,i #aafth ,,congress #b;d ,session ,h4 ,r4 #feci ,,in ,,the ,,house ,,of ,,representatives ,april #ag1 #bjbj,mrs4 ,lee of ,nevada introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce ,a ,,bill ,to amend title ,,xix of the ,social ,security ,act to increase ,federal support to ,state ,medicaid programs during economic downturns1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,coronavirus ,medicaid ,response ,act4 #b4 ,increasing ,federal support to ,state ,medicaid programs during economic downturns 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7b71 by striking and 7ff7 and inserting 7ff71 and 7gg72 and 7#b7 by adding at the end the following new subsection3 7gg7 ,increased ,,fmap during economic downturns 7#a7 ,in general ,notwithstanding subsection 7b71 7y71 or 7z77#b71 if a fiscal quarter that begins on or after ,january #a1 #bjbj1 is an economic downturn quarter 7as defined in paragraph 7#b77 with respect to a ,state1 then the ,federal medical assistance percentage applicable to amounts expended by the ,state for medical assistance for services furnished during such quarter shall be increased in accordance with paragraphs 7#c7 and 7#d74 7#b7 ,economic downturn quarter 7,a7 ,in general 7i7 ,in general ,in this subsection1 the term economic downturn quarter means1 with respect to a ,state1 a fiscal quarter during which the ,state's unemployment rate for the quarter exceeds the percentage determined for the ,state and quarter under clause 7ii74 7ii7 ,threshold percentage ,the percentage determined under this clause for a ,state and fiscal quarter is the percentage equal to the lower of-- 7,i7 the ,state unemployment rate at the #bjth percentile of the distribution of the ,state's quarterly unemployment rates for the #fj-quarter period preceding the quarter involved1 increased by #a percentage point2 and 7,,ii7 the ,state's average quarterly unemployment rate for the #ab-quarter period preceding the quarter involved1 increased by #a percentage point4 7,b7 ,unemployment data 7i7 ,in general ,except as provided in clause 7ii71 for purposes of determining unemployment rates for a ,state and a quarter under this paragraph1 the ,secretary shall use data from the ,local ,area ,unemployment ,statistics from the ,bureau of ,labor ,statistics4 7ii7 ,application to certain territories ,in the case of the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa1 the ,secretary shall use data from the ,u-#f unemployment measure of the ,bureau of ,labor ,statistics to make any necessary determinations under subparagraph 7,a74 7#c7 ,,fmap increase during economic downturn quarter 7,a7 ,in general ,during a fiscal quarter that is an economic downturn quarter with respect to a ,state1 the ,federal medical assistance percentage otherwise determined for the ,state and quarter under subsection 7b7 and1 if applicable1 the ,federal medical assistance percentage applicable under subsection 7y71 7z77#b71 or 7ff7 with respect to medical assistance furnished by the ,state during such quarter to individuals described in either such subsection shall be increased by the number of percentage points 7rounded to the nearest tenth of a percentage point7 equal to the product of-- 7i7 the number of percentage points 7rounded to the nearest tenth of a percentage point7 by which the unemployment rate for the ,state and quarter exceeds the percentage determined for the ,state and quarter under paragraph 7#b77;,a77ii72 and 7ii7 #d4h4 7,b7 ,application of ,,covid-#ai ,,fmap increase ,any increase applicable to the ,federal medical assistance percentage of a ,state for a fiscal quarter under subparagraph 7,a7 shall be in addition to any increase to such percentage for such quarter made pursuant to section #fjjh7;a7 of the ,families ,first ,coronavirus ,response ,act4 7,c7 ,limitation ,in no case shall an increase to the ,federal medical assistance percentage of a ,state under this paragraph result in a ,federal medical assistance percentage that exceeds #ie percent4 7,d7 ,scope of application ,any increase to the ,federal medical assistance percentage of a ,state for a fiscal quarter under this paragraph shall only apply with respect to payments for amounts expended by the ,state for medical assistance for services furnished during such quarter and shall not apply with respect to-- 7i7 disproportionate share hospital payments described in section #aibc2 7ii7 payments under title ,,iv or ,,xxi2 7iii7 any payments under this title that are based on the enhanced ,,fmap described in section #baje7;b72 or 7iv7 any payments under this title that are based on a ,federal medical assistance percentage determined for a ,state under subsection 7aa7 7but only to the extent that such ,federal medical assistance percentage is higher than the economic recovery ,,fmap74 7#d7 ,advance payment2 retrospective adjustment 7,a7 ,in general ,prior to the beginning of each fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary shall1 with respect to each ,state-- 7i7 determine the increase 7if any7 that is expected to apply to the ,federal medical assistance percentage of such ,state for such quarter under this subsection based on the projections made for the ,state and quarter under subparagraph 7,b72 and 7ii7 shall apply such increase to the ,federal medical assistance percentage of the ,state for purposes of making payments to the ,state for amounts expended during such quarter as medical assistance under the ,state plan4 7,b7 ,projection of ,state unemployment rates ,prior to the beginning of each fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary1 acting through the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services1 shall1 using the most recently available data described in paragraph 7#b77;,b71 make projections with respect to-- 7i7 the unemployment rates for each ,state for such quarter2 7ii7 the threshold percentages described in paragraph 7#b77;,a77ii7 for each ,state for such quarter2 and 7iii7 the national unemployment rate for such quarter4 7,c7 ,retrospective adjustment ,as soon as practicable after final unemployment data becomes available for a fiscal quarter that begins on or after ,july #a1 #bjbj1 the ,secretary shall1 with respect to each ,state-- 7i7 make a final determination of the increase 7if any7 applicable to the ,federal medical assistance percentage of the ,state for the quarter under this subsection2 and 7ii7 in accordance with subsection 7d77#b7 of section #aijc1 reduce or increase the amount payable to the ,state under subsection 7a7 of such section for a subsequent fiscal quarter to the extent of any overpayment or underpayment which the ,secretary determines was made as a result of a miscalculation of the increase applicable to the ,federal medical assistance percentage of the ,state for such prior fiscal quarter under this subsection4 7#e7 ,retrospective application of over-the-limit ,,fmap increases 7,a7 ,in general ,if a ,state has excess percentage points with respect to an economic downturn quarter and an applicable ,,fmap 7as determined under subparagraph 7,b771 the ,state may elect to apply such excess percentage points to increase such applicable ,,fmap for one or more quarters during the look-back period for the ,state and economic downturn quarter in accordance with this paragraph4 7,b7 ,excess percentage points ,for purposes of this paragraph1 the number of excess percentage points for a ,state1 economic downturn quarter1 and an applicable ,,fmap shall be equal to the number of percentage points by which-- 7i7 the applicable ,,fmap for the ,state and quarter 7after application of paragraph 7#c7 but without regard to subparagraph 7,c7 of such paragraph72 exceeds 7ii7 #ie percent4 7,c7 ,effect of application of excess percentage points ,if a ,state elects to apply excess percentage points to an applicable ,,fmap to a quarter during a look-back period under this paragraph1 the ,secretary shall determine the additional amount of payment under section #aijc7;a7 to which the ,state would have been entitled for such quarter if the applicable ,,fmap 7as so increased7 had been in effect for such quarter1 and shall treat such additional amount as an underpayment for such quarter4 7,d7 ,distribution of excess percentage points ,a ,state that has excess percentage points with respect to an economic downturn quarter and applicable ,,fmap may elect to divide such points among more than #a quarter during the look-back period for such ,state and quarter provided that no excess percentage point 7or fraction of an excess percentage point7 is applied to the applicable ,,fmap of more than #a quarter4 7,e7 ,limitations 7i7 ,no increases over #ajj percent ,a ,state may not increase an applicable ,,fmap for any quarter during a look-back period under this paragraph if such increase would result in the applicable ,,fmap for such quarter exceeding #ajj percent4 7ii7 ,scope of application ,any increase to an applicable ,,fmap of a ,state for a fiscal quarter under this paragraph-- 7,i7 shall only apply with respect to payments for amounts expended by the ,state for medical assistance for services furnished during such quarter to which such applicable ,,fmap is applicable2 and 7,,ii7 shall not apply with respect to payments described in paragraph 7#c77;,d74 7,f7 ,definitions ,in this paragraph3 7i7 ,applicable ,,fmap ,the term applicable ,,fmap means1 with respect to a ,state and fiscal quarter-- 7,i7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7b72 7,,ii7 the ,federal medical assistance percentage applicable under subsection 7y72 7,,iii7 the ,federal medical assistance percentage applicable under subsection 7z77#b72 or 7,,iv7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7ff74 7ii7 ,look-back period ,the term look-back period means1 with respect to a ,state and a fiscal quarter that is an economic downturn quarter for the ,state1 the period of #d fiscal quarters that ends with the fourth quarter which precedes the most recent fiscal quarters that was not an economic downturn quarter for the ,state4 7#f7 ,requirement for all ,states ,a ,state may not receive an increase in the ,federal medical assistance percentage for such ,state under this subsection1 with respect to a fiscal quarter1 if-- 7,a7 eligibility standards1 methodologies1 or procedures under the ,state plan or a waiver of such plan are more restrictive during such quarter than the eligibility standards1 methodologies1 or procedures1 respectively1 under such plan 7or waiver7 as in effect on the last day of the most recent fiscal quarter that was not an economic downturn quarter for the ,state2 7,b7 the amount of any premium imposed by the ,state pursuant to section #aiaf or #aiaf;,a during such quarter1 with respect to an individual enrolled under such plan 7or waiver71 exceeds the amount of such premium as of the date described in subparagraph 7,a72 or 7,c7 the ,state fails to provide that an individual who is enrolled for benefits under such plan 7or waiver7 as of the date described in subparagraph 7,a7 or enrolls for benefits under such plan 7or waiver7 during the period beginning with such date and ending with the day before the first day of the next quarter that is not an economic downturn quarter for the ,state shall be treated as eligible for such benefits for not less than #ab months 7or1 if such period is less than #ab months1 throughout such period7 unless the individual requests a voluntary termination of eligibility or the individual ceases to be a resident of the ,state4 4 7b7 ,exclusion of economic downturn ,,fmap increases from territorial caps ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7 is amended-- 7#a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsection 7g7 and section #aice7;e77#a77;,b7 and inserting subsections 7g7 and 7h7 and section #aice7;e77#a77;,b72 and 7#b7 by adding at the end the following3 7h7 ,exclusion from caps of amounts attributable to economic downturn ,,fmap ,the portion of any payment made to a territory for a fiscal year that is attributable to an increase in the ,federal medical assistance percentage for a fiscal quarter during such year under section #aije7;gg7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g74 4