Supporting Medicaid in the U.S. Territories Act of 2021
Bill: H.R.4406 | Sponsor: Rep. Soto, Darren (D-FL)
Policy area: Health

Summary:
Supporting Medicaid in the U.S. Territories Act of 2021
This bill extends, increases, and otherwise modifies Medicaid funding for U.S. territories.
Specifically, the bill extends (1) the temporarily increased Federal Medical Assistance Percentage (i.e., federal matching rate), and (2) a higher cap on Medicaid funding. Such provisions apply to Puerto Rico through FY2026 and to other territories through FY2029.
The bill also requires Puerto Rico to implement an asset verification program and to report on its ability to comply with certain reporting requirements, procurement standards, and other Medicaid program integrity measures.

To amend titles XI and XIX of the Social Security Act to provide 
   increased financial support to the territories under the Medicaid 
                    program, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting Medicaid in the U.S. 
Territories Act of 2021''.

SEC. 2. EXTENDING THE INCREASED FEDERAL MEDICAL ASSISTANCE PERCENTAGE 
              AND CAP AMOUNTS FOR TERRITORIES.

    (a) Federal Medical Assistance Percentage Extension.--
            (1) In general.--Section 1905(ff) of the Social Security 
        Act (42 U.S.C. 1396d(ff)) is amended--
                    (A) in paragraph (2), by striking ``2021'' and 
                inserting ``2026''; and
                    (B) in paragraph (3), by striking ``2021'' and 
                inserting ``2029''.
            (2) Ensuring program integrity.--Section 1108(g) of the 
        Social Security Act (42 U.S.C. 1308(g)) is amended--
                    (A) in paragraph (7)(B)(i), in the matter preceding 
                subclause (I), by striking ``2021'' and inserting 
                ``2026''; and
                    (B) in paragraph (8)(B), by striking ``2021'' and 
                inserting ``2026''.
    (b) Cap Amount Extension.--
            (1) Puerto rico.--
                    (A) Ensuring increased cap amount in response to 
                covid-19.--Section 1108(g) of the Social Security Act 
                (42 U.S.C. 1308(g)) is amended--
                            (i) in paragraph (2)(A)(ii), by striking 
                        ``2021'' and inserting ``2026''; and
                            (ii) in paragraph (6)--
                                    (I) in the header, by striking 
                                ``2021'' and inserting ``2026'';
                                    (II) in subparagraph (A)--
                                            (aa) in clause (i), by 
                                        striking ``and'' at the end; 
                                        and
                                            (bb) in clause (ii)--

                                                    (AA) by striking 
                                                ``fiscal year 2021'' 
                                                and inserting ``each of 
                                                fiscal years 2021 and 
                                                2022''; and

                                                    (BB) by striking 
                                                the period and 
                                                inserting ``; and''; 
                                                and

                                    (III) in subparagraph (B)--
                                            (aa) in clause (i), by 
                                        striking ``2021'' and inserting 
                                        ``2026''; and
                                            (bb) in clause (ii)(II), by 
                                        striking ``2021'' and inserting 
                                        ``2026''.
                    (B) Extension of cap amount for other years.--
                Section 1108(g)(6)(A) of the Social Security Act (42 
                U.S.C. 1308(g)), as amended by subparagraph (A), is 
                further amended by adding at the end the following new 
                clause:
                            ``(iii) for each of fiscal years 2023 
                        through 2026, $2,719,072,000.''.
            (2) Other territories.--
                    (A) Ensuring increased cap amounts in response to 
                covid-19.--Section 1108(g)(2) of the Social Security 
                Act (42 U.S.C. 1308(g)(2)) is amended in each of 
                subparagraphs (B)(iii), (C)(iii), (D)(iii), and 
                (E)(iii), by striking ``fiscal year 2021'' and 
                inserting ``each of fiscal years 2021 and 2022''.
                    (B) Extension of cap amounts for other years.--
                Section 1108(g)(2) of the Social Security Act (42 
                U.S.C. 1308(g)(2)) is amended--
                            (i) in subparagraph (B)--
                                    (I) in clause (i), by striking 
                                ``clause (ii)'' and inserting ``clauses 
                                (ii) through (iv)'';
                                    (II) in clause (ii), by striking 
                                ``and'' at the end;
                                    (III) in clause (iii), by adding 
                                ``and'' at the end; and
                                    (IV) by adding at the end the 
                                following new clause:
                            ``(iv) for each of fiscal years 2023 
                        through 2029, $126,000,000;'';
                            (ii) in subparagraph (C)--
                                    (I) in clause (i), by striking 
                                ``clause (ii)'' and inserting ``clauses 
                                (ii) through (iv)'';
                                    (II) in clause (ii), by striking 
                                ``and'' at the end;
                                    (III) in clause (iii), by adding 
                                ``and'' at the end; and
                                    (IV) by adding at the end the 
                                following new clause:
                            ``(iv) for each of fiscal years 2023 
                        through 2029, $127,000,000;'';
                            (iii) in subparagraph (D)--
                                    (I) in clause (i), by striking 
                                ``clause (ii)'' and inserting ``clauses 
                                (ii) through (iv)'';
                                    (II) in clause (ii), by striking 
                                ``and'' at the end;
                                    (III) in clause (iii), by adding 
                                ``and'' at the end; and
                                    (IV) by adding at the end the 
                                following new clause:
                            ``(iv) for each of fiscal years 2023 
                        through 2029, $60,000,000; and''; and
                            (iv) in subparagraph (E)--
                                    (I) in clause (i), by striking 
                                ``clause (ii)'' and inserting ``clauses 
                                (ii) through (iv)'';
                                    (II) in clause (ii), by striking 
                                ``and'' at the end;
                                    (III) in clause (iii), by adding 
                                ``and'' at the end; and
                                    (IV) by adding at the end the 
                                following new clause:
                            ``(iv) for each of fiscal years 2023 
                        through 2029, $84,000,000.''.
            (3) Modification of special rule for calculation of cap 
        amounts for certain years.--Section 1108(g)(2) of the Social 
        Security Act (42 U.S.C. 1308(g)(2)) is amended, in the matter 
        following subparagraph (E)--
                    (A) by striking ``fiscal year 2021'' and inserting 
                ``fiscal year 2029 (or, in the case of Puerto Rico, 
                fiscal year 2026)'';
                    (B) by striking ``through 2021'' and inserting 
                ``through 2029 (or, in the case of Puerto Rico, 
                2026)''; and
                    (C) by striking ``each such subparagraph'' and 
                inserting ``subparagraph (A) and any of clauses (ii) 
                through (iv) of subparagraphs (B) through (E)''.
    (c) Application of Asset Verification Program Requirements to 
Puerto Rico.--Section 1940 of the Social Security Act (42 U.S.C. 1396w) 
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (3)(A), by adding at the end the 
                following new clause:
                            ``(iii) Implementation in puerto rico.--The 
                        Secretary shall require Puerto Rico to 
                        implement an asset verification program under 
                        this subsection by the end of fiscal year 
                        2024.''; and
                    (B) in paragraph (4)--
                            (i) in the paragraph heading, by striking 
                        ``Exemption of territories'' and inserting 
                        ``Exemption of certain territories''; and
                            (ii) by striking ``and the District of 
                        Columbia'' and inserting ``, the District of 
                        Columbia, and Puerto Rico''; and
            (2) in subsection (k)--
                    (A) in paragraph (1)--
                            (i) by redesignating subparagraphs (A) 
                        through (D) as clauses (i) through (iv), 
                        respectively, and adjusting the margins 
                        accordingly;
                            (ii) in the matter preceding clause (i), as 
                        so redesignated--
                                    (I) by striking ``beginning on or 
                                after January 1, 2021''; and
                                    (II) by striking ``for a non-
                                compliant State shall be reduced--'' 
                                and inserting the following: ``for--
                    ``(A) a non-compliant State that is one of the 50 
                States or the District of Columbia shall be reduced--
                '';
                            (iii) in clause (iv), as so redesignated, 
                        by striking the period at the end and inserting 
                        ``; and''; and
                            (iv) by adding at the end the following new 
                        subparagraph:
                    ``(B) a non-compliant State that is Puerto Rico 
                shall be reduced--
                            ``(i) for calendar quarters in fiscal years 
                        2025 and 2026, by 0.12 percentage points;
                            ``(ii) for calendar quarters in fiscal year 
                        2027, by 0.25 percentage points;
                            ``(iii) for calendar quarters in fiscal 
                        year 2028, by 0.35 percentage points; and
                            ``(iv) for calendar quarters in fiscal year 
                        2029 and each fiscal year thereafter, by 0.5 
                        percentage points.''; and
                    (B) in paragraph (2)(A), by striking ``or the 
                District of Columbia'' and inserting ``the District of 
                Columbia, or Puerto Rico''.
    (d) Extension of Reporting Requirement.--Section 1108(g)(9) of the 
Social Security Act (42 U.S.C. 1308(g)(9)) is amended--
            (1) in subparagraph (A), by striking ``2021'' and inserting 
        ``2029''; and
            (2) in subparagraph (B)(i), by inserting ``or by reason of 
        the amendments made by section 2 of the Supporting Medicaid in 
        the U.S. Territories Act of 2021'' before the period at the 
        end.
    (e) Puerto Rico Program Integrity.--Section 1108(g)(7)(A) of the 
Social Security Act (42 U.S.C. 1308(g)(7)(A)) is amended--
            (1) in clause (iii), in the header, by inserting 
        ``reporting'' after ``reform''; and
            (2) by adding at the end the following new clauses:
                            ``(v) Core set reporting compliance 
                        report.--Not later than October 1, 2022, Puerto 
                        Rico shall submit to the Chair and Ranking 
                        Member of the Committee on Energy and Commerce 
                        of the House of Representatives and the Chair 
                        and Ranking Member of the Committee on Finance 
                        of the Senate a report outlining steps being 
                        taken by Puerto Rico to reach compliance with 
                        the reporting requirements described in section 
                        1139A(a)(4)(B) and section 1139B(b)(5)(C) and 
                        describing what further actions are needed by 
                        Puerto Rico in order to comply with such 
                        requirements with respect to annual State 
                        reports under section 1139A(c) and State 
                        reports under section 1139B(d)(1) beginning 
                        with fiscal year 2024.
                            ``(vi) Contracting and procurement 
                        oversight lead requirement.--
                                    ``(I) In general.--Not later than 6 
                                months after the date of the enactment 
                                of this clause, the agency responsible 
                                for the administration of Puerto Rico's 
                                Medicaid program under title XIX shall 
                                designate an officer (other than the 
                                director of such agency) to serve as 
                                the Contracting and Procurement 
                                Oversight Lead to carry out the duties 
                                specified in subclause (II).
                                    ``(II) Duties.--Not later than 60 
                                days after the end of each fiscal 
                                quarter (beginning with the first 
                                fiscal quarter beginning on or after 
                                the date that is 1 year after the date 
                                of the enactment of this clause), the 
                                officer designated pursuant to 
                                subclause (I) shall, with respect to 
                                each contract described in clause (iii) 
                                with an annual value exceeding $150,000 
                                entered into during such quarter, 
                                certify to the Secretary either--
                                            ``(aa) that such contract 
                                        has met the procurement 
                                        standards identified under any 
                                        of sections 75.327, 75.328, and 
                                        75.329 of title 45, Code of 
                                        Federal Regulations (or 
                                        successor regulations); or
                                            ``(bb) that extenuating 
                                        circumstances (including a lack 
                                        of multiple entities competing 
                                        for such contract) prevented 
                                        the compliance of such contract 
                                        with such standards.
                                    ``(III) Publication.--The officer 
                                designated pursuant to subclause (I) 
                                shall make public each certification 
                                containing extenuating circumstances 
                                described in subclause (II)(bb) not 
                                later than 30 days after such 
                                certification is made, including a 
                                description of, and justification of, 
                                such extenuating circumstances.
                                    ``(IV) Review of compliance.--Not 
                                later than 2 years after the date of 
                                the enactment of this clause, the 
                                Inspector General of the Department of 
                                Health and Human Services shall submit 
                                to Congress a report on the compliance 
                                of Puerto Rico with the provisions of 
                                this clause.''.
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