COMMITTEE PRINT
Budget Reconciliation Legislative Recommendations Relating
to Repeal and Replace of the Patient Protection and Afford-
able Care Act
TITLE I—ENERGY AND
1
COMMERCE
2
Subtitle A—Patient Access to
3
Public Health Programs
4
SEC. 101. THE PREVENTION AND PUBLIC HEALTH FUND.
5
(a) IN GENERAL.—Subsection (b) of section 4002 of
6
the Patient Protection and Affordable Care Act (42
7
U.S.C. 300u–11), as amended by section 5009 of the 21st
8
Century Cures Act, is amended—
9
(1) in paragraph (2), by adding ‘‘and’’ at the
10
end;
11
(2) in paragraph (3)—
12
(A) by striking ‘‘each of fiscal years 2018
13
and 2019’’ and inserting ‘‘fiscal year 2018’’;
14
and
15
(B) by striking the semicolon at the end
16
and inserting a period; and
17
(3) by striking paragraphs (4) through (8).
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(b) RESCISSION OF UNOBLIGATED FUNDS.—Of the
1
funds made available by such section 4002, the unobli-
2
gated balance at the end of fiscal year 2018 is rescinded.
3
SEC. 102. COMMUNITY HEALTH CENTER PROGRAM.
4
Effective as if included in the enactment of the Medi-
5
care Access and CHIP Reauthorization Act of 2015 (Pub-
6
lic Law 114–10, 129 Stat. 87), paragraph (1) of section
7
221(a) of such Act is amended by inserting ‘‘, and an ad-
8
ditional $422,000,000 for fiscal year 2017’’ after ‘‘2017’’.
9
SEC. 103. FEDERAL PAYMENTS TO STATES.
10
(a) IN GENERAL.—Notwithstanding section 504(a),
11
1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or
12
2105(a)(1) of the Social Security Act (42 U.S.C. 704(a),
13
1396a(a)(23),
1396b(a),
1397a,
1397d(a)(4),
14
1397bb(a)(7), 1397ee(a)(1)), or the terms of any Med-
15
icaid waiver in effect on the date of enactment of this Act
16
that is approved under section 1115 or 1915 of the Social
17
Security Act (42 U.S.C. 1315, 1396n), for the 1-year pe-
18
riod beginning on the date of the enactment of this Act,
19
no Federal funds provided from a program referred to in
20
this subsection that is considered direct spending for any
21
year may be made available to a State for payments to
22
a prohibited entity, whether made directly to the prohib-
23
ited entity or through a managed care organization under
24
contract with the State.
25
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(b) DEFINITIONS.—In this section:
1
(1) PROHIBITED ENTITY.—The term ‘‘prohib-
2
ited entity’’ means an entity, including its affiliates,
3
subsidiaries, successors, and clinics—
4
(A) that, as of the date of enactment of
5
this Act—
6
(i) is an organization described in sec-
7
tion 501(c)(3) of the Internal Revenue
8
Code of 1986 and exempt from tax under
9
section 501(a) of such Code;
10
(ii) is an essential community provider
11
described in section 156.235 of title 45,
12
Code of Federal Regulations (as in effect
13
on the date of enactment of this Act), that
14
is primarily engaged in family planning
15
services, reproductive health, and related
16
medical care; and
17
(iii) provides for abortions, other than
18
an abortion—
19
(I) if the pregnancy is the result
20
of an act of rape or incest; or
21
(II) in the case where a woman
22
suffers from a physical disorder, phys-
23
ical injury, or physical illness that
24
would, as certified by a physician,
25
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place the woman in danger of death
1
unless an abortion is performed, in-
2
cluding a life-endangering physical
3
condition caused by or arising from
4
the pregnancy itself; and
5
(B) for which the total amount of Federal
6
and State expenditures under the Medicaid pro-
7
gram under title XIX of the Social Security Act
8
in fiscal year 2014 made directly to the entity
9
and to any affiliates, subsidiaries, successors, or
10
clinics of the entity, or made to the entity and
11
to any affiliates, subsidiaries, successors, or
12
clinics of the entity as part of a nationwide
13
health
care
provider
network,
exceeded
14
$350,000,000.
15
(2) DIRECT SPENDING.—The term ‘‘direct
16
spending’’ has the meaning given that term under
17
section 250(c) of the Balanced Budget and Emer-
18
gency Deficit Control Act of 1985 (2 U.S.C. 900(c)).
19
Subtitle B—Medicaid Program
20
Enhancement
21
SEC. 111. REPEAL OF MEDICAID PROVISIONS.
22
The Social Security Act is amended—
23
(1) in section 1902 (42 U.S.C. 1396a)—
24
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(A) in subsection (a)(47)(B), by inserting
1
‘‘and provided that any such election shall cease
2
to be effective on January 1, 2020, and no such
3
election shall be made after that date’’ before
4
the semicolon at the end; and
5
(B) in subsection (l)(2)(C), by inserting
6
‘‘and ending December 31, 2019,’’ after ‘‘Janu-
7
ary 1, 2014,’’;
8
(2)
in
section
1915(k)(2)
(42 U.S.C.
9
1396n(k)(2)), by striking ‘‘during the period de-
10
scribed in paragraph (1)’’ and inserting ‘‘on or after
11
the date referred to in paragraph (1) and before
12
January 1, 2020’’; and
13
(3) in section 1920(e) (42 U.S.C. 1396r–1(e)),
14
by striking ‘‘under clause (i)(VIII), clause (i)(IX), or
15
clause (ii)(XX) of subsection (a)(10)(A)’’ and insert-
16
ing ‘‘under clause (i)(VIII) or clause (ii)(XX) of sec-
17
tion 1902(a)(10)(A) before January 1, 2020, section
18
1902(a)(10)(A)(i)(IX),’’.
19
SEC. 112. REPEAL OF MEDICAID EXPANSION.
20
(a) IN GENERAL.—Section 1902(a)(10)(A) of the So-
21
cial Security Act (42 U.S.C. 1396a(a)(10)(A)) is amend-
22
ed—
23
(1) in clause (i)(VIII), by inserting ‘‘at the op-
24
tion of a State,’’ after ‘‘January 1, 2014,’’; and
25
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(2) in clause (ii)(XX), by inserting ‘‘and ending
1
December 31, 2019,’’ after ‘‘2014,’’.
2
(b) TERMINATION OF EFMAP FOR NEW ACA EX-
3
PANSION ENROLLEES.—Section 1905 of the Social Secu-
4
rity Act (42 U.S.C. 1396d) is amended—
5
(1) in subsection (y)(1), in the matter preceding
6
subparagraph (A), by striking ‘‘with respect to’’ and
7
all that follows through ‘‘shall be’’ and inserting
8
‘‘with respect to amounts expended before January
9
1, 2020, by such State for medical assistance for
10
newly eligible individuals described in subclause
11
(VIII) of section 1902(a)(10)(A)(i) who are enrolled
12
under the State plan (or a waiver of the plan) before
13
such date and with respect to amounts expended
14
after such date by such State for medical assistance
15
for individuals described in such subclause who were
16
enrolled under such plan (or waiver of such plan) as
17
of December 31, 2019, and who do not have a break
18
in eligibility for medical assistance under such State
19
plan (or waiver) for more than one month after such
20
date, shall be’’; and
21
(2) in subsection (z)(2)—
22
(A) in subparagraph (A), by striking
23
‘‘medical assistance for individuals’’ and all that
24
follows through
‘‘shall be’’ and
inserting
25
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‘‘amounts expended before January 1, 2020, by
1
such State for medical assistance for individuals
2
described in section 1902(a)(10)(A)(i)(VIII)
3
who are nonpregnant childless adults with re-
4
spect to whom the State may require enrollment
5
in benchmark coverage under section 1937 and
6
who are enrolled under the State plan (or a
7
waiver of the plan) before such date and with
8
respect to amounts expended after such date by
9
such State for medical assistance for individuals
10
described in such section, who are nonpregnant
11
childless adults with respect to whom the State
12
may require enrollment in benchmark coverage
13
under section 1937, who were enrolled under
14
such plan (or waiver of such plan) as of Decem-
15
ber 31, 2019, and who do not have a break in
16
eligibility for medical assistance under such
17
State plan (or waiver) for more than one month
18
after such date, shall be’’ ; and
19
(B) in subparagraph (B)(ii)—
20
(i) in subclause (III), by adding
21
‘‘and’’ at the end; and
22
(ii) by striking subclauses (IV), (V),
23
and (VI) and inserting the following new
24
subclause:
25
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‘‘(IV) 2017 and each subsequent year is 80
1
percent.’’.
2
(c) SUNSET OF ESSENTIAL HEALTH BENEFITS RE-
3
QUIREMENT.—Section 1937(b)(5) of the Social Security
4
Act (42 U.S.C. 1396u–7(b)(5)) is amended by adding at
5
the end the following: ‘‘This paragraph shall not apply
6
after December 31, 2019.’’.
7
SEC. 113. ELIMINATION OF DSH CUTS.
8
Section 1923(f) of the Social Security Act (42 U.S.C.
9
1396r–4(f)) is amended—
10
(1) in paragraph (7)—
11
(A) in subparagraph (A)—
12
(i) in clause (i)—
13
(I) in the matter preceding sub-
14
clause (I), by striking ‘‘2025’’ and in-
15
serting ‘‘2019’’; and
16
(ii) in clause (ii)—
17
(I) in subclause (I), by adding
18
‘‘and’’ at the end;
19
(II) in subclause (II), by striking
20
the semicolon at the end and inserting
21
a period; and
22
(III) by striking subclauses (III)
23
through (VIII); and
24
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(B) by adding at the end the following new
1
subparagraph:
2
‘‘(C) EXEMPTION FROM EXEMPTION FOR
3
NON-EXPANSION STATES.—
4
‘‘(i) IN GENERAL.—In the case of a
5
State that is a non-expansion State for a
6
fiscal year, subparagraph (A)(i) shall not
7
apply to the DSH allotment for such State
8
and fiscal year.
9
‘‘(ii) NO CHANGE IN REDUCTION FOR
10
EXPANSION STATES.—In the case of a
11
State that is an expansion State for a fis-
12
cal year, the DSH allotment for such State
13
and fiscal year shall be determined as if
14
clause (i) did not apply.
15
‘‘(iii) NON-EXPANSION AND EXPAN-
16
SION STATE DEFINED.—
17
‘‘(I) The term ‘expansion State’
18
means with respect to a fiscal year, a
19
State that, as of July 1 of the pre-
20
ceding fiscal year, provides for eligi-
21
bility under
clause
(i)(VIII)
or
22
(ii)(XX) of section 1902(a)(10)(A) for
23
medical assistance under this title (or
24
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a waiver of the State plan approved
1
under section 1115).
2
‘‘(II) The term ‘non-expansion
3
State’ means, with respect to a fiscal
4
year, a State that is not an expansion
5
State.’’; and
6
(2) in paragraph (8), by striking ‘‘fiscal year
7
2025’’ and inserting ‘‘fiscal year 2019’’.
8
SEC. 114. REDUCING STATE MEDICAID COSTS.
9
(a) LETTING STATES DISENROLL HIGH DOLLAR
10
LOTTERY WINNERS.—
11
(1) IN GENERAL.—Section 1902 of the Social
12
Security Act (42 U.S.C. 1396a) is amended—
13
(A) in subsection (a)(17), by striking
14
‘‘(e)(14),
(e)(14)’’ and
inserting
‘‘(e)(14),
15
(e)(15)’’; and
16
(B) in subsection (e)—
17
(i) in paragraph (14) (relating to
18
modified adjusted gross income), by adding
19
at the end the following new subparagraph:
20
‘‘(J) TREATMENT OF CERTAIN LOTTERY
21
WINNINGS AND INCOME RECEIVED AS A LUMP
22
SUM.—
23
‘‘(i) IN GENERAL.—In the case of an
24
individual who is the recipient of qualified
25
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lottery winnings (pursuant to lotteries oc-
1
curring on or after January 1, 2020) or
2
qualified lump sum income (received on or
3
after such date) and whose eligibility for
4
medical assistance is determined based on
5
the application of modified adjusted gross
6
income under subparagraph (A), a State
7
shall, in determining such eligibility, in-
8
clude such winnings or income (as applica-
9
ble) as income received—
10
‘‘(I) in the month in which such
11
winnings or income (as applicable) is
12
received
if
the amount of such
13
winnings or
income is
less than
14
$80,000;
15
‘‘(II) over a period of 2 months
16
if the amount of such winnings or in-
17
come (as applicable) is greater than or
18
equal to $80,000 but
less than
19
$90,000;
20
‘‘(III) over a period of 3 months
21
if the amount of such winnings or in-
22
come (as applicable) is greater than or
23
equal to $90,000 but
less than
24
$100,000; and
25
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‘‘(IV) over a period of 3 months
1
plus 1 additional month for each in-
2
crement of $10,000 of such winnings
3
or income (as applicable) received, not
4
to exceed a period of 120 months (for
5
winnings or income of $1,260,000 or
6
more), if the amount of such winnings
7
or income is greater than or equal to
8
$100,000.
9
‘‘(ii) COUNTING IN EQUAL INSTALL-
10
MENTS.—For purposes of subclauses (II),
11
(III), and (IV) of clause (i), winnings or
12
income to which such subclause applies
13
shall be counted in equal monthly install-
14
ments over the period of months specified
15
under such subclause.
16
‘‘(iii) HARDSHIP EXEMPTION.—An in-
17
dividual whose income, by application of
18
clause (i), exceeds the applicable eligibility
19
threshold established by the State, may
20
continue to be eligible for medical assist-
21
ance to the extent that the State deter-
22
mines, under procedures established by the
23
State under the State plan (or in the case
24
of a waiver of the plan under section 1115,
25
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incorporated in such waiver), or as other-
1
wise established by such State in accord-
2
ance with such standards as may be speci-
3
fied by the Secretary, that the denial of eli-
4
gibility of the individual would cause an
5
undue medical or financial hardship as de-
6
termined on the basis of criteria estab-
7
lished by the Secretary.
8
‘‘(iv) NOTIFICATIONS AND ASSIST-
9
ANCE REQUIRED IN CASE OF LOSS OF ELI-
10
GIBILITY.—A State shall, with respect to
11
an individual who loses eligibility for med-
12
ical assistance under the State plan (or a
13
waiver of such plan) by reason of clause
14
(i), before the date on which the individual
15
loses such eligibility, inform the individual
16
of the date on which the individual would
17
no longer be considered ineligible by reason
18
of such clause to receive medical assistance
19
under the State plan or under any waiver
20
of such plan and the date on which the in-
21
dividual would be eligible to reapply to re-
22
ceive such medical assistance.
23
‘‘(v) QUALIFIED LOTTERY WINNINGS
24
DEFINED.—In this subparagraph, the term
25
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‘qualified lottery winnings’ means winnings
1
from a sweepstakes, lottery, or pool de-
2
scribed in paragraph (3) of section 4402 of
3
the Internal Revenue Code of 1986 or a
4
lottery operated by a multistate or multi-
5
jurisdictional lottery association, including
6
amounts awarded as a lump sum payment.
7
‘‘(vi) QUALIFIED LUMP SUM INCOME
8
DEFINED.—In this subparagraph, the term
9
‘qualified lump sum income’ means income
10
that is received as a lump sum from one
11
of the following sources:
12
‘‘(I) Monetary winnings from
13
gambling (as defined by the Secretary
14
and including monetary winnings from
15
gambling activities described in sec-
16
tion 1955(b)(4) of title 18, United
17
States Code).
18
‘‘(II) Income received as liquid
19
assets from the estate (as defined in
20
section 1917(b)(4)) of a deceased in-
21
dividual.’’; and
22
(ii) by striking ‘‘(14) EXCLUSION’’
23
and inserting ‘‘(15) EXCLUSION’’.
24
(2) RULES OF CONSTRUCTION.—
25
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(A) INTERCEPTION OF LOTTERY WINNINGS
1
ALLOWED.—Nothing in the amendment made
2
by paragraph (1)(B)(i) shall be construed as
3
preventing a State from intercepting the State
4
lottery winnings awarded to an individual in the
5
State to recover amounts paid by the State
6
under the State Medicaid plan under title XIX
7
of the Social Security Act for medical assistance
8
furnished to the individual.
9
(B) APPLICABILITY LIMITED TO ELIGI-
10
BILITY OF RECIPIENT OF LOTTERY WINNINGS
11
OR LUMP SUM INCOME.—Nothing in the amend-
12
ment made by paragraph (1)(B)(i) shall be con-
13
strued, with respect to a determination of
14
household income for purposes of a determina-
15
tion of eligibility for medical assistance under
16
the State plan under title XIX of the Social Se-
17
curity Act (42 U.S.C. 1396 et seq.) (or a waiver
18
of such plan) made by applying modified ad-
19
justed gross income under subparagraph (A) of
20
section 1902(e)(14) of such Act (42 U.S.C.
21
1396a(e)(14)), as limiting the eligibility for
22
such medical assistance of any individual that is
23
a member of the household other than the indi-
24
vidual (or the individual’s spouse) who received
25
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qualified lottery winnings or qualified lump-sum
1
income (as defined in subparagraph (J) of such
2
section 1902(e)(14), as added by paragraph
3
(1)(B)(i) of this subsection).
4
(b) REPEAL OF RETROACTIVE ELIGIBILITY.—
5
(1) IN GENERAL.—
6
(A) STATE PLAN REQUIREMENTS.—Section
7
1902(a)(34) of the Social Security Act (42
8
U.S.C. 1396a(a)(34)) is amended by striking
9
‘‘in or after the third month before the month
10
in which he made application’’ and inserting ‘‘in
11
or after the month in which the individual made
12
application’’.
13
(B) DEFINITION OF MEDICAL ASSIST-
14
ANCE.—Section 1905(a) of the Social Security
15
Act (42 U.S.C. 1396d(a)) is amended by strik-
16
ing ‘‘in or after the third month before the
17
month in which the recipient makes application
18
for assistance’’ and inserting ‘‘in or after the
19
month in which the recipient makes application
20
for assistance’’.
21
(2) EFFECTIVE DATE.—The amendments made
22
by paragraph (1) shall apply to medical assistance
23
with respect to individuals whose eligibility for such
24
assistance is based on an application for such assist-
25
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ance made (or deemed to be made) on or after Octo-
1
ber 1, 2017.
2
(c) ENSURING STATES ARE NOT FORCED TO PAY
3
FOR INDIVIDUALS INELIGIBLE FOR THE PROGRAM.—
4
(1) IN GENERAL.—Section 1137(f) of the Social
5
Security Act (42 U.S.C. 1320b–7(f)) is amended—
6
(A) by striking ‘‘Subsections (a)(1) and
7
(d)’’ and inserting ‘‘(1) Subsections (a)(1) and
8
(d)’’; and
9
(B) by adding at the end the following new
10
paragraph:
11
‘‘(2)(A) Subparagraphs (A) and (B)(ii) of subsection
12
(d)(4) shall not apply in the case of an initial determina-
13
tion made on or after the date that is 6 months after the
14
date of the enactment of this paragraph with respect to
15
the eligibility of an alien described in subparagraph (B)
16
for benefits under the program listed in subsection (b)(2).
17
‘‘(B) An alien described in this subparagraph is an
18
individual declaring to be a citizen or national of the
19
United States with respect to whom a State, in accordance
20
with section 1902(a)(46)(B), requires—
21
‘‘(i) pursuant to 1902(ee), the submission of a
22
social security number; or
23
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‘‘(ii) pursuant to 1903(x), the presentation of
1
satisfactory documentary evidence of citizenship or
2
nationality.’’.
3
(2) NO PAYMENTS FOR MEDICAL ASSISTANCE
4
PROVIDED BEFORE PRESENTATION OF EVIDENCE.—
5
Section 1903(i)(22) of the Social Security Act (42
6
U.S.C. 1396b(i)(22)) is amended—
7
(A) by striking ‘‘with respect to amounts
8
expended’’ and inserting ‘‘(A) with respect to
9
amounts expended’’;
10
(B) by inserting ‘‘and’’ at the end; and
11
(C) by adding at the end the following new
12
subparagraph:
13
‘‘(B) in the case of a State that elects to pro-
14
vide a reasonable period to present satisfactory doc-
15
umentary evidence of such citizenship or nationality
16
pursuant to paragraph (2)(C) of section 1902(ee) or
17
paragraph (4) of subsection (x) of this section, for
18
amounts expended for medical assistance for such an
19
individual (other than an individual described in
20
paragraph (2) of such subsection (x)) during such
21
period;’’.
22
(3)
CONFORMING
AMENDMENTS.—Section
23
1137(d)(4) of the Social Security Act (42 U.S.C.
24
1320b–7(d)(4)) is amended—
25
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(A) in subparagraph (A), in the matter
1
preceding clause (i), by inserting ‘‘subject to
2
subsection (f)(2),’’ before ‘‘the State’’; and
3
(B) in subparagraph (B)(ii), by inserting
4
‘‘subject to subsection (f)(2),’’ before ‘‘pending
5
such verification’’.
6
(d) UPDATING ALLOWABLE HOME EQUITY LIMITS
7
IN MEDICAID.—
8
(1) IN GENERAL.—Section 1917(f)(1) of the
9
Social Security Act (42 U.S.C. 1396p(f)(1)) is
10
amended—
11
(A) in subparagraph (A), by striking ‘‘sub-
12
paragraphs (B) and (C)’’ and inserting ‘‘sub-
13
paragraph (B)’’;
14
(B) by striking subparagraph (B);
15
(C) by redesignating subparagraph (C) as
16
subparagraph (B); and
17
(D) in subparagraph (B), as so redesig-
18
nated, by striking ‘‘dollar amounts specified in
19
this paragraph’’ and inserting ‘‘dollar amount
20
specified in subparagraph (A)’’.
21
(2) EFFECTIVE DATE.—
22
(A) IN GENERAL.—The amendments made
23
by paragraph (1) shall apply with respect to eli-
24
gibility determinations made after the date that
25
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is 180 days after the date of the enactment of
1
this section.
2
(B) EXCEPTION FOR STATE LEGISLA-
3
TION.—In the case of a State plan under title
4
XIX of the Social Security Act that the Sec-
5
retary of Health and Human Services deter-
6
mines requires State legislation in order for the
7
respective plan to meet any requirement im-
8
posed by amendments made by this subsection,
9
the respective plan shall not be regarded as fail-
10
ing to comply with the requirements of such
11
title solely on the basis of its failure to meet
12
such an additional requirement before the first
13
day of the first calendar quarter beginning after
14
the close of the first regular session of the
15
State legislature that begins after the date of
16
the enactment of this Act. For purposes of the
17
previous sentence, in the case of a State that
18
has a 2-year legislative session, each year of the
19
session shall be considered to be a separate reg-
20
ular session of the State legislature.
21
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SEC. 115. SAFETY NET FUNDING FOR NON-EXPANSION
1
STATES.
2
Title XIX of the Social Security Act is amended by
3
inserting after section 1923 (42 U.S.C. 1396r–4) the fol-
4
lowing new section:
5
‘‘ADJUSTMENT IN PAYMENT FOR SERVICES OF SAFETY
6
NET PROVIDERS IN NON-EXPANSION STATES
7
‘‘SEC. 1923A. (a) IN GENERAL.—Subject to the limi-
8
tations of this section, for each year during the period be-
9
ginning with 2018 and ending with 2021, each State that
10
is one of the 50 States or the District of Columbia and
11
that, as of July 1 of the preceding year, did not provide
12
for eligibility under clause (i)(VIII) or (ii)(XX) of section
13
1902(a)(10)(A) for medical assistance under this title (or
14
a waiver of the State plan approved under section 1115)
15
(each such State or District referred to in this section for
16
the year as a ‘non-expansion State’) may adjust the pay-
17
ment amounts otherwise provided under the State plan
18
under this title (or a waiver of such plan) to health care
19
providers that provide health care services to individuals
20
enrolled under this title (in this section referred to as ‘eli-
21
gible providers’).
22
‘‘(b) INCREASE IN APPLICABLE FMAP.—Notwith-
23
standing section 1905(b), the Federal medical assistance
24
percentage applicable with respect to expenditures attrib-
25
utable to a payment adjustment under subsection (a) for
26
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which payment is permitted under subsection (c) shall be
1
equal to—
2
‘‘(1) 100 percent for calendar quarters in cal-
3
endar years 2018, 2019, 2020, and 2021; and
4
‘‘(2) 95 percent for calendar quarters in cal-
5
endar year 2022.
6
‘‘(c) LIMITATIONS; DISQUALIFICATION OF STATES.—
7
‘‘(1) ANNUAL ALLOTMENT LIMITATION.—Pay-
8
ment under section 1903(a) shall not be made to a
9
State with respect to any payment adjustment made
10
under this section for all calendar quarters in a year
11
in excess of the $2,000,000,000 multiplied by the
12
ratio of—
13
‘‘(A) the population of the State with in-
14
come below 138 percent of the poverty line in
15
2015 (as determined based the table entitled
16
‘Health Insurance Coverage Status and Type
17
by Ratio of Income to Poverty Level in the Past
18
12 Months by Age’ for the universe of the civil-
19
ian noninstitutionalized population for whom
20
poverty status is determined based on the 2015
21
American Community Survey 1-Year Estimates,
22
as published by the Bureau of the Census), to
23
‘‘(B) the sum of the populations under
24
subparagraph (A) for all non-expansion States.
25
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‘‘(2) LIMITATION ON PAYMENT ADJUSTMENT
1
AMOUNT FOR INDIVIDUAL PROVIDERS.—The amount
2
of a payment adjustment under subsection (a) for an
3
eligible provider may not exceed the provider’s costs
4
incurred in furnishing health care services (as deter-
5
mined by the Secretary and net of payments under
6
this title, other than under this section, and by unin-
7
sured patients) to individuals who either are eligible
8
for medical assistance under the State plan (or
9
under a waiver of such plan) or have no health in-
10
surance or health plan coverage for such services.
11
‘‘(d) DISQUALIFICATION IN CASE OF STATE COV-
12
ERAGE EXPANSION.—If a State is a non-expansion for a
13
year and provides eligibility for medical assistance de-
14
scribed in subsection (a) during the year, the State shall
15
no longer be treated as a non-expansion State under this
16
section for any subsequent years.’’.
17
SEC. 116. PROVIDING INCENTIVES FOR INCREASED FRE-
18
QUENCY OF ELIGIBILITY REDETERMINA-
19
TIONS.
20
(a) IN GENERAL.—Section 1902(e)(14) of the Social
21
Security Act (42 U.S.C. 1396a(e)(14)) (relating to modi-
22
fied adjusted gross income), as amended by section
23
114(a)(1), is further amended by adding at the end the
24
following:
25
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‘‘(K) FREQUENCY OF ELIGIBILITY REDE-
1
TERMINATIONS.—Beginning on October 1,
2
2017, and notwithstanding subparagraph (H),
3
in the case of an individual whose eligibility for
4
medical assistance under the State plan under
5
this title (or a waiver of such plan) is deter-
6
mined based on the application of modified ad-
7
justed gross income under subparagraph (A)
8
and who is so eligible on the basis of clause
9
(i)(VIII) or clause (ii)(XX) of subsection
10
(a)(10)(A), a State shall redetermine such indi-
11
vidual’s eligibility for such medical assistance
12
no less frequently than once every 6 months.’’.
13
(b) CIVIL MONETARY PENALTY.—Section 1128A(a)
14
of the Social Security Act (42 U.S.C. 1320a–7(a)) is
15
amended, in the matter following paragraph (10), by strik-
16
ing ‘‘(or, in cases under paragraph (3)’’ and inserting the
17
following: ‘‘(or, in cases under paragraph (1) in which an
18
individual was knowingly enrolled on or after October 1,
19
2017, pursuant to section 1902(a)(10)(A)(i)(VIII) for
20
medical assistance under the State plan under title XIX
21
whose income does not meet the income threshold specified
22
in such section or in which a claim was presented on or
23
after October 1, 2017, as a claim for an item or service
24
furnished to an individual described in such section but
25
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whose enrollment under such State plan is not made on
1
the basis of such individual’s meeting the income threshold
2
specified in such section, $20,000 for each such individual
3
or claim; in cases under paragraph (3)’’.
4
(c) INCREASED ADMINISTRATIVE MATCHING PER-
5
CENTAGE.—For each calendar quarter during the period
6
beginning on October 1, 2017, and ending on December
7
31, 2019, the Federal matching percentage otherwise ap-
8
plicable under section 1903(a) of the Social Security Act
9
(42 U.S.C. 1396b(a)) with respect to State expenditures
10
during such quarter that are attributable to meeting the
11
requirement of section 1902(e)(14) (relating to determina-
12
tions of eligibility using modified adjusted gross income)
13
of such Act shall be increased by 5 percentage points with
14
respect to State expenditures attributable to activities car-
15
ried out by the State (and approved by the Secretary) to
16
increase the frequency of eligibility redeterminations re-
17
quired by subparagraph (K) of such section (relating to
18
eligibility redeterminations made on a 6-month basis) (as
19
added by subsection (a)).
20
Subtitle C—Per Capita Allotment
21
for Medical Assistance
22
SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL ASSIST-
23
ANCE.
24
Title XIX of the Social Security Act is amended—
25
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(1) in section 1903 (42 U.S.C. 1396b)—
1
(A) in subsection (a), in the matter before
2
paragraph (1), by
inserting
‘‘and section
3
1903A(a)’’ after ‘‘except as otherwise provided
4
in this section’’; and
5
(B) in subsection (d)(1), by striking ‘‘to
6
which’’ and inserting ‘‘to which, subject to sec-
7
tion 1903A(a),’’; and
8
(2) by inserting after such section 1903 the fol-
9
lowing new section:
10
‘‘SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR
11
MEDICAL ASSISTANCE.
12
‘‘(a) APPLICATION OF PER CAPITA CAP ON PAY-
13
MENTS FOR MEDICAL ASSISTANCE EXPENDITURES.—
14
‘‘(1) IN GENERAL.—If a State has excess ag-
15
gregate medical assistance expenditures (as defined
16
in paragraph (2)) for a fiscal year (beginning with
17
fiscal year 2020), the amount of payment to the
18
State under section 1903(a)(1) for each quarter in
19
the following fiscal year shall be reduced by 1⁄4 of
20
the excess aggregate medical assistance payments
21
(as defined in paragraph (3)) for that previous fiscal
22
year. In this section, the term ‘State’ means only the
23
50 States and the District of Columbia.
24
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‘‘(2) EXCESS AGGREGATE MEDICAL ASSISTANCE
1
EXPENDITURES.—In this subsection, the term ‘ex-
2
cess aggregate medical assistance expenditures’
3
means, for a State for a fiscal year, the amount (if
4
any) by which—
5
‘‘(A) the amount of the adjusted total med-
6
ical assistance expenditures (as defined in sub-
7
section (b)(1)) for the State and fiscal year; ex-
8
ceeds
9
‘‘(B) the amount of the target total med-
10
ical assistance expenditures (as defined in sub-
11
section (c)) for the State and fiscal year.
12
‘‘(3) EXCESS AGGREGATE MEDICAL ASSISTANCE
13
PAYMENTS.—In this subsection, the term ‘excess ag-
14
gregate medical assistance payments’ means, for a
15
State for a fiscal year, the product of—
16
‘‘(A) the excess aggregate medical assist-
17
ance expenditures (as defined in paragraph (2))
18
for the State for the fiscal year; and
19
‘‘(B) the Federal average medical assist-
20
ance matching percentage (as defined in para-
21
graph (4)) for the State for the fiscal year.
22
‘‘(4) FEDERAL AVERAGE MEDICAL ASSISTANCE
23
MATCHING PERCENTAGE.—In this subsection, the
24
term ‘Federal average medical assistance matching
25
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percentage’ means, for a State for a fiscal year, the
1
ratio (expressed as a percentage) of—
2
‘‘(A) the amount of the Federal payments
3
that would be made to the State under section
4
1903(a)(1) for medical assistance expenditures
5
for calendar quarters in the fiscal year if para-
6
graph (1) did not apply; to
7
‘‘(B) the amount of the medical assistance
8
expenditures for the State and fiscal year.
9
‘‘(b) ADJUSTED TOTAL MEDICAL ASSISTANCE EX-
10
PENDITURES.—Subject to subsection (g), the following
11
shall apply:
12
‘‘(1) IN GENERAL.—In this section, the term
13
‘adjusted total medical assistance expenditures’
14
means, for a State—
15
‘‘(A) for fiscal year 2016, the product of—
16
‘‘(i) the amount of the medical assist-
17
ance expenditures (as defined in paragraph
18
(2)) for the State and fiscal year, reduced
19
by the amount of any excluded expendi-
20
tures (as defined in paragraph (3)) for the
21
State and fiscal year otherwise included in
22
such medical assistance expenditures; and
23
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‘‘(ii) the 1903A FY16 population per-
1
centage (as defined in paragraph (4)) for
2
the State; or
3
‘‘(B) for fiscal year 2019 or a subsequent
4
fiscal year, the amount of the medical assist-
5
ance expenditures (as defined in paragraph (2))
6
for the State and fiscal year that is attributable
7
to 1903A enrollees, reduced by the amount of
8
any excluded expenditures (as defined in para-
9
graph (3)) for the State and fiscal year other-
10
wise included in such medical assistance ex-
11
penditures.
12
‘‘(2) MEDICAL ASSISTANCE EXPENDITURES.—
13
In this section, the term ‘medical assistance expendi-
14
tures’ means, for a State and fiscal year, the med-
15
ical assistance payments as reported by medical
16
service category on the Form CMS-64 quarterly ex-
17
pense report (or successor to such a report form,
18
and including enrollment data and subsequent ad-
19
justments to any such report, in this section referred
20
to collectively as a ‘CMS-64 report’) that directly re-
21
sult from providing medical assistance under the
22
State plan (including under a waiver of the plan) for
23
which payment is (or may otherwise be) made pur-
24
suant to section 1903(a)(1).
25
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‘‘(3) EXCLUDED EXPENDITURES.—In this sec-
1
tion, the term ‘excluded expenditures’ means, for a
2
State and fiscal year, expenditures under the State
3
plan (or under a waiver of such plan) that are at-
4
tributable to any of the following:
5
‘‘(A) DSH.—Payment adjustments made
6
for disproportionate share hospitals under sec-
7
tion 1923.
8
‘‘(B) MEDICARE
COST-SHARING.—Pay-
9
ments made for medicare cost-sharing (as de-
10
fined in section 1905(p)(3)).
11
‘‘(C) SAFETY NET PROVIDER PAYMENT AD-
12
JUSTMENTS IN NON-EXPANSION STATES.—Pay-
13
ment adjustments under subsection (a) of sec-
14
tion 1923A for which payment is permitted
15
under subsection (c) of such section.
16
‘‘(4) 1903A FY 16 POPULATION PERCENTAGE.—
17
In this subsection, the term ‘1903A FY16 popu-
18
lation percentage’ means, for a State, the Sec-
19
retary’s calculation of the percentage of the actual
20
medical assistance expenditures, as reported by the
21
State on the CMS–64 reports for calendar quarters
22
in fiscal year 2016, that are attributable to 1903A
23
enrollees (as defined in subsection (e)(1)).
24
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‘‘(c) TARGET TOTAL MEDICAL ASSISTANCE EXPEND-
1
ITURES.—
2
‘‘(1) CALCULATION.—In this section, the term
3
‘target total medical assistance expenditures’ means,
4
for a State for a fiscal year, the sum of the prod-
5
ucts, for each of the 1903A enrollee categories (as
6
defined in subsection (e)(2)), of—
7
‘‘(A) the target per capita medical assist-
8
ance expenditures (as defined in paragraph (2))
9
for the enrollee category, State, and fiscal year;
10
and
11
‘‘(B) the number of 1903A enrollees for
12
such enrollee category, State, and fiscal year, as
13
determined under subsection (e)(4).
14
‘‘(2) TARGET PER CAPITA MEDICAL ASSISTANCE
15
EXPENDITURES.—In this subsection, the term ‘tar-
16
get per capita medical assistance expenditures’
17
means, for a 1903A enrollee category, State, and a
18
fiscal year, an amount equal to—
19
‘‘(A) the provisional FY19 target per cap-
20
ita amount for such enrollee category (as cal-
21
culated under subsection (d)(5)) for the State;
22
increased by
23
‘‘(B) the percentage increase in the med-
24
ical care component of the consumer price index
25
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for all urban consumers (U.S. city average)
1
from September of 2019 to September of the
2
fiscal year involved.
3
‘‘(d) CALCULATION OF FY19 PROVISIONAL TARGET
4
AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.—Sub-
5
ject to subsection (g), the following shall apply:
6
‘‘(1) CALCULATION OF BASE AMOUNTS FOR FIS-
7
CAL YEAR 2016.—For each State the Secretary shall
8
calculate (and provide notice to the State not later
9
than April 1, 2018, of) the following:
10
‘‘(A) The amount of the adjusted total
11
medical assistance expenditures (as defined in
12
subsection (b)(1)) for the State for fiscal year
13
2016.
14
‘‘(B) The number of 1903A enrollees for
15
the State in fiscal year 2016 (as determined
16
under subsection (e)(4)).
17
‘‘(C) The average per capita medical as-
18
sistance expenditures for the State for fiscal
19
year 2016 equal to—
20
‘‘(i) the amount calculated under sub-
21
paragraph (A); divided by
22
‘‘(ii) the number calculated under sub-
23
paragraph (B).
24
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‘‘(2) FISCAL YEAR 2019 AVERAGE PER CAPITA
1
AMOUNT BASED ON INFLATING THE FISCAL YEAR
2
2016 AMOUNT TO FISCAL YEAR 2019 BY CPI-MED-
3
ICAL.—The Secretary shall calculate a fiscal year
4
2019 average per capita amount for each State
5
equal to—
6
‘‘(A) the average per capita medical assist-
7
ance expenditures for the State for fiscal year
8
2016 (calculated under paragraph (1)(C)); in-
9
creased by
10
‘‘(B) the percentage increase in the med-
11
ical care component of the consumer price index
12
for all urban consumers (U.S. city average)
13
from September, 2016 to September, 2019.
14
‘‘(3) AGGREGATE AND AVERAGE EXPENDI-
15
TURES PER CAPITA FOR FISCAL YEAR 2019.—The
16
Secretary shall calculate for each State the fol-
17
lowing:
18
‘‘(A) The amount of the adjusted total
19
medical assistance expenditures (as defined in
20
subsection (b)(1)) for the State for fiscal year
21
2019.
22
‘‘(B) The number of 1903A enrollees for
23
the State in fiscal year 2019 (as determined
24
under subsection (e)(4)).
25
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‘‘(4) PER CAPITA EXPENDITURES FOR FISCAL
1
YEAR 2019 FOR EACH 1903A ENROLLEE CATEGORY.—
2
The Secretary shall calculate (and provide notice to
3
each State not later than January 1, 2020, of) the
4
following:
5
‘‘(A)(i) For each 1903A enrollee category,
6
the amount of the adjusted total medical assist-
7
ance expenditures (as defined in subsection
8
(b)(1)) for the State for fiscal year 2019 for in-
9
dividuals in the enrollee category, calculated by
10
excluding from medical assistance expenditures
11
those expenditures attributable to expenditures
12
described in clause (iii) or non-DSH supple-
13
mental expenditures (as defined in clause (ii)).
14
‘‘(ii) In this paragraph, the term ‘non-
15
DSH supplemental expenditure’ means a pay-
16
ment to a provider under the State plan (or
17
under a waiver of the plan) that—
18
‘‘(I) is not made under section 1923;
19
‘‘(II) is not made with respect to a
20
specific item or service for an individual;
21
‘‘(III) is in addition to any payments
22
made to the provider under the plan (or
23
waiver) for any such item or service; and
24
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‘‘(IV) complies with the limits for ad-
1
ditional payments to providers under the
2
plan (or waiver) imposed pursuant to sec-
3
tion 1902(a)(30)(A), including the regula-
4
tions specifying upper payment
limits
5
under the State plan in part 447 of title
6
42, Code of Federal Regulations (or any
7
successor regulations).
8
‘‘(iii) An expenditure described in this
9
clause is an expenditure that meets the criteria
10
specified in subclauses (I), (II), and (III) of
11
clause (ii) and is authorized under section 1115
12
for the purposes of funding a delivery system
13
reform pool, uncompensated care pool, a des-
14
ignated state health program, or any other
15
similar expenditure (as defined by the Sec-
16
retary).
17
‘‘(B) For each 1903A enrollee category,
18
the number of 1903A enrollees for the State in
19
fiscal year 2019 in the enrollee category (as de-
20
termined under subsection (e)(4)).
21
‘‘(C) For fiscal year 2016, the State’s non-
22
DSH supplemental payment percentage is equal
23
to the ratio (expressed as a percentage) of—
24
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‘‘(i) the total amount of non-DSH
1
supplemental expenditures (as defined in
2
subparagraph (A)(ii)) for the State for fis-
3
cal year 2016; to
4
‘‘(ii) the amount described in sub-
5
section (b)(1)(A) for the State for fiscal
6
year 2016.
7
‘‘(D) For each 1903A enrollee category an
8
average medical assistance expenditures per
9
capita for the State for fiscal year 2019 for the
10
enrollee category equal to—
11
‘‘(i) the amount calculated under sub-
12
paragraph (A) for the State, increased by
13
the non-DSH supplemental payment per-
14
centage for the State (as calculated under
15
subparagraph (C)); divided by
16
‘‘(ii) the number calculated under sub-
17
paragraph (B) for the State for the en-
18
rollee category.
19
‘‘(5) PROVISIONAL FY19 PER CAPITA TARGET
20
AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.—
21
Subject to subsection (f)(2), the Secretary shall cal-
22
culate for each State a provisional FY19 per capita
23
target amount for each 1903A enrollee category
24
equal to the average medical assistance expenditures
25
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per capita for the State for fiscal year 2019 (as cal-
1
culated under paragraph (4)(D)) for such enrollee
2
category multiplied by the ratio of—
3
‘‘(A) the product of—
4
‘‘(i) the fiscal year 2019 average per
5
capita amount for the State, as calculated
6
under paragraph (2); and
7
‘‘(ii) the number of 1903A enrollees
8
for the State in fiscal year 2019, as cal-
9
culated under paragraph (3)(B); to
10
‘‘(B) the amount of the adjusted total
11
medical assistance expenditures for the State
12
for fiscal year 2019, as calculated under para-
13
graph (3)(A).
14
‘‘(e) 1903A ENROLLEE; 1903A ENROLLEE CAT-
15
EGORY.—Subject to subsection (g), for purposes of this
16
section, the following shall apply:
17
‘‘(1) 1903A ENROLLEE.—The term ‘1903A en-
18
rollee’ means, with respect to a State and a month,
19
any Medicaid enrollee (as defined in paragraph (3))
20
for the month, other than such an enrollee who for
21
such month is in any of the following categories of
22
excluded individuals:
23
‘‘(A) CHIP.—An individual who is pro-
24
vided, under this title in the manner described
25
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in section 2101(a)(2), child health assistance
1
under title XXI.
2
‘‘(B) IHS.—An individual who receives
3
any medical assistance under this title for serv-
4
ices for which payment is made under the third
5
sentence of section 1905(b).
6
‘‘(C) BREAST AND CERVICAL CANCER
7
SERVICES ELIGIBLE
INDIVIDUAL.—An indi-
8
vidual who is entitled to medical assistance
9
under this title only pursuant to section
10
1902(a)(10)(A)(ii)(XVIII).
11
‘‘(D) PARTIAL-BENEFIT ENROLLEES.—An
12
individual who—
13
‘‘(i) is an alien who is entitled to med-
14
ical assistance under this title only pursu-
15
ant to section 1903(v)(2);
16
‘‘(ii) is entitled to medical assistance
17
under this title only pursuant to subclause
18
(XII)
or
(XXI)
of
section
19
1902(a)(10)(A)(ii) (or pursuant to a waiv-
20
er that provides only comparable benefits);
21
‘‘(iii) is a dual eligible individual (as
22
defined in section 1915(h)(2)(B)) and is
23
entitled to medical assistance under this
24
title (or under a waiver) only for some or
25
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all of medicare cost-sharing (as defined in
1
section 1905(p)(3)); or
2
‘‘(iv) is entitled to medical assistance
3
under this title and for whom the State is
4
providing a payment or subsidy to an em-
5
ployer for coverage of the individual under
6
a group health plan pursuant to section
7
1906 or section 1906A (or pursuant to a
8
waiver that provides only comparable bene-
9
fits).
10
‘‘(2) 1903A ENROLLEE CATEGORY.—The term
11
‘1903A enrollee category’ means each of the fol-
12
lowing:
13
‘‘(A) ELDERLY.—A category of 1903A en-
14
rollees who are 65 years of age or older.
15
‘‘(B) BLIND AND DISABLED.—A category
16
of 1903A enrollees (not described in the pre-
17
vious subparagraph) who are eligible for med-
18
ical assistance under this title on the basis of
19
being blind or disabled.
20
‘‘(C) CHILDREN.—A category of 1903A
21
enrollees (not described in a previous subpara-
22
graph) who are children under 19 years of age.
23
‘‘(D) EXPANSION ENROLLEES.—A cat-
24
egory of 1903A enrollees (not described in a
25
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previous subparagraph) for whom the amounts
1
expended for medical assistance are subject to
2
an increase or change in the Federal medical
3
assistance percentage under subsection (y) or
4
(z)(2), respectively, of section 1905.
5
‘‘(E) OTHER NONELDERLY, NONDISABLED,
6
NON-EXPANSION
ADULTS.—A
category
of
7
1903A enrollees who are not described in any
8
previous subparagraph.
9
‘‘(3) MEDICAID ENROLLEE.—The term ‘Med-
10
icaid enrollee’ means, with respect to a State for a
11
month, an individual who is eligible for medical as-
12
sistance for items or services under this title and en-
13
rolled under the State plan (or a waiver of such
14
plan) under this title for the month.
15
‘‘(4) DETERMINATION OF NUMBER OF 1903A
16
ENROLLEES.—The number of 1903A enrollees for a
17
State and fiscal year, and, if applicable, for a 1903A
18
enrollee category, is the average monthly number of
19
Medicaid enrollees for such State and fiscal year
20
(and, if applicable, in such category) that are re-
21
ported through the CMS–64 report under (and sub-
22
ject to audit under) subsection (h).
23
‘‘(f) SPECIAL PAYMENT RULES.—
24
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‘‘(1) APPLICATION IN CASE OF RESEARCH AND
1
DEMONSTRATION PROJECTS AND OTHER WAIVERS.—
2
In the case of a State with a waiver of the State
3
plan approved under section 1115, section 1915, or
4
another provision of this title, this section shall
5
apply to medical assistance expenditures and medical
6
assistance payments under the waiver, in the same
7
manner as if such expenditures and payments had
8
been made under a State plan under this title and
9
the limitations on expenditures under this section
10
shall supersede any other payment limitations or
11
provisions (including limitations based on a per cap-
12
ita limitation) otherwise applicable under such a
13
waiver.
14
‘‘(2) TREATMENT OF STATES EXPANDING COV-
15
ERAGE AFTER FISCAL YEAR 2016.—In the case of a
16
State that did not provide for medical assistance for
17
the 1903A enrollee category described in subsection
18
(e)(2)(D) during fiscal year 2016 but which provides
19
for such assistance for such category in a subse-
20
quent year, the provisional FY19 per capita target
21
amount for such enrollee category under subsection
22
(d)(5) shall be equal to the provisional FY19 per
23
capita target amount for the 1903A enrollee cat-
24
egory described in subsection (e)(2)(E).
25
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‘‘(3) IN CASE OF STATE FAILURE TO REPORT
1
NECESSARY DATA.—If a State for any quarter in a
2
fiscal year (beginning with fiscal year 2019) fails to
3
satisfactorily submit data on expenditures and en-
4
rollees in accordance with subsection (h)(1), for such
5
fiscal year and any succeeding fiscal year for which
6
such data are not satisfactorily submitted—
7
‘‘(A) the Secretary shall calculate and
8
apply subsections (a) through (e) with respect
9
to the State as if all 1903A enrollee categories
10
for which such expenditure and enrollee data
11
were not satisfactorily submitted were a single
12
1903A enrollee category; and
13
‘‘(B) the growth factor otherwise applied
14
under subsection (c)(2)(B) shall be decreased
15
by 1 percentage point.
16
‘‘(g) RECALCULATION OF CERTAIN AMOUNTS FOR
17
DATA ERRORS.—The amounts and percentage calculated
18
under paragraphs (1) and (4)(C) of subsection (d) for a
19
State for fiscal year 2016, and the amounts of the ad-
20
justed total medical assistance expenditures calculated
21
under subsection (b) and the number of Medicaid enrollees
22
and 1903A enrollees determined under subsection (e)(4)
23
for a State for fiscal year 2016, fiscal year 2019, and any
24
subsequent fiscal year, may be adjusted by the Secretary
25
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based upon an appeal (filed by the State in such a form,
1
manner, and time, and containing such information relat-
2
ing to data errors that support such appeal, as the Sec-
3
retary specifies) that the Secretary determines to be valid,
4
except that any adjustment by the Secretary under this
5
subsection for a State may not result in an increase of
6
the target total medical assistance expenditures exceeding
7
2 percent.
8
‘‘(h) REQUIRED REPORTING AND AUDITING OF
9
CMS–64 DATA; TRANSITIONAL INCREASE IN FEDERAL
10
MATCHING PERCENTAGE FOR CERTAIN ADMINISTRATIVE
11
EXPENSES.—
12
‘‘(1) REPORTING.—In addition to the data re-
13
quired on form Group VIII on the CMS–64 report
14
form as of January 1, 2017, in each CMS-64 report
15
required to be submitted (for each quarter beginning
16
on or after October 1, 2018), the State shall include
17
data on medical assistance expenditures within such
18
categories of services and categories of enrollees (in-
19
cluding each 1903A enrollee category and each cat-
20
egory of excluded individuals under subsection
21
(e)(1)) and the numbers of enrollees within each of
22
such enrollee categories, as the Secretary determines
23
are necessary (including timely guidance published
24
as soon as possible after the date of the enactment
25
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of this section) in order to implement this section
1
and to enable States to comply with the requirement
2
of this paragraph on a timely basis.
3
‘‘(2) AUDITING.—The Secretary shall conduct
4
for each State an audit of the number of individuals
5
and expenditures reported through the CMS–64 re-
6
port for fiscal year 2016, fiscal year 2019, and each
7
subsequent fiscal year, which audit may be con-
8
ducted on a representative sample (as determined by
9
the Secretary).
10
‘‘(3) TEMPORARY
INCREASE
IN FEDERAL
11
MATCHING PERCENTAGE TO SUPPORT IMPROVED
12
DATA REPORTING SYSTEMS FOR FISCAL YEARS 2018
13
AND 2019.—For amounts expended during calendar
14
quarters beginning on or after October 1, 2017, and
15
before October 1, 2019—
16
‘‘(A) the Federal matching percentage ap-
17
plied under section 1903(a)(3)(A)(i) shall be in-
18
creased by 10 percentage points to 100 percent;
19
‘‘(B) the Federal matching percentage ap-
20
plied under section 1903(a)(3)(B) shall be in-
21
creased by 25 percentage points to 100 percent;
22
and
23
‘‘(C) the Federal matching percentage ap-
24
plied under section 1903(a)(7) shall be in-
25
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creased by 10 percentage points to 60 percent
1
but only with respect to amounts expended that
2
are attributable to a State’s additional adminis-
3
trative expenditures to implement the data re-
4
quirements of paragraph (1).’’.
5
Subtitle D—Patient Relief and
6
Health Insurance Market Stability
7
SEC. 131. REPEAL OF COST-SHARING SUBSIDY.
8
(a) IN GENERAL.—Section 1402 of the Patient Pro-
9
tection and Affordable Care Act is repealed.
10
(b) EFFECTIVE DATE.—The repeal made by sub-
11
section (a) shall apply to cost-sharing reductions (and pay-
12
ments to issuers for such reductions) for plan years begin-
13
ning after December 31, 2019.
14
SEC. 132. PATIENT AND STATE STABILITY FUND.
15
The Social Security Act (42 U.S.C. 301 et seq.) is
16
amended by adding at the end the following new title:
17
‘‘TITLE XXII—PATIENT AND
18
STATE STABILITY FUND
19
‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM.
20
‘‘There is hereby established the ‘Patient and State
21
Stability Fund’ to be administered by the Secretary of
22
Health and Human Services, acting through the Adminis-
23
trator of the Centers for Medicare & Medicaid Services
24
(in this section referred to as the ‘Administrator’), to pro-
25
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vide funding, in accordance with this title, to the 50 States
1
and the District of Columbia (each referred to in this sec-
2
tion as a ‘State’) during the period, subject to section
3
2204(c), beginning on January 1, 2018, and ending on
4
December 31, 2026, for the purposes described in section
5
2202.
6
‘‘SEC. 2202. USE OF FUNDS.
7
‘‘A State may use the funds allocated to the State
8
under this title for any of the following purposes:
9
‘‘(1) Helping, through the provision of financial
10
assistance, high-risk individuals who do not have ac-
11
cess to health insurance coverage offered through an
12
employer enroll in health insurance coverage in the
13
individual market in the State, as such market is de-
14
fined by the State (whether through the establish-
15
ment of a new mechanism or maintenance of an ex-
16
isting mechanism for such purpose).
17
‘‘(2) Providing incentives to appropriate entities
18
to enter into arrangements with the State to help
19
stabilize premiums for health insurance coverage in
20
the individual market, as such markets are defined
21
by the State.
22
‘‘(3) Reducing the cost for providing health in-
23
surance coverage in the individual market and small
24
group market, as such markets are defined by the
25
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State, to individuals who have, or are projected to