,,ii #aaeth ,,congress #ast ,session ,s4 #bjja ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,october #bd1 #bjag ,mr4 ,schatz 7for himself1 ,mr4 ,booker1 ,ms4 ,harris1 ,mr4 ,heinrich1 ,mr4 ,sanders1 ,ms4 ,cortez ,masto1 ,mr4 ,whitehouse1 ,mrs4 ,gillibrand1 ,ms4 ,klobuchar1 ,mr4 ,franken1 ,mr4 ,markey1 ,ms4 ,warren1 ,mr4 ,leahy1 ,mr4 ,merkley1 ,mr4 ,reed1 ,ms4 ,baldwin1 ,ms4 ,hirono1 ,mr4 ,murphy1 and ,mr4 ,udall7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to establish a ,state public option through ,medicaid to provide ,americans with the choice of a high-quality1 low-cost health insurance plan4 #a4 ,short title ,this ,act may be cited as the ,state ,public ,option ,act4 #b4 ,medicaid buy-in option 7a7 ,in general ,section #aijb of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7 is amended-- 7#a7 in subsection 7a77#aj7-- 7,a7 in subparagraph 7,a77ii7-- 7i7 in subclause 7,,xxi71 by striking 2 or and inserting a semicolon2 7ii7 in subclause 7,,xxii71 by adding or at the end2 and 7iii7 by adding at the end the following new subclause3 7,,xxiii7 beginning ,january #a1 #bjah1 who are residents of the ,state and are not concurrently enrolled in another health insurance coverage plan1 subject1 in the case of individuals described in subsection 7nn7 and notwithstanding section #aiaf 7except for subsection 7k7 of such section71 to payment of premiums or other cost-sharing charges2 2 and 7,b7 in the matter following subparagraph 7,g71 in clause 7,,xv71 by inserting or subsection 7nn7 after described in subparagraph 7,a77i77,,viii72 and 7#b7 by adding at the end the following new subsection3 7nn7 ,previously undescribed individuals ,individuals described in this subsection are individuals who are-- 7#a7 described in subclause 7,,xxiii7 of subsection 7a77#aj77;,a77ii72 and 7#b7 are not described in any other subclause of such subsection or any other provision in this ,act which provides for eligibility for medical assistance4 4 7b7 ,provision of at least minimum coverage 7#a7 ,in general ,section #aijb7k77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7k77#a77 is amended by inserting or an individual described in subsection 7nn7 after an individual described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 each place it appears4 7#b7 ,conforming amendment ,section #aijc7;i77#bf7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7i77#bf77 is amended by striking individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 and inserting individuals described in subsection 7a77#aj77;,a77i77,,viii7 or 7nn7 of section #aijb4 7c7 ,federal financial participation in buy-,in program 7#a7 ,enhanced match for administrative expenses ,section #aijc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is amended-- 7,a7 by redesignating paragraph 7#g7 as paragraph 7#h72 and 7,b7 by inserting after paragraph 7#f7 the following new paragraph3 7#g7 an amount equal to #ij percent of the sums expended during the quarter which are attributable to reasonable administrative expenses related to the administration of a ,medicaid buy-in program for individuals described in section #aijb7;a77#aj77;,a77ii77,,xxiii72 plus 4 7#b7 ,treatment of premium and cost-sharing revenues from ,medicaid buy-in program 7,a7 ,in general ,for purposes of section #aijc7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#a771 for any fiscal quarter during which a ,state collects premiums1 cost-sharing1 or similar charges under subsection 7k7 of section #aiaf of such ,act 7#db ,u4,s4,c4 #acifo7 7as added by this ,act71 including any advance payments of premium tax credits under section #adab of the ,patient ,protection and ,affordable ,care ,act or payments for cost-sharing reductions under section #adjb of such ,act that are received by the ,state1 the total amount expended during such quarter as medical assistance for individuals who buy into ,medicaid coverage under subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii7 of the ,social ,security ,act 7as added by this ,act7 shall be reduced by the amount of such premiums or charges4 7,b7 ,treatment of excess premiums ,each ,state that collects premiums or similar charges under subsection 7k7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 7as added by this ,act7 in a fiscal year shall pay to the ,secretary of ,health and ,human ,services1 at such time and in such form and manner as the ,secretary shall specify1 an amount equal to #ej percent of the amount1 if any1 by which-- 7i7 the total amount of such premiums and charges collected by the ,state for such year2 exceeds 7ii7 the total amount expended by the ,state during such year as medical assistance for individuals who buy into ,medicaid coverage under subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii7 of such ,act 7as added by this ,act74 7d7 ,cost-,sharing requirement ,section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 is amended by adding at the end the following new subsection3 7k7 ,premiums and cost-,sharing for individuals participating in ,medicaid buy-,in program 7#a7 ,in general ,subject to paragraph 7#b71 with respect to individuals who are eligible for medical assistance under subsection 7a77#aj77;,a77ii77,,xxiii7 of section #aijb and are described in subsection 7nn7 of such section1 a ,state may-- 7,a7 impose premiums1 deductibles1 cost-sharing1 or other similar charges that are actuarially fair2 and 7,b7 vary the premium rate imposed on an individual based only on the factors described in section #bgja7;a77#a77;,a7 of the ,public ,health ,service ,act and subject to the same limitations on the weight which may be given to such factors under such section4 7#b7 ,limitations 7,a7 ,premiums ,the total amount of premiums imposed for a year under this subsection with respect to all individuals described in paragraph 7#a7 in a family shall not exceed an amount equal to #i4e percent of the family's household income 7as defined in section #cf;,b7d77#b7 of the ,internal ,revenue ,code of #aihf7 for the year involved4 7,b7 ,other cost-sharing 7i7 ,in general ,the cost-sharing limitations described in section #acjb7;c7 of the ,patient ,protection and ,affordable ,care ,act shall apply to cost-sharing 7as defined in such section7 for medical assistance provided under section #aijb7;a77#aj77;,a77ii77,,xxiii7 in the same manner as such limitations apply to cost-sharing under qualified health plans under title ,i of such ,act4 7ii7 ,availability of cost-sharing reductions ,individuals provided medical assistance under section #aijb7;a77#aj77;,a77ii77,,xxiii7 and subject to cost-sharing under this subsection are eligible for cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act 7subject to the income eligibility threshold in subsection 7b77#b7 of such section71 and in applying such section-- 7,i7 enrollment in a ,state plan under section #aijb7;a77#aj77;,a77ii77,,xxiii7 shall be treated as coverage under a qualified health plan in the silver level of coverage in the individual market offered through an ,exchange established for or by the ,state under title ,i of the ,patient ,protection and ,affordable ,care ,act2 and 7,,ii7 the ,state agency administering such plan shall be treated as the issuer of such plan4 7#c7 ,premiums and cost-sharing for certain other individuals ,if an individual is eligible for medical assistance under subsection 7a77#aj77;,a77ii77,,xxiii7 of section #aijb and is not described in subsection 7nn7 of such section1 a ,state-- 7,a7 shall not impose premiums and cost-sharing on the individual under this subsection2 and 7,b7 may impose premiums and cost-sharing on the individual to the extent allowed by another provision of this ,act 7other than section #aijb7;a77#aj77;,a77ii77,,xxiii77 which provides for eligibility for medical assistance1 but only if the individual is described in such other provision4 7#d7 ,application of premium assistance tax credits ,an individual who is required to pay premiums under this subsection for a year for medical assistance shall be eligible for a premium assistance credit under section #cf;,b of the ,internal ,revenue ,code to the same extent that such individual would be eligible for a premium assistance credit under such section if such individual had paid the same amount in premiums for coverage under a qualified health plan for such year4 4 7e7 ,managed care ,section #aicb7;a77#a77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;a77#a77;,a77i77 is amended by inserting 1 including an individual who is eligible for such assistance after buying into such coverage under section #aijb7;a77#aj77;,a77ii77,,xxiii71 after the ,state plan under this title4 7f7 ,offering buy-,in program on ,state exchange2 enrollment periods 7#a7 ,in general ,a ,state that has elected to allow individuals to buy into ,medicaid coverage under section #aijb7;a77#aj77;,a77ii77,,xxiii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77ii77,,xxiii77 shall allow individuals to enroll in such coverage through the ,federal1 ,federally-facilitated1 or ,state ,exchange established pursuant to title ,i of the ,patient ,protection and ,affordable ,care ,act4 7#b7 ,enrollment periods ,a ,state may limit the enrollment of individuals into ,medicaid coverage under section #aijb7;a77#aj77;,a77ii77,,xxiii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77ii77,,xxiii77 to the enrollment periods provided for under section #acaa7;c77#f7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #ahjca7;c77#f774 7g7 ,application of advanced premium tax credits to ,medicaid buy-,in plans 7#a7 ,in general ,section #cf;,b of the ,internal ,revenue ,code of #aihf is amended-- 7,a7 in subsection 7b77#c77;,b71 by adding at the end the following new sentence3 ,if an applicable taxpayer resides in a rating area in which no silver plan is offered on the individual market but the taxpayer buys into ,medicaid coverage under section #aijb7;a77#aj77;,a77ii77,,xxiii7 of the ,social ,security ,act1 such ,medicaid coverage shall be deemed to be the applicable second lowest cost silver plan with respect to such taxpayer4 2 and 7,b7 by adding at the end the following new subsection3 7h7 ,application to individuals purchasing ,medicaid coverage ,in the case of any individual who buys into ,medicaid coverage under section #aijb7;a77#aj77;,a77ii77,,xxiii7 of the ,social ,security ,act1 this section shall be applied with the following modifications3 7#a7 ,the amount determined under subsection 7b77#b77;,a7 shall be increased by the amount of the monthly premiums paid for such coverage4 7#b7 ,subsection 7c77#b77;,a77i7 shall be applied by treating coverage under the ,medicaid program under title ,,xix of the ,social ,security ,act in the same manner as a qualified health plan that was enrolled in through an ,exchange4 7#c7 ,in applying subsection 7c77#b77;,b7-- 7,a7 an individual shall not be considered to be eligible for minimum essential coverage described in section #ejjj;,a7f77#a77;,a77ii7 by reason of eligibility for medical assistance under a ,state ,medicaid program under section #aijb7;a77#aj77;,a77ii77,,xxiii72 and 7,b7 an individual who is not covered by minimum essential coverage described in section #ejjj;,a7f77#a77;,b7 shall not be considered to be eligible for such coverage4 4 7#b7 ,advanced payment of credit 7,a7 ,in general ,the ,secretary of ,health and ,human ,services1 in consultation with the ,secretary of the ,treasury1 shall establish a program under which-- 7i7 upon request of a ,state agency administering a ,state ,medicaid program under title ,,xix of the ,social ,security ,act1 advance determinations are made in a manner similar to advanced determination under section #adaa of the ,patient ,protection and ,affordable ,care ,act with respect to the income eligibility of individuals enrolling in such program for the premium tax credit allowable under section #cf;,b of the ,internal ,revenue ,code of #aihf and the cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act2 7ii7 the ,secretary notifies-- 7,i7 the ,state agency administering the program and the ,secretary of the ,treasury of the advance determinations2 and 7,,ii7 the ,secretary of the ,treasury of the name and employer identification number of each employer with respect to whom #a or more employee of the employer were determined to be eligible for the premium tax credit under section #cf;,b of the ,internal ,revenue ,code of #aihf and the cost-sharing reductions under section #adjb of the ,patient ,protection and ,affordable ,care ,act because-- 7aa7 the employer did not provide minimum essential coverage2 or 7bb7 the employer provided such minimum essential coverage but it was determined under section #cf;,b7c77#b77;,c7 of such ,code to either be unaffordable to the employee or not provide the required minimum actuarial value2 and 7iii7 the ,secretary of the ,treasury makes advance payments of such credit or reductions to the ,state agency administering the program in order to reduce the premiums payable by individuals eligible for such credit4 7,b7 ,determinations and payments ,rules similar to subsections 7b7 and 7c7 of section #adab of the ,patient ,protection and ,affordable ,care ,act shall apply for purposes of this subsection4 7,c7 ,coordination with credit 7i7 ,in general ,section #cf;,b of the ,internal ,revenue ,code of #aihf is amended by inserting and under section #b7;g77#b7 of the ,state ,public ,option ,act after section #adab of the ,patient ,protection and ,affordable ,care ,act each place it appears in subsections 7f77#a71 7f77#b71 and 7g77#a74 7ii7 ,information reporting ,section #cf;,b7f77#c7 of such ,code is amended by adding at the end the following flush sentence3 ,in the case of any coverage under the medicaid program under title ,,xix of the ,social ,security ,act for which a credit under this section is allowable by reason of subsection 7h71 the ,state agency administering the ,medicaid program shall be treated as an ,exchange for purposes of this paragraph and subparagraph 7,a7 shall not apply44 7#c7 ,conforming amendment relating to employer responsibility ,paragraph 7#f7 of section #dihj;,h7c7 of the ,internal ,revenue ,code of #aihf is amended by inserting 1 except that for purposes of subsections 7a77#b7 and 7b77#b71 the term qualified health plan shall include any plan described in section #cf;,b7h7 after such ,act4 7h7 ,conforming amendments 7#a7 ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj771 as amended by subsection 7a71 is further amended1 in the matter following subparagraph 7,g7-- 7,a7 by striking and 7,,xvii7 and inserting 1 7,,xvii72 and 7,b7 by inserting 1 and 7,,xviii7 the medical assistance made available to an individual described in subparagraph 7,a77ii77,,xxiii7 shall be limited to medical assistance described in subsection 7k77#a7 before the semicolon4 7#b7 ,section #aijc7;f77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7f77#d77 is amended by inserting #aijb7;a77#aj77;,a77ii77,,xxiii71 after #aijb7;a77#aj77;,a77ii77,,xxii714 7#c7 ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended in the matter preceding paragraph 7#a7-- 7,a7 by striking or at the end of clause 7xvi72 7,b7 by inserting or at the end of clause 7xvii72 and 7,c7 by inserting after clause 7xvii7 the following new clause3 7xviii7 individuals described in section #aijb7;a77#aj77;,a77ii77,,xxiii71 4 7#d7 ,section #aiaf;,a7a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;a77#a77 is amended by striking or 7j7 and inserting 7j71 or 7k74 7#e7 ,section #aicg7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#g7;a77#a77;,b77 is amended by inserting 1 subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii71 after #aijb7;a77#aj77;,a77i74 #c4 ,development of ,state-level metrics on ,medicaid beneficiary access and satisfaction 7a7 ,in general 7#a7 ,development of metrics ,not later than #a year after the date of enactment of this ,act1 the ,director of the ,agency for ,healthcare ,research and ,quality1 in consultation with the ,deputy ,administrator for the ,center for ,medicaid and ,,chip ,services and ,state ,medicaid ,directors1 shall develop standardized1 ,state-level metrics of access to1 and satisfaction with1 providers1 including primary care and specialist providers1 with respect to individuals who are enrolled in ,state ,medicaid plans under title ,,xix of the ,social ,security ,act4 7#b7 ,process ,the ,director of the ,agency for ,healthcare ,research and ,quality shall develop the metrics described in paragraph 7#a7 through a public process1 which shall provide opportunities for stakeholders to participate4 7b7 ,updating metrics ,the ,director of the ,agency for ,healthcare ,research and ,quality1 in consultation with the ,deputy ,administrator for the ,center for ,medicaid and ,,chip ,services and ,state ,medicaid ,directors1 shall update the metrics developed under subsection 7a7 not less than once every #c years4 7c7 ,state implementation funding ,the ,director of the ,agency for ,healthcare ,research and ,quality may award funds1 from the amount appropriated under subsection 7d71 to ,states for the purpose of implementing the metrics developed under this section4 7d7 ,appropriation ,there is appropriated to the ,director of the ,agency for ,healthcare ,research and ,quality out of any funds in the ,treasury not otherwise appropriated1 #bjj1jjj1jjj for fiscal year #bjai1 to remain available until expended1 for the purpose of carrying out this section4 #d4 ,renewal of application of ,medicare payment rate floor to primary care services furnished under ,medicaid and inclusion of additional providers 7a7 ,renewal of payment floor2 additional providers 7#a7 ,in general ,section #aijb7;a77#ac7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#ac77 is amended by striking subparagraph 7,c7 and inserting the following3 7,c7 payment for primary care services 7as defined in subsection 7jj77 at a rate that is not less than #ajj percent of the payment rate that applies to such services and physician under part ,b of title ,,xviii 7or1 if greater1 the payment rate that would be applicable under such part if the conversion factor under section #ahdh7;d7 for the year involved were the conversion factor under such section for #bjji71 and that is not less than the rate that would otherwise apply to such services under this title if the rate were determined without regard to this subparagraph1 and that are-- 7i7 furnished in #bjac and #bjad1 by a physician with a primary specialty designation of family medicine1 general internal medicine1 or pediatric medicine2 or 7ii7 furnished in the period that begins on the first day of the first month that begins after the date of enactment of the ,state ,public ,option ,act-- 7,i7 by a physician with a primary specialty designation of family medicine1 general internal medicine1 or pediatric medicine1 but only if the physician self-attests that the physician is ,board certified in family medicine1 general internal medicine1 or pediatric medicine2 7,,ii7 by a physician with a primary specialty designation of obstetrics and gynecology1 but only if the physician self-attests that the physician is ,board certified in obstetrics and gynecology2 7,,iii7 by an advanced practice clinician1 as defined by the ,secretary1 that works under the supervision of-- 7aa7 a physician that satisfies the criteria specified in subclause 7,i7 or 7,,ii72 or 7bb7 a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law2 7,,iv7 by a rural health clinic1 ,federally-qualified health center1 or other health clinic that receives reimbursement on a fee schedule applicable to a physician1 a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law1 for services furnished by a physician1 nurse practitioner1 physician assistant1 or certified nurse-midwife1 or services furnished by an advanced practice clinician supervised by a physician described in subclause 7,i77aa7 or 7,,ii77aa71 another advanced practice clinician1 or a certified nurse-midwife2 or 7,v7 by a nurse practitioner or a physician assistant 7as such terms are defined in section #ahfa7;aa77#e77;,a77 who is working in accordance with ,state law1 or a certified nurse-midwife 7as defined in section #ahfa7;gg77 who is working in accordance with ,state law1 in accordance with procedures that ensure that the portion of the payment for such services that the nurse practitioner1 physician assistant1 or certified nurse-midwife is paid is not less than the amount that the nurse practitioner1 physician assistant1 or certified nurse-midwife would be paid if the services were provided under part ,b of title ,,xviii2 4 7#b7 ,conforming amendments ,section #aije7;dd7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7dd77 is amended-- 7,a7 by striking ,notwithstanding and inserting the following3 7#a7 ,in general ,notwithstanding 2 7,b7 by inserting or furnished during an additional period specified in paragraph 7#b71 after #bjae12 and 7,c7 by adding at the end the following3 7#b7 ,additional periods ,for purposes of paragraph 7#a71 the following are additional periods3 7,a7 ,the period that begins on the first day of the first month that begins after the date of enactment of the ,state ,public ,option ,act4 4 7b7 ,improved targeting of primary care ,section #aijb7;jj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7jj77 is amended-- 7#a7 by redesignating paragraphs 7#a7 and 7#b7 as subparagraphs 7,a7 and 7,b71 respectively and realigning the left margins accordingly2 7#b7 by striking ,for purposes of and inserting the following3 7#a7 ,in general ,for purposes of 2 and 7#c7 by adding at the end the following3 7#b7 ,exclusions ,such term does not include any services described in subparagraph 7,a7 or 7,b7 of paragraph 7#a7 if such services are provided in an emergency department of a hospital4 4 7c7 ,ensuring payment by managed care entities 7#a7 ,in general ,section #aijc7m77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7m77#b77;,a77 is amended-- 7,a7 in clause 7xii71 by striking and after the semicolon2 7,b7 by realigning the left margin of clause 7xiii7 so as to align with the left margin of clause 7xii7 and by striking the period at the end of clause 7xiii7 and inserting 2 and2 and 7,c7 by inserting after clause 7xiii7 the following3 7xiv7 such contract provides that 7,i7 payments to providers specified in section #aijb7;a77#ac77;,c7 for primary care services defined in section #aijb7;jj7 that are furnished during a year or period specified in section #aijb7;a77#ac77;,c7 and section #aije7;dd7 are at least equal to the amounts set forth and required by the ,secretary by regulation1 7,,ii7 the entity shall1 upon request1 provide documentation to the ,state1 sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i71 and 7,,iii7 the ,secretary shall approve payments described in subclause 7,i7 that are furnished through an agreed upon capitation1 partial capitation1 or other value-based payment arrangement if the capitation1 partial capitation1 or other value-based payment arrangement is based on a reasonable methodology and the entity provides documentation to the ,state sufficient to enable the ,state and the ,secretary to ensure compliance with subclause 7,i74 4 7#b7 ,conforming amendment ,section #aicb7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#b7;f77 is amended by inserting and clause 7xiv7 of section #aijc7m77#b77;,a7 before the period4 #e4 ,medicaid access grants 7a7 ,in general ,beginning in fiscal year #bjai1 the ,secretary of ,health and ,human ,services 7referred to in this section as the ,secretary7 shall award grants to ,states that submit an application meeting the requirements of subsection 7b7 for the purpose of improving access to services for individuals enrolled in ,state ,medicaid plans under title ,,xix of the ,social ,security ,act4 7b7 ,application requirements ,to be eligible for a grant under this section1 a ,state shall submit to the ,secretary1 at such time and in such manner as the ,secretary shall require1 an application that contains the following3 7#a7 ,a description of gaps in access to providers for individuals enrolled in the ,state ,medicaid plan that the ,state has identified1 and how the ,state proposes to fix such gaps4 7#b7 ,a discussion of any changes the ,state proposes to make to the reimbursement of providers under the ,state ,medicaid plan1 including changes to the fee-for-service rates for providers of services under such plans or moving to population-based or episode-based payment models4 7#c7 ,a justification establishing that the changes proposed by the ,state will increase access to providers for individuals enrolled in the ,state ,medicaid plan1 and a plan for measuring changes to such access over the grant period4 7c7 ,use of funds 7#a7 ,in general ,if the ,secretary determines that a ,state is using grant funds awarded under this section in a manner that is inconsistent with the purpose described in subsection 7a7 or paragraph 7#b71 the ,secretary may withhold or reduce future grant payments or recover previous grant payments to the ,state under this section as the ,secretary deems appropriate4 7#b7 ,use of funds to implement ,medicaid buy-in program ,a ,state may use up to #aj percent of the amount of a grant awarded to the ,state under this section for the purpose of implementing a ,medicaid buy-in program under subclause 7,,xxiii7 of section #aijb7;a77#aj77;,a77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77ii774 7#c7 ,use of funds to increase ,medicaid provider payment rates ,notwithstanding any other provision of law1 a ,state may use grant funds awarded under this section for the purpose of financing the portion of the non-,federal share of expenditures under the ,state ,medicaid plan under title ,,xix of the ,social ,security ,act 7#db ,u4,s4,c4 #acif et seq47 that is attributable to an increase in the payment rate for providers under such plan4 7d7 ,selection of ,states and maximum grant amount ,in awarding grants to ,states under this section1 the ,secretary shall-- 7#a7 ensure that geographically diverse areas1 including rural and underserved areas1 are included2 and 7#b7 award grants both to ,states that have elected to expand ,medicaid eligibility under section #aijb7;a77#aj77;,a77i77,,viii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77,,viii77 and to ,states that have not so elected4 7e7 ,appropriation ,there is appropriated to the ,secretary1 out of any funds in the ,treasury not otherwise appropriated1 #ajj1jjj1jjj1jjj for fiscal year #bjah1 to remain available until ,september #cj1 #bjba1 for the purpose of making grants under this section4 #f4 ,increased ,,fmap for medical assistance to newly eligible individuals 7a7 ,in general ,section #aije7y77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7y77#a77 is amended-- 7#a7 in subparagraph 7,a71 by striking #bjad1 #bjae1 and #bjaf and inserting each of the first #c consecutive #ab-month periods in which the ,state provides medical assistance to newly eligible individuals2 7#b7 in subparagraph 7,b71 by striking #bjag and inserting the fourth consecutive #ab-month period in which the ,state provides medical assistance to newly eligible individuals2 7#c7 in subparagraph 7,c71 by striking #bjah and inserting the fifth consecutive #ab-month period in which the ,state provides medical assistance to newly eligible individuals2 7#d7 in subparagraph 7,d71 by striking #bjai and inserting the sixth consecutive #ab-month period in which the ,state provides medical assistance to newly eligible individuals2 and 7#e7 in subparagraph 7,e71 by striking #bjbj and each year thereafter and inserting the seventh consecutive #ab-month period in which the ,state provides medical assistance to newly eligible individuals and each such period thereafter4 7b7 ,effective date ,the amendments made by subsection 7a7 shall take effect as if included in the enactment of ,public ,law #aaa-adh4