Title: Territories Health Care Improvement Act
Policy area: Health

Summary:
Territories Health Care Improvement Act
This bill makes a series of changes relating to Medicaid funding for U.S. territories, including by (1) establishing a specific funding cap through FY2023 for Puerto Rico and through FY2025 for the other U.S. territories, (2) establishing program integrity measures and reporting requirements relating to the use of funds, and (3) increasing the applicable Federal Medical Assistance Percentage (i.e., the federal matching rate).

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3631 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 3631

To amend titles XI and XIX of the Social Security Act to provide for a 
temporary increase to the limit on Medicaid payments for territories of 
  the United States and the Federal medical assistance percentage for 
  such territories under the Medicaid program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              July 9, 2019

  Mr. Soto (for himself, Mr. Bilirakis, Ms. Velazquez, Miss Gonzalez-
Colon of Puerto Rico, Ms. Plaskett, Mr. Sablan, Mrs. Radewagen, Mr. San 
  Nicolas, Mr. Serrano, and Mr. Fitzpatrick) introduced the following 
    bill; which was referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend titles XI and XIX of the Social Security Act to provide for a 
temporary increase to the limit on Medicaid payments for territories of 
  the United States and the Federal medical assistance percentage for 
  such 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 ``Territories Health Care Improvement 
Act''.

SEC. 2. MEDICAID PAYMENTS FOR PUERTO RICO AND THE OTHER TERRITORIES FOR 
              CERTAIN FISCAL YEARS.

    (a) Treatment of Cap.--Section 1108(g) of the Social Security Act 
(42 U.S.C. 1308(g)) is amended--
            (1) in paragraph (2)--
                    (A) in the matter preceding subparagraph (A), by 
                striking ``subject to and section 1323(a)(2) of the 
                Patient Protection and Affordable Care Act paragraphs 
                (3) and (5)'' and inserting ``subject to section 
                1323(a)(2) of the Patient Protection and Affordable 
                Care Act and paragraphs (3) and (5)'';
                    (B) in subparagraph (A)--
                            (i) by striking ``Puerto Rico shall not 
                        exceed the sum of'' and inserting ``Puerto Rico 
                        shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$100,000;'' and 
                        inserting ``$100,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2023, the amount specified in paragraph 
                        (6) for each such fiscal year;'';
                    (C) in subparagraph (B)--
                            (i) by striking ``the Virgin Islands shall 
                        not exceed the sum of'' and inserting ``the 
                        Virgin Islands shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000;'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $126,000,000;'';
                    (D) in subparagraph (C)--
                            (i) by striking ``Guam shall not exceed the 
                        sum of'' and inserting ``Guam shall not 
                        exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000;'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $127,000,000;'';
                    (E) in subparagraph (D)--
                            (i) by striking ``the Northern Mariana 
                        Islands shall not exceed the sum of'' and 
                        inserting ``the Northern Mariana Islands shall 
                        not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of''; and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $60,000,000; and''; and
                    (F) in subparagraph (E)--
                            (i) by striking ``American Samoa shall not 
                        exceed the sum of'' and inserting ``American 
                        Samoa shall not exceed--
                            ``(i) except as provided in clause (ii), 
                        the sum of'';
                            (ii) by striking ``$10,000.'' and inserting 
                        ``$10,000; and''; and
                            (iii) by adding at the end the following 
                        new clause:
                            ``(ii) for each of fiscal years 2020 
                        through 2025, $84,000,000.''; and
            (2) by adding at the end the following new paragraph:
            ``(6) Application to puerto rico for fiscal years 2020 
        through 2023.--For purposes of paragraph (2)(A)(ii), the amount 
        specified in this paragraph is--
                    ``(A) for fiscal year 2020, $2,823,188,000;
                    ``(B) for fiscal year 2021, $2,919,072,000;
                    ``(C) for fiscal year 2022, $3,012,610,000; and
                    ``(D) for fiscal year 2023, $3,114,331,000.''.
    (b) Treatment of Funding Under Enhanced Allotment Program.--Section 
1935(e) of the Social Security Act (42 U.S.C. 1396u-5(e)) is amended--
            (1) in paragraph (1)(B), by striking ``if the State'' and 
        inserting ``subject to paragraph (4), if the State'';
            (2) by redesignating paragraph (4) as paragraph (5); and
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) Treatment of funding for certain fiscal years.--
                    ``(A) Puerto rico.--Notwithstanding paragraph 
                (1)(B), in the case that Puerto Rico establishes and 
                submits to the Secretary a plan described in paragraph 
                (2) with respect to any of fiscal years 2020 through 
                2022, the amount specified in paragraph (3) for Puerto 
                Rico for such a year shall be taken into account in 
                applying subparagraph (A)(ii) of section 1108(g)(2) for 
                such year.
                    ``(B) Other territories.--Notwithstanding paragraph 
                (1)(B), in the case that the Virgin Islands, Guam, the 
                Northern Mariana Islands, or American Samoa establishes 
                and submits to the Secretary a plan described in 
                paragraph (2) with respect to any of fiscal years 2020 
                through 2025, the amount specified in paragraph (3) for 
                the Virgin Islands, Guam, the Northern Mariana Islands, 
                or American Samoa, as the case may be, shall be taken 
                into account in applying, as applicable, subparagraph 
                (B)(ii), (C)(ii), (D)(ii), or (E)(ii) of section 
                1108(g)(2) for such year.''.
    (c) Increased FMAP.--Section 1905 of the Social Security Act (42 
U.S.C. 1396d(b)) is amended--
            (1) in subsection (b), by striking ``and (aa)'' and 
        inserting ``(aa), and (ff)''; and
            (2) by adding at the end the following new subsection:
    ``(ff) Temporary Increase in FMAP for Territories for Certain 
Fiscal Years.--
            ``(1) Puerto rico.--Notwithstanding subsection (b), the 
        Federal medical assistance percentage for Puerto Rico shall be 
        equal to--
                    ``(A) 83 percent for fiscal years 2020 and 2021; 
                and
                    ``(B) 76 percent for fiscal years 2022 and 2023.
            ``(2) Virgin islands.--Notwithstanding subsection (b), the 
        Federal medical assistance percentage for the Virgin Islands 
        shall be equal to--
                    ``(A) 100 percent for fiscal year 2020;
                    ``(B) 83 percent for fiscal years 2021 through 
                2024; and
                    ``(C) 76 percent for fiscal year 2025.
            ``(3) Other territories.--Notwithstanding subsection (b), 
        the Federal medical assistance percentage for Guam, the 
        Northern Mariana Islands, and American Samoa shall be equal 
        to--
                    ``(A) 100 percent for fiscal years 2020 and 2021;
                    ``(B) 83 percent for fiscal years 2022 through 
                2024; and
                    ``(C) 76 percent for fiscal year 2025.''.
    (d) Annual Report.--Section 1108(g) of the Social Security Act (42 
U.S.C. 1308(g)), as amended by subsection (a), is further amended by 
adding at the end the following new paragraph:
            ``(7) Annual report.--
                    ``(A) In general.--Not later than the date that is 
                30 days after the end of each fiscal year (beginning 
                with fiscal year 2020 and ending with fiscal year 
                2025), in the case that a specified territory receives 
                a Medicaid cap increase, or an increase in the Federal 
                medical assistance percentage for such territory under 
                section 1905(ff), for such fiscal year, such territory 
                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 that 
                describes how such territory has used such Medicaid cap 
                increase, or such increase in the Federal medical 
                assistance percentage, as applicable, to increase 
                access to health care under the State Medicaid plan of 
                such territory under title XIX (or a waiver of such 
                plan). Such report may include--
                            ``(i) the extent to which such territory 
                        has, with respect to such plan (or waiver)--
                                    ``(I) increased payments to health 
                                care providers;
                                    ``(II) increased covered benefits;
                                    ``(III) expanded health care 
                                provider networks; or
                                    ``(IV) improved in any other manner 
                                the carrying out of such plan (or 
                                waiver); and
                            ``(ii) any other information as determined 
                        necessary by such territory.
                    ``(B) Definitions.--In this paragraph:
                            ``(i) Medicaid cap increase.--The term 
                        `Medicaid cap increase' means, with respect to 
                        a specified territory and fiscal year, any 
                        increase in the amounts otherwise determined 
                        under this subsection for such territory for 
                        such fiscal year by reason of the amendments 
                        made by section 2(a) of the Territories Health 
                        Care Improvement Act.
                            ``(ii) Specified territory.--The term 
                        `specified territory' means Puerto Rico, the 
                        Virgin Islands, Guam, the Northern Mariana 
                        Islands, and American Samoa.''.

SEC. 3. APPLICATION OF CERTAIN REQUIREMENTS UNDER MEDICAID PROGRAM TO 
              CERTAIN TERRITORIES.

    (a) Application of Payment Error Rate Measurement Requirements to 
Puerto Rico.--Section 1903(u)(4) of the Social Security Act (42 U.S.C. 
1396b(u)(4)) is amended--
            (1) by striking ``to Puerto Rico, Guam'' and inserting ``to 
        Guam''; and
            (2) by striking ``or American Samoa.'' and inserting ``or 
        American Samoa, or, for fiscal years before fiscal year 2023, 
        to Puerto Rico.''.
    (b) Application of Asset Verification Program Requirements to 
Puerto Rico and Virgin Islands.--Section 1940(a) of the Social Security 
Act (42 U.S.C. 1396w(a)) is amended--
            (1) in paragraph (3)(A), by adding at the end the following 
        new clause:
                            ``(iii) Implementation in puerto rico and 
                        virgin islands.--The Secretary shall require 
                        Puerto Rico to implement an asset verification 
                        program under this subsection by the end of 
                        fiscal year 2022 and the Virgin Islands to 
                        implement such a program by the end of fiscal 
                        year 2023.''; and
            (2) in paragraph (4)--
                    (A) in the paragraph heading, by striking 
                ``Exemption of territories'' and inserting ``Exemption 
                of certain territories''; and
                    (B) by striking ``and the District of Columbia'' 
                and inserting ``, the District of Columbia, Puerto 
                Rico, and the Virgin Islands''.
    (c) Application of Certain Data Reporting and Program Integrity 
Requirements to Northern Mariana Islands, American Samoa, and Guam.--
            (1) In general.--Section 1902 of the Social Security Act 
        (42 U.S.C. 1396a) is amended by adding at the end the following 
        new subsection:
    ``(qq) Application of Certain Data Reporting and Program Integrity 
Requirements to Northern Mariana Islands, American Samoa, and Guam.--
Not later than October 1, 2023, the Northern Mariana Islands, American 
Samoa, and Guam shall--
            ``(1) implement methods, satisfactory to the Secretary, for 
        the collection and reporting of reliable data to the 
        Transformed Medicaid Statistical Information System (T-MSIS) 
        (or a successor system); and
            ``(2) demonstrate progress in establishing a State medicaid 
        fraud control unit described in section 1903(q).''.
            (2) Conforming amendment.--Section 1902(j) of the Social 
        Security Act (42 U.S.C. 1396a(j)) is amended--
                    (A) by striking ``or the requirement'' and 
                inserting ``, the requirement''; and
                    (B) by inserting before the period at the end the 
                following: ``, or the requirements under subsection 
                (qq) (relating to data reporting and program 
                integrity)''.
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