I 
115TH CONGRESS 
2D SESSION 
H. R. 6809 
To amend title XVIII of the Social Security Act to provide for temporary 
stabilization of Medicare Advantage payments following Hurricane Maria. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 13, 2018 
Miss GONZA´LEZ-COLO´N of Puerto Rico (for herself, Mr. SERRANO, Mr. 
BACON, Mr. SOTO, and Mrs. MURPHY of Florida) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act to provide 
for temporary stabilization of Medicare Advantage pay-
ments following Hurricane Maria. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Puerto Rico Integrity 
in Medicare Advantage Act’’. 
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SEC. 2. TEMPORARY STABILIZATION OF MEDICARE ADVAN-
TAGE PAYMENTS FOLLOWING HURRICANE 
MARIA. 
(a) IN GENERAL.—Section 1853(n) of the Social Se-
curity Act (42 U.S.C. 1395w–23(n)) is amended— 
(1) in paragraph (1)(B), by striking ‘‘subse-
quent year’’ and inserting ‘‘subsequent year, subject 
to paragraph (7),’’; 
(2) in paragraph (4), by striking ‘‘In’’ and in-
serting ‘‘Subject to paragraph (7), in’’; and 
(3) by adding at the end the following new 
paragraph: 
‘‘(7) 
AVERAGE
GEOGRAPHIC
ADJUSTMENT 
FLOOR.—For each of 2019, 2020, and 2021, when 
calculating the adjusted average capital amount 
under section 1876(a)(4) for the purposes of estab-
lishing the base payment amount, the average geo-
graphic adjustment shall not be less than 0.70 for 
any area.’’. 
(b) ENSURING PAYMENTS FLOW TO PUERTO RICO 
PROVIDERS AND PATIENTS.—Section 1854(a)(6) of the 
Social Security Act (42 U.S.C. 1395w–24(a)(6)) is 
amended— 
(1) in subparagraph (B)(iv)— 
(A) by striking ‘‘EXCEPTION.—In the case 
of’’ and inserting ‘‘EXCEPTIONS.— 
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‘‘(I) In the case of’’; and 
(B) by adding at the end the following new 
subclause: 
‘‘(II) In the case of an area to 
which section 1853(n)(7) applies with 
respect to a year, clause (iii) shall be 
waived for bids submitted for such 
area and year and subparagraph (C) 
shall apply.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(C) 
STRENGTHENING
SUPPORT
TO 
HEALTH CARE PROVIDERS IN PUERTO RICO.— 
When reviewing bids submitted by plans serving 
areas in Puerto Rico, the Secretary shall ensure 
that, of the increase in blended benchmark 
amount attributable to section 1853(n)(7) 
(above the amount that would otherwise be de-
termined under section 1853(n)), no less than 
50 percent is directed toward provider com-
pensation.’’. 
Æ 
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