,i #aafth ,,congress #ast ,session ,h4 ,r4 #ccga ,,in ,,the ,,house ,,of ,,representatives ,june #ai1 #bjai,ms4 ,velzquez 7for herself1 ,mr4 ,soto1 ,mr4 ,serrano1 ,mr4 ,grijalva1 ,mr4 ,espaillat1 ,ms4 ,ocasio-,cortez1 ,mr4 ,garca of ,illinois1 and ,miss ,gonzlez-,coln of ,puerto ,rico7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend titles ,,xi and ,,xix of the ,social ,security ,act to stabilize the ,medicaid program in ,puerto ,rico4 #a4 ,short title ,this ,act may be cited as the ,puerto ,rico ,health ,care ,fairness1 ,accountability1 and ,beneficiary ,access ,act of #bjai4 #b4 ,adjustments to ,,fmap and cap for ,puerto ,rico 7a7 ,adjustments to ,,fmap ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b7-- 7,a7 by striking for ,puerto ,rico1 the ,virgin ,islands and inserting for the ,virgin ,islands2 and 7,b7 by striking and ,american ,samoa shall be #ee percent1 and inserting and ,america ,samoa 7and1 for calendar quarters in a fiscal year before fiscal year #bjbj1 ,puerto ,rico7 shall be #ee percent1 and for ,puerto ,rico1 for calendar quarters in a fiscal year beginning with fiscal year #bjbj1 shall be the ,,pr specified percent under subsection 7ff7 for such fiscal year12 and 7#b7 by adding at the end the following new subsection3 7ff7 7#a7 ,for purposes of subsection 7b71 the ,,pr specified percent under this subsection is-- 7,a7 subject to paragraph 7#b71 for each of fiscal years #bjbj through #bjbd1 #hc percent2 7,b7 subject to paragraph 7#c77;,d77iii71 for each of fiscal years #bjbe through #bjbi1 #hc percent2 and 7,c7 subject to paragraph 7#c77;,d77iii71 for fiscal year #bjcj and each subsequent fiscal year1 the ,federal medical assistance percentage calculated in accordance with the first sentence of subsection 7b71 as such sentence applies to the #ej ,states4 7#b7 7,a7 ,if ,puerto ,rico-- 7i7 for fiscal year #bjba1 is in compliance with none of the program enhancement requirements described in subparagraph 7,b71 the ,,pr specified percent specified under paragraph 7#a7 for such fiscal year shall be reduced by #b percent2 7ii7 for fiscal year #bjbb1 is in compliance with fewer than two of the four program enhancement requirements described in subparagraph 7,b71 the ,,pr specified percent specified under paragraph 7#a7 for such fiscal year shall be reduced by #c percent2 7iii7 for fiscal year #bjbc1 is in compliance with fewer than three of the four program enhancement requirements described in subparagraph 7,b71 the ,,pr specified percent specified under paragraph 7#a7 for such fiscal year shall be reduced by #e percent2 and 7iv7 for fiscal year #bjbd1 is in compliance with fewer than four of the program enhancement requirements described in subparagraph 7,b71 the ,,pr specified percent specified under paragraph 7#a7 for such fiscal year shall be reduced by #e percent4 7,b7 ,for purposes of this subsection1 the program enhancement requirements described in this subparagraph are each of the following3 7i7 ,rates of payment under the ,state plan under this title for inpatient hospital services are not less than the costs incurred for such services4 7ii7 ,rates of payment under the ,state plan under this title for physicians' services are not less than #gj percent of the amount that is payable for such services under section #ahdh4 7iii7 ,the ,state plan provides for medical assistance for ,hepatitis ,c drugs1 in accordance with the requirements of section #aibg otherwise applicable to the #ej ,states4 7iv7 ,the ,state plan provides for medical assistance for ,medicare cost-sharing described in subsection 7p77#c77;,a77ii7 for qualified ,medicare beneficiaries described in subsection 7p77#a71 in accordance with the requirements under subsection 7p7 otherwise applicable to the #ej ,states4 7#c7 7,a7 7i7 ,not later than ,january #a1 #bjbb1 the ,governor of ,puerto ,rico shall submit to the ,secretary a ,territory ,transition ,plan1 which shall be developed with stakeholder input and with a public comment period1 that includes-- 7,i7 a detailed description of which program enhancements described in subparagraph 7,c7 ,puerto ,rico will include as medical assistance under the ,state plan under title ,,xix1 the first plan year by which each such program enhancement will be so included in order to satisfy the requirements described in subparagraph 7,b71 and a timeline for milestones for including such program enhancements2 and 7,,ii7 a description of any challenges1 including infrastructure challenges1 provider shortages1 and financing challenges1 for so including such program enhancements and a plan to ameliorate any such challenges4 7ii7 ,the plan submitted under clause 7i7 shall be treated as approved by the ,secretary not later than #ahj days after the date of submission of the plan unless within such #ahj-;day period the ,secretary disapproves such plan and notifies ,puerto ,rico of such disapproval with the reason for such disapproval4 ,in the case of such a disapproval1 the ,governor of ,puerto ,rico shall1 within the #ij-;day period following such notification1 submit to the ,secretary a ,territory ,transition ,plan that addresses the reason specified in such notification for such disapproval4 ,such resubmitted plan shall be treated as approved by the ,secretary under this clause unless the ,secretary notifies ,puerto ,rico within the #cj-;day period following such submission of its disapproval with a reason for such disapproval4 ,the ,governor of ,puerto ,rico may develop and submit to the ,secretary1 in the same manner and subject to the same conditions as apply under clause 7i7 to the development and submission of the ,territory ,transition ,plan1 modifications to the plan and such modifications shall be treated as approved by the ,secretary and incorporated into the plan in the same manner and subject to the same conditions that apply under this clause to the approval of the plan4 7,b7 ,for purposes of this paragraph1 the requirements described in this subparagraph1 with respect to ,puerto ,rico1 are the following3 7i7 ,for #bjbg1 the ,state plan under title ,,xix includes at least #b of the program enhancements described in subparagraph 7,c74 7ii7 ,for #bjbi1 the ,state plan includes at least #d of such program enhancements4 7iii7 ,for #bjca1 the ,state plan includes at least #f of such program enhancements4 7iv7 ,for #bjcc and each subsequent year1 the ,state plan includes all of such program enhancements4 7,c7 ,for purposes of this paragraph1 the program enhancements described in this subparagraph are the following3 7i7 ,the ,state plan provides for medical assistance to all individuals described in clause 7i7 of section #aijb7;a77#aj77;,a774 7ii7 ,the ,state plan provides for inclusion as medical assistance of home health services1 in accordance with section #aijb7;a77#aj77;,d74 7iii7 ,the ,state plan provides for inclusion as medical assistance of nonemergency transportation to medically necessary services4 7iv7 ,the ,state plan provides for inclusion as medical assistance of services described in subsection 7a77#ba7 to all individuals described in clause 7i7 of section #aijb7;a77#aj77;,a774 7v7 ,the ,state plan provides for inclusion as medical assistance of services described in subsection 7a77#ag7 to all individuals described in such clause 7other than subclause 7,,viii7 of such clause4 7vi7 ,the ,state plan provides for inclusion as medical assistance of nursing facility services1 as defined in subsection 7a77#d77;,a74 7vii7 ,the ,state plan provides for inclusion as medical assistance of early and periodic screening1 diagnosis1 and treatment services under subsection 7a77#d77;,b74 7viii7 ,the ,state plan provides for inclusion as medical assistance of freestanding birth center services and other ambulatory services1 as described in subsection 7a77#bh74 7,d7 7i7 ,for fiscal year #bjbb and each subsequent fiscal year through fiscal year #bjcc-- 7,i7 the ,comptroller ,general of the ,united ,states shall review1 and submit to the ,secretary and ,congress a report on1 whether or not ,puerto ,rico is in compliance with the timeline and achieving the milestones described in the ,territory ,transition plan 7as modified1 if applicable7 approved under subparagraph 7,a7 and1 beginning with fiscal year #bjbg1 whether ,puerto ,rico is in compliance with the applicable requirements described in subparagraph 7,b72 and 7,,ii7 ,puerto ,rico shall submit to the ,secretary a report on the extent to which ,puerto ,rico has met the timelines and milestones included in such plan 7as modified1 if applicable74 7ii7 ,if1 for a fiscal year described in clause 7i7 after fiscal year #bjbd1 the ,comptroller ,general submits a report with a finding that ,puerto ,rico is not in compliance with the timeline or with achieving milestones as described in subclause 7,i7 7or1 with respect to a fiscal year after fiscal year #bjbf1 not in compliance with the applicable requirement under subparagraph 7,b771 not later than #ij days after the date of such finding1 ,puerto ,rico shall submit to the ,secretary for approval a corrective action plan to remedy such noncompliance4 7iii7 ,if1 by not later than a period specified by the ,secretary after the date of the submission 7and approval7 of a corrective action plan under clause 7ii71 with respect to a fiscal year after fiscal year #bjbd for which a finding of non-compliance was made under clause 7i71 the ,secretary determines that ,puerto ,rico has not fulfilled the terms of such corrective action plan1 the ,,pr specified percent specified under paragraph 7#a7 for the fiscal year involved shall be reduced by #e percent for the period beginning with the month beginning after such determination and ending with the first month beginning after the ,secretary determines ,puerto ,rico has fulfilled the terms of the corrective action plan4 4 7b7 ,treatment of cap ,section #aajh7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;g77 is amended-- 7#a7 in paragraph 7#b7-- 7,a7 in the matter preceding subparagraph 7,a71 by striking subject to and section #acbc7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act paragraphs 7#c7 and 7#e7 and inserting subject to section #acbc7;a77#b7 of the ,patient ,protection and ,affordable ,care ,act and paragraphs 7#c71 7#e71 and 7#g72 and 7,b7 in subparagraph 7,a7-- 7i7 by striking ,puerto ,rico shall not exceed the sum of and inserting ,puerto ,rico shall not exceed-- 7i7 in the case of a fiscal year before fiscal year #bjbj1 the sum of 2 7ii7 by striking #ajj1jjj2 and inserting #ajj1jjj2 and2 and 7iii7 by adding at the end the following new clause3 7ii7 in the case of fiscal year #bjbj and each subsequent fiscal year 7before fiscal year #bjbe71 the amount specified in paragraph 7#f7 for such fiscal year2 2 and 7#b7 by adding at the end the following new paragraphs3 7#f7 ,application to ,puerto ,rico for fiscal years #bjbj through #bjbd ,for purposes of paragraph 7#b77;,a77ii71 the amount specified in this paragraph is-- 7,a7 for fiscal year #bjbj1 #b1hbc1ahh1jjj2 7,b7 for fiscal year #bjba1 #b1iai1jgb1jjj2 7,c7 for fiscal year #bjbb1 #c1jab1faj1jjj2 7,d7 for fiscal year #bjbc1 #c1aad1cca1jjj2 and 7,e7 for fiscal year #bjbd1 #c1bbe1fbg1jjj4 7#g7 ,puerto ,rico exclusion from payment limitation beginning fiscal year #bjbe ,beginning with fiscal year #bjbe1 there shall be no limitation applied under this subsection 7f7 or this subsection on the total amount certified by the ,secretary under title ,,xix for payment to ,puerto ,rico4 4 7c7 ,temporary increase in ,federal match for ,state plan administrative costs ,section #aijc7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#g77 is amended by inserting 7or1 in the case of ,puerto ,rico for each of fiscal years #bjbj through #bjcc1 #ajj percent7 after #ej per centum4