Sec. 5101. Medicaid adjustments for the territories
2,106 words·~10 min read·
/bill/117/hr/2617/unknown/section-5101A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1108(g) of the Social Security Act ( 42 U.S.C. 1308(g) ) is amended— in paragraph (2)— in subparagraph (A)— in clause (i)— by striking clause
(ii)and inserting clause
(ii)or
(iii); and by striking and at the end; in clause (ii), by striking the semicolon and inserting ; and ; and by adding at the end the following new clause: for fiscal year 2023 and each subsequent fiscal year, the amount specified in paragraph
(11)for such fiscal year; ; and in the matter following subparagraph (E), by striking each fiscal year after fiscal year 2021 and inserting fiscal year 2022 (and, in the case of a territory other than Puerto Rico, for each subsequent fiscal year) ; and by adding at the end the following new paragraphs: For purposes of paragraph (2)(A)(iii), subject to paragraphs
(12)and (13), the amounts specified in this paragraph are the following: For fiscal year 2023, $3,275,000,000. For fiscal year 2024, $3,325,000,000. For fiscal year 2025, $3,475,000,000. For fiscal year 2026, $3,645,000,000. For fiscal year 2027, $3,825,000,000. For fiscal year 2028, the sum of the amount that would have been provided under this subsection for Puerto Rico for such fiscal year in accordance with clause
(i)of paragraph (2)(A) (without regard to clause
(iii)of such paragraph) had the amount provided under this subsection for Puerto Rico for each of fiscal years 2020 through 2027 been equal to the following: For fiscal year 2020, the sum of the amount provided under this subsection for Puerto Rico for fiscal year 2019, increased by the percentage increase in the medical care component of the Consumer Price Index for all urban consumers (as published by the Bureau of Labor Statistics) for the 12-month period ending in March preceding the beginning of the fiscal year, rounded to the nearest $100,000. For each of fiscal years 2021 through 2027, the sum of the amount provided under this subparagraph for the preceding fiscal year, increased in accordance with the percentage increase described in clause (i), rounded to the nearest $100,000. For fiscal year 2029 and each subsequent fiscal year, the sum of the amount specified in this paragraph for the preceding fiscal year, increased by the percentage increase in the medical care component of the Consumer Price Index for all urban consumers (as published by the Bureau of Labor Statistics) for the 12-month period ending in March preceding the beginning of the fiscal year, rounded to the nearest $100,000. In determining the amount specified under subparagraph
(F)for fiscal year 2028 or under subparagraph
(G)for fiscal year 2029 or a subsequent fiscal year, the Secretary may in no way take into account the amount that was provided under this subsection for Puerto Rico for fiscal year 2022 that was based on the Centers for Medicare & Medicaid Services’ interpretation of the flush language following paragraph (2)(E) (as described in the letters sent by the Centers for Medicare & Medicaid Services to the Director of the Medicaid Program for Puerto Rico dated September 24, 2021, and November 18, 2021, respectively). For fiscal year 2023 and each subsequent fiscal year through fiscal year 2027, the amount specified in paragraph
(11)for the fiscal year shall be equal to the amount specified for such fiscal year under such paragraph increased by $300,000,000 if the Secretary certifies that, with respect to such fiscal year, Puerto Rico’s State plan under title XIX (or waiver of such plan) establishes a reimbursement floor, implemented through a directed payment arrangement plan, for physician services that are covered under the Medicare part B fee schedule in the Puerto Rico locality established under section 1848(b) that is not less than 75 percent of the payment that would apply to such services if they were furnished under part B of title XVIII during such fiscal year. In certifying whether Puerto Rico has established a reimbursement floor under a directed payment arrangement plan that satisfies the requirements of subparagraph (A)— for fiscal year 2023, the Secretary shall apply such requirements to payments for physician services under a managed care contract entered into or renewed after the date of enactment of this paragraph and disregard payments for physician services under any managed care contract that was entered into prior to such date; and for each subsequent fiscal year through fiscal year 2027— the Secretary shall disregard payments made under subcapitated arrangements for services such as primary care case management; and if the reimbursement floor for physician services applicable under a managed care contract satisfies the requirements of subparagraph
(A)for the fiscal year in which the contract is entered into or renewed, such reimbursement floor shall be deemed to satisfy such requirements for the subsequent fiscal year. An increase under this paragraph for a fiscal year may not be taken into account in calculating the amount specified under paragraph
(11)for the succeeding fiscal year. For each of fiscal years 2023 through 2027, the amount specified in paragraph
(11)for the fiscal year shall be equal to the amount specified for such fiscal year under such paragraph (increased, if applicable, in accordance with paragraph (12)) and further increased— in the case of each of fiscal years 2023 through 2025, by $75,000,000 if the Secretary determines that Puerto Rico fully satisfies the requirements described in paragraph (7)(A)(i) for such fiscal year; and in the case of each of fiscal years 2026 and 2027, by $75,000,000 if the Secretary determines that Puerto Rico fully satisfies the requirements described in— paragraph (7)(A)(i) for such fiscal year; and paragraph (7)(A)(v) for such fiscal year. An increase under this paragraph for a fiscal year may not be taken into account in calculating the amount specified under paragraph
(11)for the succeeding fiscal year. . Section 1905(ff) of the Social Security Act ( 42 U.S.C. 1396d(ff) ) is amended— in the header, by striking ; Temporary in paragraph (2)— by striking subject to section 1108(g)(7)(C), ; and by striking December 23, 2022 and inserting September 30, 2027, ; and in paragraph (3), by striking for the period beginning December 21, 2019, and ending December 23, 2022 and inserting beginning December 21, 2019 . Section 1940 of the Social Security Act ( 42 U.S.C. 1396w ) is amended— in subsection (a)— in paragraph (3)(A), by adding at the end the following new clause: The Secretary shall require Puerto Rico to implement an asset verification program under this subsection by January 1, 2026. ; and in paragraph (4)— in the paragraph heading, by striking and inserting Exemption of territories ; and Exemption of certain territories by striking and the District of Columbia and inserting , the District of Columbia, and Puerto Rico ; and in subsection (k)— in paragraph (1)— by redesignating subparagraphs
(A)through
(D)as clauses
(i)through (iv), respectively, and adjusting the margins accordingly; in the matter preceding clause (i), as so redesignated— by striking beginning on or after January 1, 2021 ; and by striking for a non-compliant State shall be reduced— and inserting the following: for— a non-compliant State that is one of the 50 States or the District of Columbia shall be reduced— ; in clause (iv), as so redesignated, by striking the period at the end and inserting ; and ; and by adding at the end the following new subparagraph: a non-compliant State that is Puerto Rico shall be reduced— for calendar quarters in fiscal year 2026 beginning on or after January 1, 2026, by 0.12 percentage points; for calendar quarters in fiscal year 2027, by 0.25 percentage points; for calendar quarters in fiscal year 2028, by 0.35 percentage points; and for calendar quarters in fiscal year 2029 and each fiscal year thereafter, by 0.5 percentage points. ; and in paragraph (2)(A), by striking or the District of Columbia and inserting , the District of Columbia, or Puerto Rico . Section 1108(g)(9) of the Social Security Act ( 42 U.S.C. 1308(g)(9) ) is amended— in subparagraph (A), by inserting and for fiscal year 2023 and each subsequent fiscal year (or, in the case of Puerto Rico, and for fiscal year 2023 and each subsequent fiscal year before fiscal year 2028) after fiscal year 2021) ; and in subparagraph (B)(i), by inserting or by reason of the amendments made by section 5101 of the Health Extenders, Improving Access to Medicare, Medicaid, and CHIP, and Strengthening Public Health Act of 2022 before the period at the end. Section 1108(g)(7)(A) of the Social Security Act ( 42 U.S.C. 1308(g)(7)(A) ) is amended— in clause (iii), in the header, by inserting after reporting ; and reform by adding at the end the following new clause: 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). 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— 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 that extenuating circumstances (including a lack of multiple entities competing for such contract) prevented the compliance of such contract with such standards. 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. 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. . Section 1108 of the Social Security Act ( 42 U.S.C. 1308 ) is amended by adding at the end the following new subsection: Subject to paragraphs
(2)and (3), the Secretary shall pay to each eligible territory an amount equal to 100 percent of the qualifying data system improvement expenditures incurred by such territory on or after October 1, 2023. Payments to eligible territories made under this paragraph shall be considered to have been made under, and are subject to the requirements of, section 1903. No payment shall be made under title XIX (other than as provided under paragraph (1)), title XXI, or any other provision of law with respect to an expenditure for which payment is made under such paragraph. The Secretary shall specify an allotment for each eligible territory for payments made under paragraph
(1)in a manner such that— the total amount of payments made under such paragraph for all eligible territories does not exceed $20,000,000; and each eligible territory receives an equitable allotment of such payments. A payment to an eligible territory under this subsection shall not be taken into account for purposes of applying the payment limits under subsections
(f)and (g). In this subsection: The term eligible territory means American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands. The term qualifying data system improvement expenditure means an expenditure by an eligible territory to improve, update, or enhance a data system that is used by the territory to carry out an administrative activity for which Federal financial participation is available under section 1903(a). . Each territory described in paragraph
(2)shall— not later than September 30, 2023, submit to the Secretary of Health and Human Services a 4-year strategic plan that outlines the territory's goals relating to workforce development, financing, systems implementation and operation, and program integrity with respect to the territory’s Medicaid program under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ); and not later than September 30, 2027, submit to the Secretary of Health and Human Services an analysis of the extent to which the territory has achieved, or is making progress toward achieving, the goals described in such strategic plan, and any policy changes relating to such goals that were adopted by the territory after the submission of the plan. The territories described in this paragraph are American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands.
Connectionstraces to 4
Citation graph
cites case law
Cites 4Cited by 0 across 0 sources