SEC. 3. CLARIFYING AUTHORITY OF STATE MEDICAID 
FRAUD AND ABUSE CONTROL UNITS TO IN-
VESTIGATE AND PROSECUTE CASES OF MED-
ICAID PATIENT ABUSE AND NEGLECT IN ANY 
SETTING. 
(a) IN GENERAL.—Section 1903(q)(4)(A)(ii) of the 
Social Security Act (42 U.S.C. 1396b(q)(4)(A)(ii)) is 
amended by inserting after ‘‘patients residing in board 
and care facilities’’ the following: ‘‘and of patients (who 
are receiving medical assistance under the State plan 
under this title) in a noninstitutional or other setting’’. 
(b) AVAILABILITY OF FUNDING.—Section 1903(a)(6) 
of the Social Security Act (42 U.S.C. 1396b(a)(6)) is 
amended, in the matter following subparagraph (B), by 
striking ‘‘(as found necessary by the Secretary for the 
elimination of fraud in the provision and administration 
of medical assistance provided under the State plan)’’. 
SEC. 4. EXTENSION OF PROTECTION FOR MEDICAID RE-
CIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES AGAINST SPOUSAL IMPOVERISH-
MENT. 
(a) IN GENERAL.—Section 2404 of Public Law 111– 
148 (42 U.S.C. 1396r–5 note) is amended by striking 
‘‘September 30, 2019’’ and inserting ‘‘March 31, 2024’’. 
(b) RULE OF CONSTRUCTION.—Nothing in section 
2404 of Public Law 111–148 (42 U.S.C. 1396r–5 note),
section 1924 of the Social Security Act (42 U.S.C. 1396r– 
5), or section 1902(a)(17) of such Act (42 U.S.C. 
1396a(a)(17)) shall be construed as prohibiting a State 
from applying an income or resource disregard authorized 
under section 1902(r)(2) of such Act (42 U.S.C. 
1396a(r)(2))— 
(1) to the income or resources of individuals de-
scribed in section 1902(a)(10)(A)(ii)(VI) of such Act 
(42 U.S.C. 1396a(a)(10)(A)(ii)(VI)) (including a 
disregard of the income or resources of such individ-
ual’s spouse); or 
(2) on the basis of an individual’s need for 
home and community-based services authorized 
under subsection (c), (d), (i), or (k) of section 1915 
of such Act (42 U.S.C. 1396n) or under section 
1115 of such Act (42 U.S.C. 1315). 
SEC. 5. EXTENSION OF THE COMMUNITY MENTAL HEALTH 
SERVICES DEMONSTRATION PROGRAM. 
Section 223(d) of the Protecting Access to Medicare 
Act of 2014 (42 U.S.C. 1396a note) is amended— 
(1) in paragraph (3), by striking ‘‘June 30, 
2019’’ and inserting ‘‘December 31, 2021’’; and 
(2) in paragraph (7)(B), by striking ‘‘December 
31, 2021’’ and inserting ‘‘June 30, 2021’’.
SEC. 6. PREVENTING INAPPROPRIATELY LOW REBATES 
UNDER MEDICAID DRUG REBATE PROGRAM. 
(a) PROHIBITING MANUFACTURERS FROM BLEND-
ING AVERAGE MANUFACTURER PRICE OF BRAND DRUG 
AND ANY AUTHORIZED GENERIC OF SUCH DRUG.—Sec-
tion 1927(k)(1)(C) of the Social Security Act (42 U.S.C. 
1396r–8(k)(1)(C)) is amended— 
(1) in the subparagraph heading, by striking 
‘‘INCLUSION’’ and inserting ‘‘EXCLUSION’’; 
(2) by striking ‘‘a new drug application’’ and 
inserting ‘‘the manufacturer’s new drug applica-
tion’’; and 
(3) by striking ‘‘inclusive’’ and inserting ‘‘exclu-
sive’’. 
(b) ELIMINATING MANUFACTURERS FROM DEFINI-
TION OF WHOLESALER.—Section 1927(k)(11) of the So-
cial Security Act (42 U.S.C. 1396r–8(k)(11)) is amend-
ed— 
(1) by striking ‘‘manufacturers,’’; and 
(2) by striking ‘‘manufacturer’s and’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to covered outpatient 
drugs dispensed on or after January 1, 2020.
SEC. 7. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 
1396w–1(b)(1)) 
is 
amended 
by 
striking 
‘‘$6,000,000’’ and inserting ‘‘$45,500,000’’. 
SEC. 8. DETERMINATION OF BUDGETARY EFFECTS. 
The budgetary effects of this Act, for the purpose of 
complying with the Statutory Pay-As-You-Go Act of 2010, 
shall be determined by reference to the latest statement 
titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 
Act, submitted for printing in the Congressional Record 
by the Chairman of the House Budget Committee, pro-
vided that such statement has been submitted prior to the 
vote on passage. 
Passed the House of Representatives June 18, 2019. 
Attest: 
Clerk.
116TH CONGRESS 
1ST SESSION 
H. R. 3253 
AN ACT 
To provide for certain extensions with respect to 
the Medicaid program under title XIX of the So-
cial Security Act, and for other purposes.