Sec. 30741. Investments to ensure continued access to health care for children and other individuals

3,122 words·~14 min read·/bill/117/hr/5376/eh/section-30741·

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Section 1902(e) of the Social Security Act ( 42 U.S.C. 1396a(e) ) is amended— in paragraph (12), by inserting before the date that is one year after the date of the enactment of paragraph

(17)after subsection (a)(10)(A) ; and by adding at the end following new paragraph: The State plan (or waiver of such State plan) shall provide that an individual who is under the age of 19 and who is determined to be eligible for benefits under a State plan (or waiver of such plan) approved under subsection (a)(10)(A) shall remain eligible for such benefits until the earlier of— the end of the 12-month period beginning on the date of such determination; the time that such individual attains the age of 19; or the date that such individual ceases to be a resident of such State. . Subject to clause (ii), the amendments made by subparagraph (A)(ii) shall take effect one year after the date of enactment of this Act. In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 through 1396w-6) that the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet any requirement imposed by amendments made under subparagraph (A)(ii), the plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such a requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session shall be considered to be a separate regular session of the State legislature. Section 2107(e)(1) of the Social Security Act ( 42 U.S.C. 1397gg(e)(1) ) is amended— by redesignating subparagraphs

(K)through

(T)as subparagraphs

(L)through (U), respectively; and by inserting after subparagraph

(J)the following new subparagraph: Section 1902(e)(17) (relating to 1 year of continuous eligibility for children). . Section 6008 of the Families First Coronavirus Response Act ( 42 U.S.C. 1396d note) is amended— in subsection (a)— by striking and inserting In general.— Subject to Temporary increase.— Subject to ; in the paragraph

(1)inserted by subparagraph (A)— by striking the last day of the calendar quarter in which the last day of such emergency period occurs and inserting September 30, 2022 ; and by striking 6.2 percentage points and inserting the number of percentage points specified in paragraph

(2)with respect to such calendar quarter ; and by adding at the end the following new paragraph: For purposes of paragraph (1), the number of percentage points specified in this paragraph is— 6.2 percentage points with respect to each calendar quarter occurring during the period beginning on the first day of the emergency period defined in paragraph (1)(B) of section 1135(g) of the Social Security Act ( 42 U.S.C. 1320b-5(g) ) and ending March 31, 2022; 3.0 percentage points with respect to the calendar quarter beginning on April 1, 2022, and ending on June 30, 2022; and 1.5 percentage points with respect to the calendar quarter beginning on July 1, 2022, and ending on September 30, 2022. ; in subsection (b)(3)— by striking the State fails and inserting subject to subsection (f), the State fails ; by striking and ending the last day of the month in which the emergency period described in subsection

(a)ends and inserting and ending on March 31, 2022, ; and by striking through the end of the month in which such emergency period ends and inserting through September 30, 2022, ; and by adding at the end the following new subsection: For calendar quarters during the period described in subsection

(a)that begin on or after April 1, 2022, a State described in such subsection may, in accordance with paragraph (3), terminate coverage for an individual who is determined to be no longer eligible for medical assistance and who has been enrolled for at least 12 consecutive months under the State plan of such State under title XIX of the Social Security Act ( 42 U.S.C. 1396 ) (or waiver of such plan), and such State shall not be ineligible for the increase to the Federal medical assistance percentage of the State described in such subsection on the basis that the State is in violation of the requirement of subsection (b)(3), if the State, with respect to such terminations of coverage conducted through September 30, 2022, for such individuals, is in compliance with each of the following: The State shall conduct such eligibility redeterminations, with respect to such an individual, in accordance with the provisions of section 435.916 of title 42 of the Code of Federal Regulations (or any successor regulation) and the provisions of section 1943 of the Social Security Act, as applicable. Prior to terminating coverage for an individual, the State shall undertake a good faith effort to ensure that the State has contact information (including an up-to-date mailing address, phone number, or email address) for such individuals by coordinating with Medicaid managed care organizations (where applicable), and other applicable State health and human services agencies. The State may not disenroll from the State plan (or waiver) such an individual determined ineligible pursuant to such a redetermination for medical assistance under the State plan (or waiver) on the basis of returned mail unless— there have been at least two failed attempts to contact such individual through at least 2 modalities; and after the second attempt, the individual had 30 days notice, through at least 2 modalities, before such disenrollment takes effect. The State may not initiate eligibility redeterminations for more than 1/12 of individuals enrolled in the State plan (or waiver) with respect to any month during the period beginning on April 1, 2022, and ending on September 30, 2022. The State shall submit to the Secretary monthly reports during the period described in subsection

(a)that begin on or after April 1, 2022 which the State receives an increase pursuant to such subsection period on the activities of the State, including, with respect to the period for which the report is submitted— the number of eligibility renewals initiated, beneficiaries renewed, and individuals whose eligibility was terminated; the number of such cases in which eligibility for medical assistance under the State plan (or waiver) were so terminated due to the individual’s failure to return a renewal form or other information needed by the state to make an eligibility determination; the number of such cases in which eligibility for medical assistance under the State plan (or waiver) were so terminated pursuant to such a redetermination due to a known change in circumstance; the number of individuals whose coverage was terminated pursuant to such a redetermination whose accounts were, during such period, transitioned to the Exchange, CHIP, or basic health program; and with respect to eligibility redeterminations, the daily average volume, wait times, and abandonment rate (as determined by the Secretary) for each call center during such month. . The subdivision

(A)following paragraph

(31)of section 1905(a) of the Social Security Act ( 42 U.S.C. 1396d(a) ) is amended by inserting and, beginning on the first day of the first fiscal year quarter that begins two years after the date of the enactment of the Act titled after An Act to provide for reconciliation pursuant to title II of S. Con. Res. 14 , except during the 30-day period preceding the date of release of an inmate of a public institution medical institution . Section 1902(a) of the Social Security Act ( 42 U.S.C. 1396a(a) ) is amended— in paragraph (74), by striking at the end and ; and in paragraph (84)— in subparagraph (A), by inserting , except, beginning on the first day of the first fiscal year quarter that begins two years after the date of the enactment of the Act titled after An Act to provide for reconciliation pursuant to title II of S. Con. Res. 14 , the State may not suspend coverage during the 30-day period preceding the date of release of the juvenile during the period the juvenile is such an inmate ; and in subparagraph (C), by striking upon release and inserting 30 days prior to release . Section 2110(b)(2) of the Social Security Act ( 42 U.S.C. 1397jj(b)(2) )— in subparagraph (A), by striking at the end or ; in subparagraph (B), by striking the period at the end and inserting ; or ; and by adding at the end the following new subparagraph: except, beginning on the first day of the first fiscal year quarter that begins two years after the date of the enactment of the Act titled An Act to provide for reconciliation pursuant to title II of S. Con. Res. 14, except during the 30-day period preceding the date of release of such child from such public institution. . Section 1902(e)(13) of the Social Security Act ( 42 U.S.C. 1396a(e)(13) ) is amended by striking subparagraph (I). Section 1902(gg)(2) of the Social Security Act ( 42 U.S.C. 1396a(gg)(2) ) is amended— in the paragraph heading, by striking ; and through September 30, 2027 by striking through September 30 and all that follows through ends on September 30, 2027 and inserting (but beginning on October 1, 2019, . Section 223 of the Protecting Access to Medicare Act of 2014 ( 42 U.S.C. 1396a note) is amended— in subsection (c), by adding at the end the following new paragraph: In addition to the planning grants awarded under paragraph (1), the Secretary shall award planning grants to States (other than States selected to conduct demonstration programs under paragraph

(1)or

(8)of subsection (d)) for the purpose of developing proposals to participate in time-limited demonstration programs described in subsection (d). ; in subsection (d)— in paragraph (3), by striking Subject to paragraph

(8)and inserting Subject to paragraphs

(8)and

(9); in paragraph (5)(C)(iii)(II), by inserting or paragraph

(9)after paragraph

(8); in paragraph (7)— in subparagraph (A), by inserting through the year in which the last demonstration under this section ends after annually thereafter ; and in subparagraph (B)— by striking December 31, 2021 and inserting March 31, 2026 ; by striking recommendations concerning and all that follows through the period and inserting recommendations concerning whether and how the demonstration programs under this section should be modified. ; and by adding at the end the following new sentence: Such recommendations shall be based on data collected from States selected to conduct demonstration programs under paragraph

(1)and, to the extent available, data collected from States selected to conduct demonstration programs under paragraphs

(8)and (9). ; and by adding at the end the following new paragraph: In addition to the States selected under paragraphs

(1)and

(8)and without regard to paragraph (4), the Secretary shall select any State that meets the requirements described in subparagraph

(B)to conduct a demonstration program that meets the requirements of this subsection for 2 years. The requirements described in this subparagraph with respect to a State are that the State— was awarded a planning grant under paragraph

(1)or

(3)of subsection (c); and submits an application (in addition to any application that the State may have previously submitted under this section) that meets the requirements of paragraph (2)(B). The requirements applicable to States selected under paragraph

(8)pursuant to subparagraph

(C)of such paragraph shall apply in the same manner to States selected under this paragraph. ; in subsection (e), by amending paragraph

(4)to read as follows: The term State means each of the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. ; and in subsection (f)(1)— in subparagraph (A), by striking ; and and inserting a semicolon; in subparagraph (B), by striking the period and inserting , and $40,000,000 for fiscal year 2022; and ; and by adding at the end the following new subparagraph: for purposes of updating the criteria under subsection

(a)as needed for certified community behavioral health clinics and carrying out subsections (c)(3), (d)(7), and (d)(9) (including the provision of technical assistance to States applying for planning grants under subsection (c)(3) and conducting demonstration projects under this section), $5,000,000 for fiscal year 2022. . Section 1108 of the Social Security Act ( 42 U.S.C. 1308 ) is amended— in subsection (f), in the matter preceding paragraph (1), by striking subsections

(g)and

(h)and inserting subsections (g), (h), and

(i); and by adding at the end the following: Any additional amount paid to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa for expenditures for medical assistance that is attributable to an enhanced Federal medical assistance percentage applicable to such expenditures under section 223(d)(5) of the Protecting Access to Medicare Act of 2014 shall not be taken into account for purposes of applying payment limits under subsections

(f)and (g). . Section 1947 of the Social Security Act ( 42 U.S.C. 1396w–6 ) is amended— in subsection (a), by striking during the 5-year period ; in subsection (c), by striking occurring during the period described in subsection

(a)that a State and inserting in which a State provides medical assistance for qualifying community-based mobile crisis intervention services under this section and ; and in subsection (d)(2)— in subparagraph (A), by striking for the fiscal year preceding the first fiscal quarter occurring during the period described in subsection

(a)and inserting for the fiscal year preceding the first fiscal quarter in which the State provides medical assistance for qualifying community-based mobile crisis intervention services under this section ; and in subparagraph (B), by striking occurring during the period described in subsection

(a)and inserting occurring during a fiscal quarter . The third sentence of section 1905(b) of the Social Security Act ( 42 U.S.C. 1396d(b) ) is amended— by striking for the 8 fiscal year quarters beginning with the first fiscal year quarter beginning after the date of the enactment of the and inserting American Rescue Plan Act of 2021 for the period of the 16 fiscal year quarters that begins on April 1, 2021 ; and by striking such 8 fiscal year quarters and inserting such period of 16 fiscal year quarters . Section 1927(f) of the Social Security Act ( 42 U.S.C. 1396r–8(f) ) is amended— by striking and after the semicolon at the end of paragraph (1)(A)(i) and all that precedes it through

(1)and inserting the following: The Secretary shall conduct a survey of retail community pharmacy drug prices in the 50 States and the District of Columbia, to determine the national average drug acquisition cost, as follows: The Secretary may contract services for— with respect to retail community pharmacies, the determination of retail survey prices of the national average drug acquisition cost for covered outpatient drugs based on a monthly survey of such pharmacies, net of all discounts and rebates (to the extent any information with respect to such discounts and rebates is available), the average reimbursement received for such drugs by such pharmacies from all sources of payment and, to the extent available, the usual and customary charges to consumers for such drugs; and ; by adding at the end of paragraph

(1)the following: A State shall require that any retail community pharmacy in the State that receives any payment, reimbursement, administrative fee, discount, or rebate related to the dispensing of covered outpatient drugs to individuals receiving benefits under this title or title XXI, regardless of whether such payment, fee, discount, or rebate is received from the State or a managed care entity directly or from a pharmacy benefit manager or another entity that has a contract with the State or a managed care entity or other specified entity (as such terms are defined in section 1903(m)(9)(D)), shall respond to surveys of retail prices conducted under this subsection with the specific information requested by the vendor. Information on retail community actual acquisition prices obtained under this paragraph shall be made publicly available and shall include at least the following: The monthly response rate of the survey, including a list of pharmacies not in compliance with subparagraph

(F)and the identification numbers for such pharmacies. The sampling frame and number of pharmacies sampled monthly. Characteristics of reporting pharmacies, including type (such as independent or chain), geographic or regional location, and dispensing volume. Reporting of a separate national average drug acquisition cost for each drug for independent retail pharmacies and chain pharmacies. Information on price concessions including on and off invoice discounts, rebates, and other price concessions. Information on average professional dispensing fees paid. A retail community pharmacy that knowingly fails to respond to a survey conducted under this subsection on a timely basis may be subject to a civil monetary penalty in an amount not to exceed $10,000 for each day in which such information has not been provided. A retail community pharmacy shall not be subject to such penalty if the pharmacy makes a good faith effort to provide the information requested by the survey on a timely basis. A retail community pharmacy that knowingly provides false information in response to a survey conducted under this subsection may be subject to a civil money penalty in an amount not to exceed $100,000 for each item of false information. ; and in paragraph (4), by inserting , and $7,000,000 for fiscal year 2023 and each fiscal year thereafter, after 2010 . Section 1903(i)(10) of the Social Security Act ( 42 U.S.C. 1396b(i)(10) ) is amended— in subparagraph (D), by striking and after the semicolon; in subparagraph (E), by striking or after the semicolon and inserting and ; and by inserting after subparagraph (E), the following new subparagraph: with respect to any amount expended for reimbursement to a retail community pharmacy under this title unless the State requires the retail community pharmacy to respond to surveys of retail prices conducted under section 1927(f) in accordance with paragraph (1)(F) of such section; or . The amendments made by this section take effect on the 1st day of the 1st quarter that begins on or after the date that is 18 months after the date of enactment of this Act. In addition to amounts otherwise available, there is appropriated to the Secretary, for fiscal year 2022, to be available until expended, out of any money in the Treasury not otherwise appropriated, $20,000,000, to provide technical assistance and guidance and cover administrative costs associated with implementing the amendments made by this part and part 2.

Connectionstraces to 8

Traces to 8 documents

U.S. Code