and inserting ‘‘subject to subsections (hh) and (ii)’’; and 
(3) by adding at the end the following new subsection: 
‘‘(ii) TEMPORARY INCREASE IN FMAP FOR MEDICAL ASSISTANCE 
UNDER STATE MEDICAID PLANS WHICH BEGIN TO EXPEND AMOUNTS 
FOR CERTAIN MANDATORY INDIVIDUALS.— 
‘‘(1) IN GENERAL.—For each quarter occurring during the 
8-quarter period beginning with the first calendar quarter 
during which a qualifying State (as defined in paragraph (3)) 
expends amounts for all individuals described in section 
1902(a)(10)(A)(i)(VIII) under the State plan (or waiver of such 
plan), the Federal medical assistance percentage determined 
under subsection (b) for such State shall, after application 
of any increase, if applicable, under section 6008 of the Families 
First Coronavirus Response Act, be increased by 5 percentage 
points, except for any quarter (and each subsequent quarter) 
during such period during which the State ceases to provide 
medical assistance to any such individual under the State plan 
(or waiver of such plan). 
‘‘(2) SPECIAL APPLICATION RULES.—Any increase described 
in paragraph (1) (or payment made for expenditures on medical 
assistance that are subject to such increase)— 
‘‘(A) shall not apply with respect to disproportionate 
share hospital payments described in section 1923; 
‘‘(B) shall not be taken into account in calculating 
the enhanced FMAP of a State under section 2105; 
‘‘(C) shall not be taken into account for purposes of 
part A, D, or E of title IV; and 
‘‘(D) shall not be taken into account for purposes of 
applying payment limits under subsections (f) and (g) of 
section 1108. 
‘‘(3) DEFINITION.—For purposes of this subsection, the term 
‘qualifying State’ means a State which has not expended 
amounts 
for 
all 
individuals 
described 
in 
section 
1902(a)(10)(A)(i)(VIII) before the date of the enactment of this 
subsection.’’. 
SEC. 9815. EXTENSION OF 100 PERCENT FEDERAL MEDICAL ASSIST-
ANCE 
PERCENTAGE 
TO 
URBAN 
INDIAN 
HEALTH 
ORGANIZATIONS AND NATIVE HAWAIIAN HEALTH CARE 
SYSTEMS. 
Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)) 
is amended by inserting after ‘‘(as defined in section 4 of the 
Indian Health Care Improvement Act)’’ the following: ‘‘; for the 
8 fiscal year quarters beginning with the first fiscal year quarter 
beginning after the date of the enactment of the American Rescue 
Plan Act of 2021, the Federal medical assistance percentage shall 
also be 100 per centum with respect to amounts expended as 
medical assistance for services which are received through an Urban
H. R. 1319—213 
Indian organization (as defined in paragraph (29) of section 4 of 
the Indian Health Care Improvement Act) that has a grant or 
contract with the Indian Health Service under title V of such 
Act; and, for such 8 fiscal year quarters, the Federal medical assist-
ance percentage shall also be 100 per centum with respect to 
amounts expended as medical assistance for services which are 
received through a Native Hawaiian Health Center (as defined 
in section 12(4) of the Native Hawaiian Health Care Improvement 
Act) or a qualified entity (as defined in section 6(b) of such Act) 
that has a grant or contract with the Papa Ola Lokahi under 
section 8 of such Act’’. 
SEC. 9816. SUNSET OF LIMIT ON MAXIMUM REBATE AMOUNT FOR 
SINGLE SOURCE DRUGS AND INNOVATOR MULTIPLE 
SOURCE DRUGS. 
Section 1927(c)(2)(D) of the Social Security Act (42 U.S.C. 
1396r–8(c)(2)(D)) is amended by inserting after ‘‘December 31, 
2009,’’ the following: ‘‘and before January 1, 2024,’’. 
SEC. 9817. ADDITIONAL SUPPORT FOR MEDICAID HOME AND COMMU-
NITY-BASED SERVICES DURING THE COVID–19 EMER-
GENCY. 
(a) INCREASED FMAP.— 
(1) IN GENERAL.—Notwithstanding section 1905(b) of the 
Social Security Act (42 U.S.C. 1396d(b)) or section 1905(ff), 
in the case of a State that meets the HCBS program require-
ments under subsection (b), the Federal medical assistance 
percentage determined for the State under section 1905(b) of 
such Act (or, if applicable, under section 1905(ff)) and, if 
applicable, increased under subsection (y), (z), (aa), or (ii) of 
section 1905 of such Act (42 U.S.C. 1396d), section 1915(k) 
of such Act (42 U.S.C. 1396n(k)), or section 6008(a) of the 
Families First Coronavirus Response Act (Public Law 116– 
127), shall be increased by 10 percentage points with respect 
to expenditures of the State under the State Medicaid program 
for home and community-based services (as defined in para-
graph (2)(B)) that are provided during the HCBS program 
improvement period (as defined in paragraph (2)(A)). In no 
case may the application of the previous sentence result in 
the Federal medical assistance percentage determined for a 
State being more than 95 percent with respect to such expendi-
tures. Any payment made to Puerto Rico, the Virgin Islands, 
Guam, the Northern Mariana Islands, or American Samoa for 
expenditures on medical assistance that are subject to the 
Federal medical assistance percentage increase specified under 
the first sentence of this paragraph shall not be taken into 
account for purposes of applying payment limits under sub-
sections (f) and (g) of section 1108 of the Social Security Act 
(42 U.S.C. 1308). 
(2) DEFINITIONS.—In this section: 
(A) HCBS PROGRAM IMPROVEMENT PERIOD.—The term 
‘‘HCBS program improvement period’’ means, with respect 
to a State, the period— 
(i) beginning on April 1, 2021; and 
(ii) ending on March 31, 2022. 
(B) HOME AND COMMUNITY-BASED SERVICES.—The term 
‘‘home and community-based services’’ means any of the 
following:
H. R. 1319—214 
(i) Home health care services authorized under 
paragraph (7) of section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d(a)). 
(ii) Personal care services authorized under para-
graph (24) of such section. 
(iii) PACE services authorized under paragraph 
(26) of such section. 
(iv) Home and community-based services author-
ized under subsections (b), (c), (i), (j), and (k) of section 
1915 of such Act (42 U.S.C. 1396n), such services 
authorized under a waiver under section 1115 of such 
Act (42 U.S.C. 1315), and such services through cov-
erage authorized under section 1937 of such Act (42 
U.S.C. 1396u–7). 
(v) Case management services authorized under 
section 1905(a)(19) of the Social Security Act (42 U.S.C. 
1396d(a)(19)) and section 1915(g) of such Act (42 U.S.C. 
1396n(g)). 
(vi) Rehabilitative services, including those related 
to behavioral health, described in section 1905(a)(13) 
of such Act (42 U.S.C. 1396d(a)(13)). 
(vii) Such other services specified by the Secretary 
of Health and Human Services. 
(C) ELIGIBLE
INDIVIDUAL.—The term ‘‘eligible indi-
vidual’’ means an individual who is eligible for and enrolled 
for medical assistance under a State Medicaid program 
and includes an individual who becomes eligible for medical 
assistance under a State Medicaid program when removed 
from a waiting list. 
(D) MEDICAID
PROGRAM.—The term ‘‘Medicaid pro-
gram’’ means, with respect to a State, the State program 
under title XIX of the Social Security Act (42 U.S.C. 1396 
et seq.) (including any waiver or demonstration under such 
title or under section 1115 of such Act (42 U.S.C. 1315) 
relating to such title). 
(E) STATE.—The term ‘‘State’’ has the meaning given 
such term for purposes of title XIX of the Social Security 
Act (42 U.S.C. 1396 et seq.). 
(b) STATE REQUIREMENTS FOR FMAP INCREASE.—As conditions 
for receipt of the increase under subsection (a) to the Federal 
medical assistance percentage determined for a State, the State 
shall meet each of the following requirements (referred to in sub-
section (a) as the HCBS program requirements): 
(1) SUPPLEMENT, NOT SUPPLANT.—The State shall use the 
Federal funds attributable to the increase under subsection 
(a) to supplement, and not supplant, the level of State funds 
expended for home and community-based services for eligible 
individuals through programs in effect as of April 1, 2021. 
(2) REQUIRED IMPLEMENTATION OF CERTAIN ACTIVITIES.— 
The State shall implement, or supplement the implementation 
of, one or more activities to enhance, expand, or strengthen 
home and community-based services under the State Medicaid 
program.
H. R. 1319—215 
SEC. 9818. FUNDING FOR STATE STRIKE TEAMS FOR RESIDENT AND 
EMPLOYEE SAFETY IN NURSING FACILITIES. 
Section 1919 of the Social Security Act (42 U.S.C. 1396r) is 
amended by adding at the end the following new subsection: 
‘‘(k) FUNDING
FOR
STATE
STRIKE
TEAMS.—In addition to 
amounts otherwise available, there is appropriated to the Secretary, 
out of any monies in the Treasury not otherwise appropriated, 
$250,000,000, to remain available until expended, for purposes of 
allocating such amount among the States (including the District 
of Columbia and each territory of the United States) for such 
a State to establish and implement a strike team that will be 
deployed to a nursing facility in the State with diagnosed or sus-
pected cases of COVID–19 among residents or staff for the purposes 
of assisting with clinical care, infection control, or staffing during 
the emergency period described in section 1135(g)(1)(B) and the 
1-year period immediately following the end of such emergency 
period.’’. 
SEC. 9819. SPECIAL RULE FOR THE PERIOD OF A DECLARED PUBLIC 
HEALTH EMERGENCY RELATED TO CORONAVIRUS. 
(a) IN GENERAL.—Section 1923(f)(3) of the Social Security Act 
(42 U.S.C. 1396r–4(f)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘subparagraph (E)’’ 
and inserting ‘‘subparagraphs (E) and (F)’’ ; and 
(2) by adding at the end the following new subparagraph: 
‘‘(F) ALLOTMENTS
DURING
THE
CORONAVIRUS
TEM-
PORARY MEDICAID FMAP INCREASE.— 
‘‘(i) IN
GENERAL.—Notwithstanding any other 
provision of this subsection, for any fiscal year for 
which the Federal medical assistance percentage 
applicable to expenditures under this section is 
increased pursuant to section 6008 of the Families 
First Coronavirus Response Act, the Secretary shall 
recalculate the annual DSH allotment, including the 
DSH allotment specified under paragraph (6)(A)(vi), 
to ensure that the total DSH payments (including both 
Federal and State shares) that a State may make 
related to a fiscal year is equal to the total DSH 
payments that the State could have made for such 
fiscal year without such increase to the Federal medical 
assistance percentage. 
‘‘(ii) NO APPLICATION TO ALLOTMENTS BEGINNING 
AFTER COVID–19 EMERGENCY PERIOD.—The DSH allot-
ment for any State for the first fiscal year beginning 
after the end of the emergency period described in 
section 1135(g)(1)(B) or any succeeding fiscal year shall 
be determined under this paragraph without regard 
to the DSH allotments determined under clause (i).’’. 
(b) EFFECTIVE DATE.—The amendment made by subsection (a) 
shall take effect and apply as if included in the enactment of 
the Families First Coronavirus Response Act (Public Law 116– 
127).
H. R. 1319—216 
Subtitle K—Children’s Health Insurance 
Program 
SEC. 9821. MANDATORY COVERAGE OF COVID–19 VACCINES AND 
ADMINISTRATION AND TREATMENT UNDER CHIP. 
(a) COVERAGE.— 
(1) IN
GENERAL.—Section 2103(c) of the Social Security 
Act (42 U.S.C. 1397cc(c)) is amended by adding at the end 
the following paragraph: 
‘‘(11) REQUIRED
COVERAGE
OF
COVID–19
VACCINES
AND 
TREATMENT.—Regardless of the type of coverage elected by a 
State under subsection (a), the child health assistance provided 
for a targeted low-income child, and, in the case of a State 
that elects to provide pregnancy-related assistance pursuant 
to section 2112, the pregnancy-related assistance provided for 
a targeted low-income pregnant woman (as such terms are 
defined for purposes of such section), shall include coverage, 
during the period beginning on the date of the enactment 
of this paragraph and ending on the last day of the first 
calendar quarter that begins one year after the last day of 
the emergency period described in section 1135(g)(1)(B), of— 
‘‘(A) a COVID–19 vaccine (and the administration of 
the vaccine); and 
‘‘(B) testing and treatments for COVID–19, including 
specialized equipment and therapies (including preventive 
therapies), and, in the case of an individual who is 
diagnosed with or presumed to have COVID–19, during 
the period during which such individual has (or is pre-
sumed to have) COVID–19, the treatment of a condition 
that may seriously complicate the treatment of COVID– 
19, if otherwise covered under the State child health plan 
(or waiver of such plan).’’. 
(2) PROHIBITION OF COST SHARING.—Section 2103(e)(2) of 
the Social Security Act (42 U.S.C. 1397cc(e)(2)), as amended 
by section 6004(b)(3) of the Families First Coronavirus 
Response Act, is amended— 
(A) in the paragraph header, by inserting ‘‘A COVID– 
19 VACCINE, COVID–19 TREATMENT,’’ before ‘‘OR PREGNANCY- 
RELATED ASSISTANCE’’; and 
(B) 
by 
striking 
‘‘visits 
described 
in 
section 
1916(a)(2)(G), or’’ and inserting ‘‘services described in sec-
tion 
1916(a)(2)(G), 
vaccines 
described 
in 
section 
1916(a)(2)(H) administered during the period described in 
such section (and the administration of such vaccines), 
testing or treatments described in section 1916(a)(2)(I) fur-
nished during the period described in such section, or’’. 
(b) TEMPORARY INCREASE IN FEDERAL PAYMENTS FOR COVERAGE 
AND ADMINISTRATION OF COVID–19 VACCINES.—Section 2105(c) of 
the Social Security Act (42 U.S.C. 1397ee(c)) is amended by adding 
at the end the following new paragraph: 
‘‘(12) TEMPORARY ENHANCED PAYMENT FOR COVERAGE AND 
ADMINISTRATION
OF
COVID–19
VACCINES.—During the period 
described in section 1905(hh)(2), notwithstanding subsection 
(b), the enhanced FMAP for a State, with respect to payments 
under subsection (a) for expenditures under the State child 
health plan (or a waiver of such plan) for a vaccine described
H. R. 1319—217 
in section 1905(a)(4)(E) (and the administration of such a vac-
cine), shall be equal to 100 percent.’’. 
(c) ADJUSTMENT OF CHIP ALLOTMENTS.—Section 2104(m) of 
the Social Security Act (42 U.S.C. 1397dd(m)) is amended— 
(1) in paragraph (2)(B), in the matter preceding clause 
(i), by striking ‘‘paragraphs (5) and (7)’’ and inserting ‘‘para-
graphs (5), (7), and (12)’’; and 
(2) by adding at the end the following new paragraph: 
‘‘(12) ADJUSTING ALLOTMENTS TO ACCOUNT FOR INCREASED 
FEDERAL
PAYMENTS
FOR
COVERAGE
AND
ADMINISTRATION
OF 
COVID–19
VACCINES.—If a State, commonwealth, or territory 
receives payment for a fiscal year (beginning with fiscal year 
2021) under subsection (a) of section 2105 for expenditures 
that are subject to the enhanced FMAP specified under sub-
section (c)(12) of such section, the amount of the allotment 
determined for the State, commonwealth, or territory under 
this subsection— 
‘‘(A) for such fiscal year shall be increased by the 
projected expenditures for such year by the State, common-
wealth, or territory under the State child health plan (or 
a waiver of such plan) for vaccines described in section 
1905(a)(4)(E) (and the administration of such vaccines); 
and 
‘‘(B) once actual expenditures are available in the sub-
sequent fiscal year, the fiscal year allotment that was 
adjusted by the amount described in subparagraph (A) 
shall be adjusted on the basis of the difference between— 
‘‘(i) 
such 
projected 
amount 
of 
expenditures 
described in subparagraph (A) for such fiscal year 
described in such subparagraph by the State, common-
wealth, or territory; and 
‘‘(ii) the actual amount of expenditures for such 
fiscal year described in subparagraph (A) by the State, 
commonwealth, or territory under the State child 
health plan (or waiver of such plan) for vaccines 
described in section 1905(a)(4)(E) (and the administra-
tion of such vaccines).’’. 
SEC. 9822. MODIFICATIONS TO CERTAIN COVERAGE UNDER CHIP FOR 
PREGNANT AND POSTPARTUM WOMEN. 
(a) MODIFICATIONS TO COVERAGE.— 
(1) IN GENERAL.—Section 2107(e)(1) of the Social Security 
Act (42 U.S.C. 1397gg(e)(1)) is amended— 
(A) by redesignating subparagraphs (J) through (S) 
as subparagraphs (K) through (T), respectively; and 
(B) by inserting after subparagraph (I) the following 
new subparagraph: 
‘‘(J) Paragraphs (5) and (16) of section 1902(e) (relating 
to the State option to provide medical assistance consisting 
of full benefits during pregnancy and throughout the 12- 
month postpartum period under title XIX), if the State 
provides child health assistance for targeted low-income 
children who are pregnant or to targeted low-income preg-
nant women and the State has elected to apply such para-
graph (16) with respect to pregnant women under title 
XIX, the provision of assistance under the State child 
health plan or waiver for targeted low-income children
H. R. 1319—218 
or targeted low-income pregnant women during pregnancy 
and the 12-month postpartum period shall be required 
and not at the option of the State and shall include coverage 
of all items or services provided to a targeted low-income 
child 
or 
targeted 
low-income 
pregnant 
woman 
(as 
applicable) under the State child health plan or waiver).’’. 
(2) OPTIONAL COVERAGE OF TARGETED LOW-INCOME PREG-
NANT WOMEN.—Section 2112(d)(2)(A) of the Social Security Act 
(42 U.S.C. 1397ll(d)(2)(A)) is amended by inserting after ‘‘60- 
day period’’ the following: ‘‘, or, in the case that subparagraph 
(A) of section 1902(e)(16) applies to the State child health 
plan (or waiver of such plan), pursuant to section 2107(e)(1), 
the 12-month period,’’. 
(b) EFFECTIVE DATE.—The amendments made by subsection 
(a), shall apply with respect to State elections made under para-
graph (16) of section 1902(e) of the Social Security Act (42 U.S.C. 
1396a(e)), as added by section 9812(a) of subtitle J of this title, 
during the 5-year period beginning on the 1st day of the 1st fiscal 
year quarter that begins one year after the date of the enactment 
of this Act. 
Subtitle L—Medicare 
SEC. 9831. FLOOR ON THE MEDICARE AREA WAGE INDEX FOR HOS-
PITALS IN ALL-URBAN STATES. 
(a) IN GENERAL.—Section 1886(d)(3)(E) of the Social Security 
Act (42 U.S.C. 1395ww(d)(3)(E)) is amended— 
(1) in clause (i), in the first sentence, by striking ‘‘or (iii)’’ 
and inserting ‘‘, (iii), or (iv)’’; and 
(2) by adding at the end the following new clause: 
‘‘(iv) FLOOR ON AREA WAGE INDEX FOR HOSPITALS 
IN ALL-URBAN STATES.— 
‘‘(I) IN GENERAL.—For discharges occurring on 
or after October 1, 2021, the area wage index 
applicable under this subparagraph to any hospital 
in an all-urban State (as defined in subclause (IV)) 
may not be less than the minimum area wage 
index for the fiscal year for hospitals in that State, 
as established under subclause (II). 
‘‘(II) MINIMUM AREA WAGE INDEX.—For pur-
poses of subclause (I), the Secretary shall establish 
a minimum area wage index for a fiscal year for 
hospitals in each all-urban State using the method-
ology described in section 412.64(h)(4)(vi) of title 
42, Code of Federal Regulations, as in effect for 
fiscal year 2018. 
‘‘(III) WAIVING
BUDGET
NEUTRALITY.—Pursu-
ant to the fifth sentence of clause (i), this clause 
shall not be applied in a budget neutral manner. 
‘‘(IV) ALL-URBAN
STATE
DEFINED.—In this 
clause, the term ‘all-urban State’ means a State 
in which there are no rural areas (as defined in 
paragraph (2)(D)) or a State in which there are 
no hospitals classified as rural under this section.’’.