,,ii #aafth ,,congress #b;d ,session ,s4 #deji ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,august #f1 #bjbj,mr4 ,wyden introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to provide for affordable coverage of ,,covid-#ai vaccines under ,medicare1 ,medicaid1 and the ,children's ,health ,insurance ,program1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,vaccine ,and ,coverage ,certainty ,act or the ,,vacc ,act4 7b7 ,table of contents ,the table of contents for this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4,,title ,i--,ensuring coverage of ,,covid-#ai vaccines,sec4 #aja4 ,ensuring affordability of federally funded ,,covid-#ai vaccines under ,medicare4,sec4 #ajb4 ,mandatory coverage of ,,covid-#ai vaccines under ,medicaid and ,,chip4,sec4 #ajc4 ,inclusion of federally funded ,,covid-#ai vaccines under ,medicaid drug rebate program2 coverage of ,,covid-#ai vaccines under ,state pediatric vaccine distribution program4,sec4 #ajd4 ,temporary enhanced ,federal match for medical assistance for ,,covid-#ai vaccines4,,title ,,ii--,ensuring coverage under ,medicaid,sec4 #bja4 ,increased ,,fmap for medical assistance to newly eligible individuals4,sec4 #bjb4 ,medicaid coverage for citizens of ,freely ,associated ,states4,,title ,,iii--,ensuring coverage in the ,marketplace,sec4 #cja4 ,disregard of additional unemployment compensation for purposes of premium tax credit and cost-sharing subsidies4 ,i ,ensuring coverage of ,,covid-#ai vaccines #aja4 ,ensuring affordability of federally funded ,,covid-#ai vaccines under ,medicare 7a7 ,in general ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7#a7 in subsection 7a77#a77;,b71 by inserting subject to subsection 7dd77#a7 7with respect to payment for federally funded ,,covid-#ai vaccines71 after #ahfa7s77#aj77;,a712 and 7#b7 by adding at the end the following new subsection3 7dd7 ,ensuring affordability of federally funded ,,covid-#ai vaccines 7#a7 ,initial payment ,for purposes of subsection 7a77#a77;,b71 the amount of charges that are considered reasonable with respect to an applicable ,,covid-#ai vaccine during the first year that such vaccine is administered under this part 7referred to in this subsection as the initial payment year7 shall not exceed the amount described in paragraph 7#c74 7#b7 ,applicable covid-#ai vaccine 7,a7 ,in general ,in this subsection1 the term applicable ,,covid-#ai vaccine means a vaccine-- 7i7 approved by the ,food and ,drug ,administration under section #cea of the ,public ,health ,service ,act or authorized for emergency use under section #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act for immunization against ,,covid-#ai2 and 7ii7 whose manufacturer was provided funding for research or development of such vaccine or for the manufacture of such vaccine under a contract with the ,federal ,government 7including the ,biodefense ,advanced ,research and ,development ,authority of the ,department of ,health and ,human ,services7 or under a ,federal grant program using funds made available under the ,coronavirus ,aid1 ,relief1 and ,economic ,security ,act 7,public ,law #aaf-acf71 or subsequently enacted legislation4 7,b7 ,nonapplication to vaccines purchased for ,federal distribution ,such term shall not include any doses of such vaccine that are purchased under a ,federal contract or grant agreement described in paragraph 7#b77;,b7 for ,federal distribution4 7#c7 ,amount described ,the amount described in this paragraph1 with respect to an applicable ,,covid-#ai vaccine1 is the ,federal procurement cost per dose accounting for ,federal costs under all ,federal contracts or grant agreements described in paragraph 7#b77;,b7 for the initial supply order with respect to such vaccine1 not including the cost of any option to buy future doses of such vaccine under such contracts or agreements4 7#d7 ,payment in subsequent years ,for provisions relating to payment for an applicable ,,covid-#ai vaccine in years after the initial payment year1 see section #ahdb7o77#a77;,a77iv7 7relating to payment amount equal to #ie percent of the average wholesale price74 7#e7 ,rebate if price increases faster than inflation 7,a7 ,in general ,subject to subparagraph 7,b71 the ,secretary shall establish a process under which1 with respect to an applicable ,,covid-#ai vaccine of a manufacturer1 effective beginning with the first year after the initial payment year1 if the amount of payment for the vaccine under this part increases faster than inflation with respect to a rebate period specified by the ,secretary1 the manufacturer of such vaccine shall1 not later than #cj days after receipt from the ,secretary of the rebate amount for such rebate period1 provide a rebate to the ,secretary that is equal to the amount specified in subparagraph 7,c7 for such vaccine and rebate period4 7,b7 ,exceptions ,the process established under this paragraph shall provide for the following exceptions with respect to an applicable ,,covid-#ai vaccine of a manufacturer3 7i7 ,if the ,secretary determines that there are exceptional circumstances1 such as a substantial increase in development or manufacturing costs due to circumstances outside the control of the manufacturer4 7ii7 ,the manufacturer demonstrates1 to the satisfaction of the ,secretary1 that it has significantly improved the clinical efficacy or safety of such vaccine relative to its clinical efficacy or safety when it was first procured or contracted for by the ,federal ,government4 ,for purposes of the preceding sentence1 a manufacturer may demonstrate the improved clinical efficacy or safety of a particular ,,covid-#ai vaccine according to a process established by the ,advisory ,committee on ,immunization ,practices at the ,centers for ,disease ,control in coordination with the ,food and ,drug ,administration4 ,the results of any assessment under this clause with respect to an applicable ,,covid-#ai vaccine shall be made public4 7,c7 ,rebate amount ,the amount of a rebate under this subparagraph1 with respect to an applicable ,,covid-#ai vaccine of a manufacturer1 is the product of-- 7i7 the total number of doses of such vaccine administered during the rebate period2 and 7ii7 the amount 7if any7 by which-- 7,i7 the amount of payment for the vaccine under this part during the rebate period2 exceeds 7,,ii7 the inflation-adjusted payment amount determined under subparagraph 7,d7 of this paragraph for such vaccine during the rebate period4 7,d7 ,determination of inflation-adjusted payment amount ,the inflation-adjusted payment amount determined under this subparagraph for an applicable ,,covid-#ai vaccine for a rebate period is-- 7i7 the amount of payment for the vaccine under this part during the initial payment year as described in paragraph 7#a72 increased by 7ii7 the percentage by which the rebate period ,,cpi-,u 7as defined in subparagraph 7,f77 for the rebate period exceeds the benchmark period ,,cpi-,u 7as defined in subparagraph 7,e774 7,e7 ,benchmark period ,,cpi-,u ,the term benchmark period ,,cpi-,u means the consumer price index for all urban consumers 7,united ,states city average7 for the first calendar quarter in the initial payment year4 7,f7 ,rebate period ,,cpi-,u ,the term rebate period ,,cpi-,u means1 with respect to a rebate period1 the consumer price index for all urban consumers 7,united ,states city average7 for the last month of the calendar quarter that is two calendar quarters prior to the rebate period4 7,g7 ,provision of information ,a manufacturer of an applicable ,,covid-#ai vaccine shall provide to the ,secretary such information1 at such time and in such manner as the ,secretary specifies1 as is needed to carry out this paragraph4 7,h7 ,rebate deposits ,amounts paid as rebates under this paragraph shall be deposited into the ,federal ,supplementary ,medical ,insurance ,trust ,fund established under section #ahda4 7,i7 ,enforcement 7i7 ,civil money penalty 7,i7 ,in general ,the ,secretary shall impose a civil money penalty on a manufacturer that fails to comply with the requirements under this paragraph with respect to providing a rebate for an applicable ,,covid-#ai vaccine for a rebate period for each such failure in an amount equal to the sum of-- 7aa7 the rebate amount specified pursuant to subparagraph 7,c7 for such vaccine for such rebate period2 and 7bb7 #be percent of such amount4 7,,ii7 ,application ,the provisions of section #aabh;,a 7other than subsections 7a7 7with respect to amounts of penalties or additional assessments7 and 7b77 shall apply to a civil money penalty under this clause in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a7a74 7ii7 ,no payment for manufacturers who fail to pay penalty ,if the manufacturer of an applicable ,,covid-#ai vaccine fails to pay a civil money penalty under clause 7i7 with respect to the failure to provide a rebate for an applicable ,,covid-#ai vaccine for a rebate period by a date specified by the ,secretary after the imposition of such penalty1 no payment shall be available under this part for such vaccine for calendar quarters beginning on or after such date until the ,secretary determines the manufacturer has paid the penalty due under such clause4 7,j7 ,implementation ,there shall be no administrative or judicial review under section #ahfi1 section #ahgh1 or otherwise1 of the determination of the rebate amount for an applicable ,,covid-#ai vaccine under subparagraph 7,c71 including the determination of-- 7i7 the total number of ,,covid-#ai vaccines administered during the rebate period under subparagraph 7,c77i72 and 7ii7 the inflation-adjusted payment amount under subparagraph 7,d74 4 7b7 ,conforming amendment ,section #ahdb7o77#a77;,a77iv7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieu7o77#a77;,a77iv77 is amended by striking ,a vaccine and inserting ,subject to section #ahcc7;dd77#a7 7relating to payment for an applicable ,,covid-#ai vaccine during initial payment year71 a vaccine4 #ajb4 ,mandatory coverage of ,,covid-#ai vaccines under ,medicaid and ,,chip 7a7 ,medicaid 7#a7 ,in general ,section #aije7;a77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77#d77 is amended-- 7,a7 by striking and 7,d7 and inserting 7,d72 and 7,b7 by striking the semicolon at the end and inserting 2 and 7,e7 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under sections #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and administration of the vaccine24 7#b7 ,prohibition of cost sharing 7,a7 ,in general ,subsections 7a77#b7 and 7b77#b7 of section #aiaf of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo7 are each amended-- 7i7 in subparagraph 7,f71 by striking or at the end2 7ii7 in subparagraph 7,g71 by striking 2 and and inserting 1 or2 and 7iii7 by adding at the end the following subparagraph3 7,h7 a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under sections #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine2 and 4 7,b7 ,application to alternative cost sharing ,section #aiaf;,a7b77#c77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifo-#a7;b77#c77;,b77 is amended-- 7i7 in clause 7xi71 by striking any visit and inserting any service2 and 7ii7 by adding at the end the following clause3 7xii7 ,a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under sections #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine4 4 7,c7 ,clarification ,the amendments made by this subsection shall apply with respect to a ,state plan of a territory in the same manner as the amendments apply to a ,state plan of #a of the #ej ,states or the ,district of ,columbia4 7b7 ,,chip 7#a7 ,in general ,section #bajc7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7c77 is amended by adding at the end the following paragraph3 7#aa7 ,coverage of ,,covid-#ai vaccines ,regardless of the type of coverage elected by a ,state under subsection 7a71 child health assistance provided under such coverage for targeted low-income children and1 in the case of a ,state that ,state elects to provide pregnancy-related assistance under such coverage pursuant to section #baab1 such pregnancy-related assistance for targeted low-income pregnant women 7as defined in section #baab7;d77 shall include coverage of a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under sections #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 and the administration of such vaccine4 4 7#b7 ,prohibition of cost sharing ,section #bajc7;e77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acig;cc7e77#b771 as amended by section #fjjd7;b77#c7 of the ,families ,first ,coronavirus ,response ,act1 is amended-- 7,a7 in the paragraph header1 by inserting a ,,covid-#ai vaccine1 before or pregnancy-related assistance2 and 7,b7 by striking visits described in section #aiaf7;a77#b77;,g71 or and inserting services described in section #aiaf7;a77#b77;,g71 vaccines described in section #aiaf7;a77#b77;,h71 or4 #ajc4 ,inclusion of federally funded ,,covid-#ai vaccines under ,medicaid drug rebate program2 coverage of ,,covid-#ai vaccines under ,state pediatric vaccine distribution program 7a7 ,inclusion in ,medicaid drug rebate program 7#a7 ,in general ,section #aibg of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7 is amended-- 7,a7 in subsection 7b77#a77;,a71 by inserting 7or1 in the case of an applicable ,,covid-#ai vaccine administered after ,july #a1 #bjbj1 an amount specified in subsection 7l77 after #aiij2 7,b7 in subsection 7k7-- 7i7 in paragraph 7#b7-- 7,i7 in subparagraph 7,b7-- 7aa7 in the matter preceding clause 7i71 by inserting 7except in the case of an applicable ,,covid-#ai vaccine7 after other than a vaccine2 and 7bb7 in clause 7iii71 by striking 2 and and inserting a semicolon2 7,,ii7 in subparagraph 7,c71 by striking the period at the end and inserting 2 and2 and 7,,iii7 by adding at the end the following new subparagraph3 7,d7 an applicable ,,covid-#ai vaccine4 2 and 7ii7 by adding at the end the following new paragraph3 7#ab7 ,applicable ,,covid-#ai vaccine ,the term applicable ,,covid-#ai vaccine has the meaning given such term in section #ahcc7;dd77#b74 2 and 7,c7 by adding at the end the following new subsection3 7l7 ,determination of amount of rebate for applicable ,,covid-#ai vaccines 7#a7 ,in general ,the amount of the rebate specified in this subsection for a rebate period with respect to an applicable ,,covid-#ai vaccine shall be equal to the product of-- 7,a7 the total number of units of the vaccine paid for under the ,state plan in the rebate period 7as reported by the ,state72 and 7,b7 the difference between the average manufacturer price and the inflation-adjusted ,federal procurement price 7as defined in paragraph 7#b77 for the vaccine4 7#b7 ,inflation-adjusted ,federal procurement price ,for purposes of this section1 the term inflation-adjusted ,federal procurement price means1 with respect to an applicable ,,covid-#ai vaccine and a rebate period-- 7,a7 for rebate periods occurring during the first #ab-month period that such vaccine is provided to ,state plans under this title1 the amount specified for the vaccine under section #ahcc7;dd77#c72 and 7,b7 for rebate periods occurring after such #ab-month period-- 7i7 the amount specified for the vaccine under section #ahcc7;dd77#c72 increased by 7ii7 the percentage by which the consumer price index for all urban consumers 7,united ,states city average7 for the month before the month in which the rebate period begins exceeds such index for the month in which such #ab-month period begins4 7#c7 ,exceptions ,no rebate shall be payable with respect to an applicable ,,covid-#ai vaccine of a manufacturer and a rebate period occurring after the #ab-month period described in paragraph 7#b77;,a7 if the ,secretary determines that an exception described in section #ahcc7;dd77#e77;,b7 applies with respect to the vaccine for the rebate period4 4 7#b7 ,prohibition on prior authorization ,section #aibg7;d77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#a77;,a77 is amended by inserting other than an applicable ,,covid-#ai vaccine after covered outpatient drug4 7#c7 ,no exclusion of applicable ,,covid-#ai vaccines ,section #aibg7;d77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acifr-#h7;d77#g77 is amended by adding at the end the following3 7,d7 ,applicable ,,covid-#ai vaccines4 4 7b7 ,ensuring coverage and affordability under ,state pediatric vaccine distribution program ,section #aibh of the ,social ,security ,act 7#db ,u4,s4,c4 #acifs7 is amended-- 7#a7 in subsection 7a77#a7-- 7,a7 in subparagraph 7,a71 by striking 2 and and inserting a semicolon2 7,b7 in subparagraph 7,b71 by striking the period and inserting 2 and2 and 7,c7 by adding at the end the following subparagraph3 7,c7 each vaccine-eligible child 7as defined in subsection 7b77 is entitled to receive a ,,covid-#ai vaccine from a program-registered provider without charge for-- 7i7 the cost of such vaccine2 or 7ii7 the administration of such vaccine4 2 7#b7 in subsection 7c77#b71 by adding at the end the following subparagraph3 7,d7 ,the provider will provide and administer a ,,covid-#ai vaccine to a vaccine-eligible child in accordance with the same requirements as the requirements that apply under the preceding subparagraphs to the provision and administration of a qualified pediatric vaccine to such a child4 2 7#c7 in subsection 7d77#c71 by adding at the end the following new subparagraph3 7,d7 ,limitation on price increases for applicable ,,covid-#ai vaccines 7i7 ,in general ,subject to clause 7ii71 with respect to any contract entered into under this subsection for an applicable ,,covid-#ai vaccine after the first such contract entered into with respect to such vaccine1 no price for the purchase of such vaccine for vaccine-eligible children shall be agreed to by the ,secretary under this subsection if the price per dose of such vaccine 7including any delivery costs and any applicable excise tax established under section #daca of the ,internal ,revenue ,code of #aihf7 exceeds-- 7,i7 the price per dose for the vaccine in effect under the first contract entered into under this subsection for the purchase of such vaccine2 increased by 7,,ii7 the percentage increase in the consumer price index for all urban consumers 7all items2 ,united ,states city average7 from the month before such first contract is entered into to the month before the month in which the contract involved is entered into4 7ii7 ,exception ,the limitation described in clause 7i7 shall not apply with respect to an applicable ,,covid-#ai vaccine and a contract if the ,secretary determines that an exception described in section #ahcc7;dd77#e77;,b7 applies with respect to the vaccine for the contract period4 2 and 7#d7 in subsection 7h71 by adding at the end the following new paragraph3 7#aj7 ,,covid-#ai vaccine2 applicable ,,covid-#ai vaccine 7,a7 ,,covid-#ai vaccine ,the term ,,covid-#ai vaccine means a ,,covid-#ai vaccine licensed under section #cea of the ,public ,health ,service ,act1 or approved or authorized under section #eje or #efd of the ,federal ,food1 ,drug1 and ,cosmetic ,act1 provided that such vaccine is included on the list under subsection 7e74 7,b7 ,applicable ,,covid-#ai vaccine ,the term applicable ,,covid-#ai vaccine means a vaccine described in section #ahcc7;dd77#b71 provided that such vaccine is included on the list under subsection 7e74 4 7c7 ,effective date ,the amendments made by this section take effect on the date of enactment of this ,act and apply to rebate agreements entered into on or after such date without regard to whether final regulations to carry out such amendments have been promulgated as of such date4 #ajd4 ,temporary enhanced ,federal match for medical assistance for ,,covid-#ai vaccines 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 ,temporary enhanced ,federal match for ,,covid-#ai vaccine and administration 7#a7 ,in general ,notwithstanding subsection 7b71 with respect to medical assistance for vaccines and the administration of vaccines described in subsection 7a77#d77;,e7 that is furnished during the period described in paragraph 7#b71 the ,federal medical assistance percentage for a ,state shall be equal to #ajj percent4 7#b7 ,period described ,the period described in this paragraph is the period that-- 7,a7 begins with the date of enactment of this subsection2 and 7,b7 ends with the date that is #a year after the last day of the emergency period defined in paragraph 7#a77;,b7 of section #aace7;g74 4 7b7 ,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 certain increased ,,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 ,,ii ,ensuring coverage under ,medicaid #bja4 ,increased ,,fmap for medical assistance to newly eligible individuals 7a7 ,in general ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7#a7 in subsection 7y77#a7-- 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 thereafter2 and 7#b7 in subsection 7z77#b77;,b77i77,,ii71 by inserting 7as in effect on the day before the enactment of the ,vaccine ,and ,coverage ,certainty ,act7 after subsection 7y77#a74 7b7 ,retroactive application ,the amendments made by subsection 7a77#a7 shall take effect as if included in the enactment of ,public ,law #aaa-adh and shall apply to amounts expended by any ,state for medical assistance for newly eligible individuals described in subclause 7,,viii7 of section #aijb7;a77#aj77;,a77i7 of the ,social ,security ,act under a ,state ,medicaid plan 7or a waiver of such plan7 during the period before the date of enactment of this ,act4 #bjb4 ,medicaid coverage for citizens of ,freely ,associated ,states 7a7 ,in general ,section #djb7;b77#b7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afab7;b77#b77 is amended by adding at the end the following new subparagraph3 7,g7 ,medicaid exception for citizens of ,freely ,associated ,states ,with respect to eligibility for benefits for the designated ,federal program defined in paragraph 7#c77;,c7 7relating to the ,medicaid program71 section #dja7;a7 and paragraph 7#a7 shall not apply to any individual who lawfully resides in #a of the #ej ,states or the ,district of ,columbia in accordance with the ,compacts of ,free ,association between the ,government of the ,united ,states and the ,governments of the ,federated ,states of ,micronesia1 the ,republic of the ,marshall ,islands1 and the ,republic of ,palau and shall not apply1 at the option of the ,governor of ,puerto ,rico1 the ,virgin ,islands1 ,guam1 the ,northern ,mariana ,islands1 or ,american ,samoa as communicated to the ,secretary of ,health and ,human ,services in writing1 to any individual who lawfully resides in the respective territory in accordance with such ,compacts4 4 7b7 ,exception to #e-,year limited eligibility ,section #djc7;d7 of such ,act 7#h ,u4,s4,c4 #afac7;d77 is amended-- 7#a7 in paragraph 7#a71 by striking or at the end2 7#b7 in paragraph 7#b71 by striking the period at the end and inserting 2 or2 and 7#c7 by adding at the end the following new paragraph3 7#c7 an individual described in section #djb7;b77#b77;,g71 but only with respect to the designated ,federal program defined in section #djb7;b77#c77;,c74 4 7c7 ,definition of qualified alien ,section #dca7;b7 of such ,act 7#h ,u4,s4,c4 #afda7;b77 is amended-- 7#a7 in paragraph 7#f71 by striking 2 or at the end and inserting a comma2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 1 or2 and 7#c7 by adding at the end the following new paragraph3 7#h7 an individual who lawfully resides in the ,united ,states in accordance with a ,compact of ,free ,association referred to in section #djb7;b77#b77;,g71 but only with respect to the designated ,federal program defined in section #djb7;b77#c77;,c7 7relating to the ,medicaid program74 4 7d7 ,application to ,state plans ,section #aijb7;a77#aj77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,a77i77 is amended by inserting after subclause 7,,ix7 the following3 7,x7 who are described in section #djb7;b77#b77;,g7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif and eligible for benefits under this title by reason of application of such section2 4 7e7 ,conforming amendments ,section #aajh of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh71 as amended by section #ajd1 is amended-- 7#a7 in subsection 7f71 in the matter preceding paragraph 7#a71 by striking subsections 7g7 and 7h7 and inserting subsections 7g71 7h71 and 7i72 and 7#b7 by adding at the end the following3 7i7 ,exclusion of medical assistance expenditures for citizens of ,freely ,associated ,states ,expenditures for medical assistance provided to an individual described in section #dca7;b77#h7 of the ,personal ,responsibility and ,work ,opportunity ,reconciliation ,act of #aiif 7#h ,u4,s4,c4 #afda7;b77#h77 shall not be taken into account for purposes of applying payment limits under subsections 7f7 and 7g74 4 7f7 ,effective date ,the amendments made by this section shall apply to benefits for items and services furnished on or after the date of the enactment of this ,act4 ,,iii ,ensuring coverage in the ,marketplace #cja4 ,disregard of additional unemployment compensation for purposes of premium tax credit and cost-sharing subsidies 7a7 ,in general ,section #cf;,b7d77#b77;,b7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by redesignating clauses 7i71 7ii71 and 7iii7 as subclauses 7,i71 7,,ii71 and 7,,iii71 respectively1 and by moving such subclauses #b ems to the right2 7#b7 by striking adjusted gross income increased by and inserting adjusted gross income-- 7i7 decreased by the amount of any ,federal pandemic unemployment compensation paid to an individual under section #bajd of division ,a of the ,,cares ,act during the taxable year2 and 7ii7 increased by-- 2 and 7#c7 by adding at the end the following new flush sentence3 ,clause 7i7 shall not apply to the extent that such decrease results in a household income for the taxpayer which is less than #ajj percent of the poverty line for a family of the size involved4 4 7b7 ,temporary suspension of recapture of excess advance payments ,section #cf;,b7f77#b7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new subparagraph3 7,c7 ,special rule for #bjbj and #bjba ,subparagraph 7,a7 shall not apply to any taxable year beginning in #bjbj or #bjba4 4 7c7 ,effective date ,the amendments made by this section shall apply to taxable years beginning after ,december #ca1 #bjai4