,,ii #aafth ,,congress #b;d ,session ,s4 #dajh ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,june #cj1 #bjbj,mr4 ,casey 7for himself1 ,ms4 ,cortez ,masto1 ,mr4 ,brown1 ,mr4 ,bennet1 ,mr4 ,wyden1 ,ms4 ,rosen1 ,ms4 ,smith1 ,mr4 ,merkley1 ,mr4 ,tester1 ,ms4 ,stabenow1 ,mrs4 ,shaheen1 ,mr4 ,booker1 ,ms4 ,klobuchar1 ,mr4 ,van ,hollen1 ,mr4 ,whitehouse1 ,mr4 ,peters1 and ,mr4 ,menendez7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 ,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 determined for each ,state for such quarter under subsection 7b7 shall be equal to the percentage determined for the ,state and quarter under paragraph 7#c74 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 ,american ,samoa1 or any other jurisdiction for which suitable data from the ,local ,area ,unemployment ,statistics from the ,bureau of ,labor ,statistics are unavailable1 the ,secretary shall use data from the ,u-#c unemployment measure of the ,bureau of ,labor ,statistics to make any necessary determinations under subparagraph 7,a74 7#c7 ,increased ,,fmap 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 for the ,state and quarter determined under subsection 7b7 shall be equal to-- 7i7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7b7 without regard to this subsection 7but including any increase to such percentage for such quarter made pursuant to section #fjjh7;a7 of the ,families ,first ,coronavirus ,response ,act72 increased by 7ii7 the number of percentage points 7rounded to the nearest tenth of a percentage point7 equal to the product of-- 7,i7 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 7,,ii7 #d4h4 7,b7 ,rules of application ,the following rules shall apply with respect to the ,federal medical assistance percentage determined for a ,state and an economic downturn quarter under this subsection3 7i7 ,scope of application ,such ,federal medical assistance percentage shall not apply for purposes of-- 7,i7 disproportionate share hospital payments described in section #aibc2 7,,ii7 payments under part ,d of title ,,iv2 or 7,,iii7 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 7ii7 ,limitation ,in no case shall-- 7,i7 the ,federal medical assistance percentage determined for a ,state and quarter pursuant to this subsection exceed #ie percent2 or 7,,ii7 any increase to the ,federal medical assistance percentage determined for a ,state and quarter pursuant to this subsection result in the application of a ,federal medical assistance percentage that exceeds #ie percent4 7iii7 ,application to ,,chip ,notwithstanding the first sentence of section #baje7;b71 the application of this subsection may result in the enhanced ,,fmap of a ,state for a fiscal year under such section exceeding #he percent1 but in no case may the application of this subsection before application of the second sentence of such section result in the enhanced ,,fmap of the ,state exceeding #ie percent4 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 make an initial determination1 based on the projections made for the ,state and quarter under subparagraph 7,b71 as to-- 7,i7 whether the application of this subsection is expected to result in the application of a higher ,federal medical assistance percentage for the ,state and quarter than the percentage that would otherwise apply without regard to this subsection2 and-- 7,,ii7 if the application of this subsection is expected to result in such a higher ,federal medical assistance percentage for the ,state and quarter1 what such higher percentage is expected to be2 and 7ii7 if the ,secretary determines under clause 7i7 that the application of this subsection is expected to result in the application of a higher ,federal medical assistance percentage for the ,state and quarter than the percentage that would otherwise apply without regard to this subsection-- 7,i7 apply such higher ,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 plan2 and 7,,ii7 take into account such higher ,federal medical assistance percentage of the ,state for purposes of calculating the enhanced ,,fmap for the ,state and quarter under section #baje7;b74 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 with respect to the application of this subsection for purposes of determining the ,federal medical assistance percentage and enhanced ,,fmap of the ,state for the quarter2 and 7ii7 in accordance with section #aijc7;d77#b7 and section #baje7;e71 reduce or increase the amount payable to the ,state under section #aijc7;a7 or section #baje for a subsequent fiscal quarter to the extent of any overpayment or underpayment under either such section which the ,secretary determines was made as a result of an incorrect initial determination under subparagraph 7,a77i7 with respect to the application of this subsection for purposes of determining the ,federal medical assistance percentage and enhanced ,,fmap of the ,state for such prior fiscal quarter4 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,b77ii7 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;,b77i74 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 7,,iv7 the ,federal medical assistance percentage determined for the ,state and quarter under subsection 7ff72 or 7,v7 the enhanced ,,fmap determined for the ,state and quarter under section #baje7;b74 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 ,this subsection shall not apply to a ,state 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 after such date or 7if later7 the date that such individual so enrolls 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 caps2 special rule for ,,chip allotments 7#a7 ,exclusion 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 ,any payment made to a territory for a fiscal year in which the ,federal medical assistance percentage for the territory is determined under section #aije7;gg7 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g7 to the extent that such payment exceeds the amount of the payment that would have been made to the territory for the year if the ,federal medical assistance percentage for the territory had been determined without regard to such section4 4 7#b7 ,,chip allotments ,section #bajd7m7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;dd7m77 is amended-- 7,a7 in paragraph 7#b77;,b71 in the matter preceding clause 7i71 by striking paragraphs 7#e7 and 7#g7 and inserting paragraphs 7#e71 7#g71 and 7#ab72 and 7,b7 by adding at the end the following new paragraph3 7#ab7 ,special rule for adjusting allotments during fiscal years with economic downturn quarters 7,a7 ,in general ,if a fiscal quarter occurring during fiscal year #bjbj or any succeeding fiscal year is determined to be an economic downturn quarter with respect to a ,state 7as determined under section #aije7;gg77 then1 as soon as practicable after such determination1 the ,secretary shall increase the allotment for the ,state and fiscal year in accordance with subparagraph 7,b74 7,b7 ,amount of increase 7i7 ,in general ,the amount of an increase to the allotment of a ,state described in subparagraph 7,a7 for a fiscal year shall be equal to the amount by which ,federal payments made to the ,state for the preceding fiscal year under this title would have been increased 7without regard to whether such payments would exceed the amount of the ,state's allotment for such preceding fiscal year7 if the enhanced ,,fmap determined for the ,state for such preceding fiscal year had been increased to the same extent that the ,state's enhanced ,,fmap for the fiscal year involved is expected to be increased as a result of the application of section #aije7;gg7 relative to the enhanced ,,fmap that would apply to the ,state for the fiscal year involved without the application of such section4 7ii7 ,inclusion of projected increases ,in increasing the allotment of a ,state for a fiscal year under this paragraph1 the ,secretary may base the calculation of such increase on projections made by the ,secretary with respect to-- 7,i7 the number of fiscal quarters during such fiscal year that will be economic downturn quarters2 and 7,,ii7 the effect that the application of section #aije7;gg7 is expected to have on the enhanced ,,fmap of the ,state for such fiscal year4 7,c7 ,disregard of increased payments for purposes of future allotments ,any ,federal payment made to a ,state under this title for a fiscal year in which the ,federal medical assistance percentage for the ,state is determined under section #aije7;gg7 shall be disregarded when determining the allotment of the ,state for any subsequent year1 including for purposes of applying this paragraph1 to the extent that such payment exceeds the amount of the payment that would have been made to the ,state for the year if the ,federal medical assistance percentage for the ,state and year had been determined without regard to such section4 4