Sec. 30731. Increasing Medicaid cap amounts and the Federal medical assistance percentage for the territories
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/bill/117/hr/5376/eh/section-30731·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 1108(g)(2) of the Social Security Act ( 42 U.S.C. 1308(g)(2) ) is amended— in subparagraph (A)— in clause (i)— by striking except as provided in clause
(ii)and inserting for each of fiscal years 1999 through 2019 ; and by striking and at the end; and by adding at the end the following new clauses: for fiscal year 2022, $3,600,000,000; and for fiscal year 2023 and each subsequent year, the sum of the amount provided in this subsection for the preceding fiscal year, increased by the percentage increase, if any, in Medicaid spending under title XIX during the preceding year (as determined based on the most recent National Health Expenditure data with respect to such year), rounded to the nearest $100,000; ; in subparagraph (B)— in clause (i), by striking except as provided in clause (ii), and inserting for each of fiscal years 1999 through 2019, ; in clause (ii), by striking and at the end; by adding at the end the following: for fiscal year 2022, $135,000,000; and for fiscal year 2023 and each subsequent year, the sum of the amount provided in this subsection for the preceding fiscal year, increased by the percentage increase described in subparagraph (A)(iv) for the preceding year, rounded to the nearest $10,000; ; in subparagraph (C)— in clause (i), by striking except as provided in clause (ii), and inserting for each of fiscal years 1999 through 2019, ; in clause (ii), by striking and at the end; by adding at the end the following: for fiscal year 2022, $140,000,000; and for fiscal year 2023 and each subsequent year, the sum of the amount provided in this subsection for the preceding fiscal year, increased by the percentage increase described in subparagraph (A)(iv) for the preceding year, rounded to the nearest $10,000; ; in subparagraph (D)— in clause (i), by striking except as provided in clause (ii), and inserting for each of fiscal years 1999 through 2019, ; in clause (ii), by striking and at the end; in clause (iii), by striking and at the end; and by adding at the end the following new clauses: for fiscal year 2022, $70,000,000; and for fiscal year 2023 and each subsequent year, the sum of the amount provided in this subsection for the preceding fiscal year, increased by the percentage increase described in subparagraph (A)(iv) for the preceding year, rounded to the nearest $10,000; and ; in subparagraph (E)— in clause (i), by striking except as provided in clause (ii), and inserting for each of fiscal years 1999 through 2019, ; in clause (ii), by striking and at the end; in clause (iii), by striking the period and inserting a semicolon; and by adding at the end the following: for fiscal year 2022, $90,000,000; and for fiscal year 2023 and each subsequent year, the sum of the amount provided in this subsection for the preceding fiscal year, increased by the percentage increase described in subparagraph (A)(iv) for the preceding year, rounded to the nearest $10,000. ; and by striking the flush matter following subparagraph (E). Section 1905(ff) of the Social Security Act ( 42 U.S.C. 1396d(ff) ) is amended— by redesignating paragraphs
(1)through
(3)as subparagraphs
(A)through (C), respectively, and adjusting the margins accordingly; by striking Notwithstanding and inserting the following: Notwithstanding ; in paragraph (1), as so inserted— in the matter preceding subparagraph (A), as so redesignated, by inserting paragraph
(2)and after subject to ; in subparagraph (B), as so redesignated— by striking December 3, 2021, and inserting September 30, 2021 ; and by striking and at the end; in subparagraph (C), as so redesignated, by striking December 3, 2021, and inserting September 30, 2021 ; by adding at the end the following: for fiscal year 2022 and each subsequent fiscal year, the Federal medical assistance percentage for the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be equal to 83 percent; for fiscal year 2022, the Federal medical assistance percentage for Puerto Rico shall be equal to 76 percent; and for fiscal year 2023 and each subsequent fiscal year, the Federal medical assistance percentage for Puerto Rico shall be equal to 83 percent. ; and by adding at the end the following new paragraph: For each fiscal quarter (beginning with the first fiscal quarter beginning on or after the date of the enactment of this paragraph), Puerto Rico’s State plan (or waiver of such plan) shall establish 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 70 percent of the payment that would apply to such services if they were furnished under part B of title XVIII during such fiscal quarter. In determining whether Puerto Rico has established a reimbursement floor under a directed payment arrangement plan that satisfies the requirements of subparagraph
(A)for a fiscal quarter occurring during fiscal year 2022 or a subsequent fiscal year— the Secretary shall disregard payments made under sub-capitated 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 a fiscal quarter occurring during a year in which the contract is entered into or renewed, such reimbursement floor shall be deemed to satisfy such requirements for each subsequent fiscal quarter occurring during such year and for each fiscal quarter occurring during the subsequent fiscal year. In the case that the Secretary determines that Puerto Rico has failed to meet the requirement of subparagraph
(A)with respect to a fiscal quarter, the Federal medical assistance percentage otherwise determined under this subsection for Puerto Rico shall be reduced for such quarter by the applicable number of percentage points described in clause (ii). For purposes of clause (i), the applicable number of percentage points described in this clause is, with respect to a fiscal quarter, the following: In the case no reduction was made under this subparagraph for the preceding fiscal quarter, 0.5 percentage points. In the case a reduction was made under this subparagraph for the preceding fiscal quarter, the number of percentage points of such reduction for such preceding fiscal quarter, plus 0.25 percentage points, except that in no case may the application of this subclause result in a reduction of more than 5 percentage points. .
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Sec. 30731
Increasing Medicaid cap amounts and the Federal medical assistance percentage for the territories
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