II 
116TH CONGRESS 
1ST SESSION H. R. 3253 
IN THE SENATE OF THE UNITED STATES 
JUNE 19, 2019 
Received 
AN ACT 
To provide for certain extensions with respect to the Med-
icaid program under title XIX of the Social Security 
Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Empowering 
Beneficiaries, 
Ensuring 
Access, 
and 
Strengthening Accountability Act of 2019’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; Table of contents. 
Sec. 2. Extension of Money Follows the Person Rebalancing Demonstration. 
Sec. 3. Clarifying authority of State Medicaid fraud and abuse control units to 
investigate and prosecute cases of Medicaid patient abuse and 
neglect in any setting. 
Sec. 4. Extension of protection for Medicaid recipients of home and community- 
based services against spousal impoverishment. 
Sec. 5. Extension of the Community Mental Health Services Demonstration 
Program. 
Sec. 6. Preventing inappropriately low rebates under Medicaid drug rebate pro-
gram. 
Sec. 7. Medicaid Improvement Fund. 
Sec. 8. Determination of budgetary effects. 
SEC. 2. EXTENSION OF MONEY FOLLOWS THE PERSON RE-
BALANCING DEMONSTRATION. 
(a) IN GENERAL.— 
(1) FUNDING.—Section 6071(h) of the Deficit 
Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(A) in paragraph (1)— 
(i) in subparagraph (E), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (F)— 
(I) by striking ‘‘subject to para-
graph (3), 132,000,000’’ and insert-
ing ‘‘$132,000,000’’; and 
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(II) by striking the period at the 
end and inserting a semicolon; and 
(iii) by adding at the end the fol-
lowing new subparagraphs: 
‘‘(G) $417,000,000 for fiscal year 2020; 
‘‘(H) $450,000,000 for each of fiscal years 
2021 through 2023; and 
‘‘(I) $225,000,000 for fiscal year 2024.’’; 
(B) in paragraph (2)— 
(i) by striking ‘‘Subject to paragraph 
(3), amounts’’ and inserting ‘‘Amounts’’; 
and 
(ii) by striking ‘‘2021’’ and inserting 
‘‘2024’’; and 
(C) by striking paragraph (3). 
(2) RESEARCH
AND
EVALUATION.—Section 
6071(g) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396a note) is amended— 
(A) in paragraph (2), by striking ‘‘2016’’ 
and inserting ‘‘2024’’; and 
(B) in paragraph (3), by inserting ‘‘and 
for each of fiscal years 2019 through 2024,’’ 
after ‘‘2016,’’. 
(b) CHANGES TO INSTITUTIONAL RESIDENCY PE-
RIOD REQUIREMENT.— 
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‘‘(iv) contain assurances that grant funds 
used to accomplish the objective described in 
subsection (a)(1) shall be obligated not later 
than 24 months after the date on which the 
funds are awarded and shall be expended not 
later than 60 months after the date on which 
the funds are awarded (unless the Secretary ap-
proves a waiver of either such requirement).’’; 
and 
(3) in paragraph (13)— 
(A) in subparagraph (A), by striking ‘‘; 
and’’ and inserting ‘‘, and in such manner as 
will meet the reporting requirements set forth 
for the Transformed Medicaid Statistical Man-
agement Information System (T–MSIS);’’; 
(B) by redesignating subparagraph (B) as 
subparagraph (D); and 
(C) by inserting after subparagraph (A) 
the following: 
‘‘(B) the State shall report on a quarterly 
basis on the use of grant funds by distinct ac-
tivity, as described in the approved work plan, 
and by specific population as targeted by the 
State; 
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‘‘(C) if the State fails to report the infor-
mation required under subparagraph (B), fails 
to report such information on a quarterly basis, 
or fails to make progress under the approved 
work plan, the State shall implement a correc-
tive action plan and any lack of progress under 
the approved work plan may result in with-
holding of grant funds made available to the 
State; and’’. 
(d) FUNDING FOR QUALITY ASSURANCE AND IM-
PROVEMENT; TECHNICAL
ASSISTANCE; OVERSIGHT.— 
Section 6071(f) of the Deficit Reduction Act of 2005 (42 
U.S.C. 1396a note) is amended by striking paragraph (2) 
and inserting the following: 
‘‘(2) FUNDING.—From the amounts appro-
priated under subsection (h)(1) for each of fiscal 
years 2019 through 2024, $1,000,000 shall be avail-
able to the Secretary for each such fiscal year to 
carry out this subsection.’’. 
(e) BEST PRACTICES EVALUATION.—Section 6071 of 
the Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) 
is amended by adding at the end the following: 
‘‘(i) BEST PRACTICES.— 
‘‘(1) REPORT.—The Secretary, directly or 
through grant or contract, shall submit a report to 
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the President and Congress not later than Sep-
tember 30, 2020, that contains findings and conclu-
sions on best practices from the State MFP dem-
onstration projects carried out with grants made 
under this section. The report shall include informa-
tion and analyses with respect to the following: 
‘‘(A) The most effective State strategies 
for transitioning beneficiaries from institutional 
to qualified community settings carried out 
under the State MFP demonstration projects 
and how such strategies may vary for different 
types of beneficiaries, such as beneficiaries who 
are aged, physically disabled, intellectually or 
developmentally disabled, or individuals with se-
rious mental illnesses, and other targeted waiv-
er beneficiary populations. 
‘‘(B) The most common and the most ef-
fective State uses of grant funds carried out 
under the State MFP demonstration projects 
for transitioning beneficiaries from institutional 
to qualified community settings and improving 
health outcomes, including differentiating fund-
ing for current initiatives that are designed for 
such purpose and funding for proposed initia-
tives that are designed for such purpose. 
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‘‘(C) The most effective State approaches 
carried out under State MFP demonstration 
projects for improving person-centered care and 
planning. 
‘‘(D) Identification of program, financing, 
and other flexibilities available under the State 
MFP demonstration projects, that are not 
available under the traditional Medicaid pro-
gram, and which directly contributed to suc-
cessful transitions and improved health out-
comes under the State MFP demonstration 
projects. 
‘‘(E) State strategies and financing mecha-
nisms for effective coordination of housing fi-
nanced or supported under State MFP dem-
onstration projects with local housing authori-
ties and other resources. 
‘‘(F) Effective State approaches for deliv-
ering Money Follows the Person transition serv-
ices through managed care entities. 
‘‘(G) Other best practices and effective 
transition strategies demonstrated by States 
with approved MFP demonstration projects, as 
determined by the Secretary. 
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‘‘(H) Identification and analyses of oppor-
tunities and challenges to integrating effective 
Money Follows the Person practices and State 
strategies into the traditional Medicaid pro-
gram. 
‘‘(2) COLLABORATION.—In preparing the report 
required under this subsection, the Secretary shall 
collect and incorporate information from States with 
approved MFP demonstration projects and bene-
ficiaries participating in such projects, and providers 
participating in such projects. 
‘‘(3) FUNDING.—From the amounts appro-
priated under subsection (h)(1) for each of fiscal 
years 2020 and 2021, not more than $300,000 shall 
be available to the Secretary for each such fiscal 
year to carry out this subsection.’’. 
(f) MACPAC REPORT ON QUALIFIED SETTINGS CRI-
TERIA.—Section 6071 of the Deficit Reduction Act of 
2005 (42 U.S.C. 1396a note), as amended by subsection 
(e), is further amended by adding at the end the following: 
‘‘(j) MACPAC REPORT.—Prior to the final imple-
mentation date established by the Secretary for the cri-
teria established for home and community-based settings 
in section 441.301(c)(4) of title 42, Code of Federal Regu-
lations, as part of final implementation of the Home and 
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Community Based Services (HCBS) Final Rule published 
on January 16, 2014 (79 Fed. Reg. 2947) (referred to 
in this subsection as the ‘HCBS final rule’), the Medicaid 
and CHIP Payment and Access Commission (MACPAC) 
shall submit to Congress a report that— 
‘‘(1) identifies the types of home and commu-
nity-based settings and associated services that are 
available to eligible individuals in both the MFP 
demonstration program and sites in compliance with 
the HCBS final rule; and 
‘‘(2) if determined appropriate by the Commis-
sion, recommends policies to align the criteria for a 
qualified residence under subsection (b)(6) (as in ef-
fect on October 1, 2017) with the criteria in the 
HCBS final rule.’’. 
(g) APPLICATION
TO CURRENT PROJECTS.—Not 
later than 1 year after the date of the enactment of this 
Act, any State with an approved MFP demonstration 
project under section 6071 of the Deficit Reduction Act 
of 2005 (42 U.S.C. 1396a note) on the date of the enact-
ment of this Act shall submit a revised application to the 
Secretary that contains the same information and assur-
ances as are required for any new State applicant under 
the amendments made by this section. 
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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), 
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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’’. 
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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. 
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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: 
CHERYL L. JOHNSON, 
Clerk. 
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