Sec. 2202. Administrative flexibility with respect to the territories
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Section 1108 of the Social Security Act ( 42 U.S.C. 1308 ) is amended by adding at the end the following: Notwithstanding any other provision of this Act, with respect to the applicability to Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa of payment formulas under titles XVIII and XIX, the Secretary shall do the following: Determine the availability of data for payment calculation factors required or authorized by respective payment formulas under such titles.
Determine the sufficiency, relevance and reliability of available data for payment calculation factors to adequately account for variations in standard benefits under programs established under this Act, variations in program penetration, and variations in the cost of delivering care that are unique to such territories. Determine whether the inclusion of payment calculation factors or certain data sources thereunder, whether prescribed by the respective titles or ordinarily used by the Secretary, disproportionately impact the resulting payment calculation with respect to each such territory, either generally or relative to the States.
Insofar as the Secretary determines in accordance with paragraph (1), (2), or
(3)that data are not available, that available data is insufficient to reliably and adequately account for variations in standard benefits under programs established under this Act, variations in program penetration, and variations in the cost of delivering care that are unique to such territories, or to the extent that disproportionate impact to such territories would otherwise occur— establish and apply a proxy for payment calculation factors or substitute data sources where data sources are determined unavailable, or as determined necessary to adequately reflect variations in standard benefits under programs established under this Act and in the cost of delivering care that are unique to such territories; or to the extent the inclusion of payment calculation factors or certain data sources thereunder disproportionately impacts the resulting payment calculation with respect to each such territory, either generally or relative to the States, disregard the factor or data source or devise and apply an appropriate adjustment factor. For purposes of extending the full benefits of payments to such territories intended under the respective titles, ensure that the application of payment calculation factors with respect to such territories occurs in a manner that takes into account the geographic and demographic differences, abnormalities in the cost of delivering care in such territories, and the potential disproportionate impact to each such territory, either generally or relative to the States. . The Secretary of Health and Human Services shall determine and apply the payment calculation adjustments authorized under section 1108(h) of the Social Security Act ( 42 U.S.C. 1308(h) ), as added by subsection (a), as soon as practicable after the date of enactment of this Act in order to allow for the application of appropriate payment calculation factors to Puerto Rico, the United States Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa under titles XVIII and XIX of the Social Security Act ( 42 U.S.C. 1395 et seq., 1396 et seq.) at the earliest feasible opportunity.
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