Subtitle C—Medicare Advantage 
(Part C) 
SEC. 221. ADJUSTMENT IN BENCHMARK FOR LOW-BASE 
PAYMENT COUNTIES IN PUERTO RICO. 
Section 1853(n) of the Social Security Act (42 U.S.C. 
1395w–103(n)) is amended— 
(1) in paragraph (1), by striking ‘‘and (5)’’ and 
inserting ‘‘, (5), and (6)’’; 
(2) in paragraph (4), by striking ‘‘In no case’’ 
and inserting ‘‘Subject to paragraph (6), in no 
case’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(6) SPECIAL
RULES
FOR
BLENDED
BENCH-
MARK AMOUNT FOR TERRITORIES.— 
‘‘(A) IN GENERAL.—Subject to paragraph 
(2), the blended benchmark amount for an area 
in a territory for a year (beginning with 2018) 
shall not be less than 80 percent of the national 
average of the base payment amounts specified 
in subparagraph (2)(E) for such year for areas 
within the 50 States and the District of Colum-
bia. 
‘‘(B) LIMITATION.—In no case shall the 
blended benchmark amount for an area in a 
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territory for a year under subparagraph (A) ex-
ceed the lowest blended benchmark amount for 
any area within the 50 States and the District 
of Columbia for such year.’’. 
Subtitle D—Part D 
SEC. 231. IMPROVED USE OF ALLOCATED PRESCRIPTION 
DRUG FUNDS BY TERRITORIES. 
Section 1935(e) of the Social Security Act (42 U.S.C. 
1396u–5(e)) is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(5) IMPROVED USE OF FUNDS FOR LOW-IN-
COME PART D ELIGIBLE INDIVIDUALS.—This sub-
section shall be applied beginning with fiscal year 
2018 as follows, notwithstanding any other provision 
of this title: 
‘‘(A) CLARIFYING STATE FLEXIBILITY TO 
COVER
NON-DUAL-ELIGIBLE
INDIVIDUALS.—In 
this title, the term ‘medical assistance’ includes 
financial assistance furnished by a State under 
this subsection to part D eligible individuals 
who, if they were residing in one of the 50 
States or the District of Columbia, would qual-
ify as subsidy eligible individuals under section 
1860D–14(a)(3), and without regard to wheth-
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er such individuals otherwise qualify for medical 
assistance under this title. 
‘‘(B) 100 PERCENT FMAP TO REFLECT NO 
STATE MATCHING REQUIRED FOR PART D LOW 
INCOME SUBSIDIES.—The Federal medical as-
sistance percentage applicable to the assistance 
furnished under this subsection is 100 percent. 
‘‘(C) LIMITED
FUNDING
FOR
SPECIAL 
RULES.—Subparagraphs (A) and (B), and the 
provision of medical assistance for covered part 
D drugs to low-income part D eligible individ-
uals for a State and period under this sub-
section, is limited to the amount specified in 
paragraph (3) for such State and period, with-
out regard to the application of subsection (f) 
or (g) of section 1108.’’. 
SEC. 232. REPORT ON TREATMENT OF TERRITORIES 
UNDER MEDICARE PART D. 
Paragraph (4) of section 1935(e) of the Social Secu-
rity Act (42 U.S.C. 1396u–5(e)) is amended to read as 
follows: 
‘‘(4) REPORT
ON
APPLICATION
OF
SUB-
SECTION.— 
‘‘(A) IN GENERAL.—Not later than Feb-
ruary 1, 2020, the Secretary shall submit to 
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Congress a report on the application of this 
subsection during the period beginning fiscal 
year 2006 and ending fiscal year 2019. 
‘‘(B) INFORMATION TO BE INCLUDED IN 
REPORT.—Such report shall include— 
‘‘(i) program guidance issued by the 
Secretary to implement this subsection; 
‘‘(ii) for each territory, information on 
the increased amount under paragraph (3) 
and how the territory has applied such 
amount, including the territory’s program 
design, expenditures, and number of indi-
viduals (and dual-eligible individuals) as-
sisted; and 
‘‘(iii) differences between how such 
territories are treated under part D of title 
XVIII and under this title compared with 
the treatment of the 50 States and the 
District of Columbia under such part and 
this title for different fiscal years within 
the period covered under the report. 
‘‘(C) RECOMMENDATIONS.—Such report 
shall include recommendations for improving 
prescription drug coverage for low-income indi-
viduals 
in 
each 
territory, 
including 
rec-
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ommendations regarding each of the following 
alternative approaches: 
‘‘(i) Adjusting the aggregate amount 
specified in paragraph (3)(B). 
‘‘(ii) Allowing residents of the terri-
tories to be subsidy eligible individuals 
under section 1860D–14, notwithstanding 
subsection (a)(3)(F) of such section, or 
providing substantially equivalent low-in-
come prescription drug subsidies to such 
residents.’’. 
TITLE III—MISCELLANEOUS 
SEC. 301. MODIFIED TREATMENT OF TERRITORIES WITH 
RESPECT TO APPLICATION OF ACA ANNUAL 
HEALTH INSURANCE PROVIDER FEES. 
Section 9010 of the Patient Protection and Afford-
able Care Act (26 U.S.C. 4001 note prec.) is amended— 
(1) in subsection (b)(1), by inserting ‘‘subject 
to subsection (j)(1),’’ after ‘‘With respect to each 
covered entity,’’; and 
(2) by striking subsection (j) and inserting the 
following: 
‘‘(j) SPECIAL RULES FOR TREATMENT OF TERRI-
TORIES.— 
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‘‘(1) IN
GENERAL.—In applying this section 
with respect to United States health risks located 
outside of the 50 States or the District of Columbia 
for years beginning with 2018— 
‘‘(A) the amount of the fee under sub-
section (b) shall be 50 percent of the amount 
of the fee otherwise determined; 
‘‘(B) the Secretary shall deposit the 
amount of such fees collected for each territory 
into a separate account; and 
‘‘(C) amounts in such an account for a ter-
ritory for a year are appropriated and shall be 
available to the territory in accordance with 
paragraph (2). 
‘‘(2) AVAILABILITY OF FUNDS.—Amounts made 
available to a territory under paragraph (1)(C) with 
respect to a territory for a year shall be made avail-
able to the territory, upon application of the terri-
tory to the Secretary of Health and Human Serv-
ices, only for the following purposes, as elected by 
the territory in such application: 
‘‘(A) INCREASED PRESCRIPTION DRUG AS-
SISTANCE FOR LOW-INCOME PART D ELIGIBLE 
INDIVIDUALS.—For increasing the amount of 
funds made available to the territory under sec-
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tion 1935(e)(3) of the Social Security Act (42 
U.S.C. 1396u–5(e)(3)) for assistance for low-in-
come part D eligible individuals in obtaining 
part D covered drugs. 
‘‘(B) 
SATISFYING
STATE
MEDICAID 
MATCHING
REQUIREMENT.—For purposes of 
the territory meeting non-Federal matching re-
quirements imposed with respect to obtaining 
Federal financial participation under title XIX 
of the Social Security Act.’’. 
SEC. 302. MEDICAID AND CHIP TERRITORY TRANSPARENCY 
AND INFORMATION. 
(a) PUBLICATION OF INFORMATION ON FEDERAL 
EXPENDITURES UNDER MEDICAID AND CHIP IN THE 
TERRITORIES.—Not later than 180 days after the date 
of the enactment of this Act, the Secretary of Health and 
Human Services shall publish, and periodically update, on 
the Internet site of the Centers for Medicare & Medicaid 
Services information on Medicaid and CHIP carried out 
in the territories of the United States. Such information 
shall include, with respect to each such territory— 
(1) the income levels established by the terri-
tory for purposes of eligibility of an individual to re-
ceive medical assistance under Medicaid or child 
health assistance under CHIP; 
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(2) the number of individuals enrolled in Med-
icaid and CHIP in such territory; 
(3) any State plan amendments in effect to 
carry out Medicaid or CHIP in such territory; 
(4) any waiver of the requirements of title XIX 
or title XXI issued by the Secretary to carry out 
Medicaid or CHIP in the territory, including a waiv-
er under section 1115 of the Social Security Act (42 
U.S.C. 1315), any application for such a waiver, and 
any documentation related to such application (in-
cluding correspondence); 
(5) the amount of the Federal and non-Federal 
share of expenditures under Medicaid and CHIP in 
such territory; 
(6) the systems in place for the furnishing of 
health care items and services under Medicaid and 
CHIP in such territory; 
(7) the design of CHIP in such territory; and 
(8) other information regarding the carrying 
out of Medicaid and CHIP in the territory that is 
published on such Internet site with respect to car-
rying out Medicaid and CHIP in each State and the 
District of Columbia. 
(b) DEFINITIONS.—In this section: 
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(1) CHIP.—The term ‘‘CHIP’’ means the 
State Children’s Health Insurance Program under 
title XXI of the Social Security Act. 
(2) MEDICAID.—The term ‘‘Medicaid’’ means 
the Medicaid program under title XIX of the Social 
Security Act. 
(3) TERRITORY.—The term ‘‘territory of the 
United States’’ includes Puerto Rico, the Virgin Is-
lands of the United States, Guam, the Northern 
Mariana Islands, and American Samoa. 
SEC. 303. REPORT ON EXCLUSION OF TERRITORIES FROM 
EXCHANGES. 
(a) IN GENERAL.—Not later than February 1, 2020, 
the Secretary of Health and Human Services shall submit 
to Congress a report that details the adverse impacts in 
each territory from the practical exclusion of the terri-
tories from the provisions of part II of subtitle D of title 
I of the Patient Protection and Affordable Care Act inso-
far as such provisions provide for the establishment of an 
American Health Benefit Exchange or the administration 
of a federally facilitated Exchange in each State and in 
the District of Columbia for the purpose of making health 
insurance more affordable and accessible for individuals 
and small businesses. 
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(b) INFORMATION IN REPORT.—The report shall in-
clude information on the following: 
(1) An estimate of the total number of unin-
sured and underinsured individuals residing in each 
territory with respect to health insurance coverage. 
(2) A description of the number of health insur-
ance issuers in each territory and the health insur-
ance plans these issuers offer. 
(3) An estimate of the number of individuals re-
siding in each territory who are denied premium and 
cost-sharing assistance that would otherwise be 
available to them for obtaining health insurance cov-
erage through an Exchange if they resided in one of 
the 50 States or in the District of Columbia. 
(4) An estimate of the amount of Federal as-
sistance described in paragraph (3) that is not being 
made available to residents of each territory. 
(5) An estimate of the number of small employ-
ers in each territory that would be eligible to pur-
chase health insurance coverage through a Small 
Business Health Options Program (SHOP) Market-
place that would operate as part of an Exchange if 
the employers were in one of the 50 States or in the 
District of Columbia. 
Æ 
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