,i #aaith ,,congress #ast ,session ,h4 ,r4 #fjh ,,in ,,the ,,house ,,of ,,representatives ,january #bb1 #bjbe,mr4 ,doggett 7for himself1 ,mr4 ,bishop1 ,mr4 ,casar1 ,ms4 ,castor of ,florida1 ,mr4 ,castro of ,texas1 ,mr4 ,cohen1 ,mr4 ,clyburn1 ,mr4 ,cuellar1 ,ms4 ,escobar1 ,mr4 ,figures1 ,mrs4 ,fletcher1 ,ms4 ,lois ,frankel of ,florida1 ,ms4 ,garcia of ,texas1 ,mr4 ,green of ,texas1 ,mr4 ,johnson of ,georgia1 ,ms4 ,johnson of ,texas1 ,mrs4 ,mc,bath1 ,mrs4 ,cherfilus-,mc,cormick1 ,mr4 ,david ,scott of ,georgia1 ,ms4 ,sewell1 ,mr4 ,soto1 ,mr4 ,thompson of ,mississippi1 ,mr4 ,turner of ,texas1 ,mr4 ,veasey1 ,ms4 ,wasserman ,schultz1 ,ms4 ,williams of ,georgia1 ,ms4 ,wilson of ,florida1 ,ms4 ,adams1 ,mr4 ,cleaver1 ,mr4 ,connolly1 ,ms4 ,norton1 and ,mr4 ,raskin7 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 provide for a demonstration project under the ,medicaid program for political subdivisions of ,states to provide medical assistance for the expansion population under such program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,cover ,outstanding ,vulnerable ,expansion-eligible ,residents ,now ,act or the ,,cover ,now ,act4 #b4 ,demonstration project for political subdivisions of ,states to provide medical assistance for ,medicaid expansion population 7a7 ,in general ,section #aijb of the ,social ,security ,act is amended-- 7#a7 in subsection 7a7-- 7,a7 in paragraph 7#hf71 by striking at the end and2 7,b7 in paragraph 7#hg71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after paragraph 7#hg7 the following new paragraph3 7#hh7 provide1 at the option of the qualifying political subdivisions of a ,state1 for a demonstration project described in subsection 7uu74 2 and 7#b7 by adding at the end the following new subsection3 7uu7 ,demonstration project for political subdivisions of ,states ,to provide medical assistance for expansion population 7#a7 ,in general ,notwithstanding section subsection 7a77#e71 the ,secretary shall conduct a demonstration project under which the ,secretary shall1 subject to paragraph 7#i71 select qualifying political subdivisions described in paragraph 7#b7 to provide1 in accordance with the requirements of this subsection1 medical assistance for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 who reside in such political subdivisions in accordance with the timeline specified under paragraph 7#h74 7#b7 ,waiver authority ,the ,secretary may waive the requirements of paragraphs 7#a7 and 7#e7 of subsection 7a7 relating to statewideness and relating to single state agency1 respectively4 7#c7 ,qualifying political subdivision ,a qualifying political subdivision described in this paragraph is-- 7,a7 a political subdivision-- 7i7 located in a ,state that has not elected to provide medical assistance for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 as of the date of the enactment of this subsection2 and 7ii7 submits an application to the ,secretary-- 7,i7 at such time1 in such manner1 and containing such information as the ,secretary may require2 and 7,,ii7 which has undergone a process for public notice and comment at the political subdivision level1 including public hearings1 sufficient to ensure a meaningful level of public input2 or 7,b7 any number of political subdivisions described in subparagraph 7,a7 which form a partnership for purposes of implementing the demonstration project under this subsection4 7#d7 ,length of demonstration project 7,a7 ,in general ,subject to subparagraph 7,b71 a qualifying political subdivision selected to participate in the demonstration project under this subsection or partnership described in paragraph 7#c77;,b7 7referred to in this subsection as a participating political subdivision7 shall provide medical assistance for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 for seven years or through the day before the date on which the ,state in which such political subdivision is located provides for medical assistance under the ,state plan 7or a waiver of such plan7 for such individuals1 whichever is shorter4 7,b7 ,extension ,a participating political subdivision that participates in the demonstration project under this subsection for five years may extend its participation in the demonstration project by submitting an application to the ,secretary at such time1 in such manner1 and containing such information as the ,secretary may require4 ,under such extension1 such political subdivision shall provide medical assistance for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 for up to an additional five years or through the day before the date on which the ,state in which such political subdivision is located provides for medical assistance under the ,state plan 7or a waiver of such plan7 for such individuals1 whichever is shorter4 7,c7 ,automatic enrollment in case of ,states that elect to provide medical assistance for expansion population ,in the case of a participating political subdivision whose participation in the demonstration project under this subsection ends because the ,state in which such political subdivision is located elects to provide for medical assistance under the ,state plan 7or a waiver of such plan7 for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i71 such ,state shall automatically enroll under such ,state plan 7or waiver7 any eligible and enrolled individual so described receiving medical assistance from such political subdivision and coverage for such individual under such ,state plan 7or waiver7 beginning with the first day on which the ,state provides medical assistance under such ,state plan 7or waiver7 for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i74 7#e7 ,payments 7,a7 ,in general ,the ,secretary shall pay a participating political subdivision the ,federal matching percentage specified in subparagraph 7,b7 for amounts expended by such political subdivision to provide medical assistance for individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i74 7,b7 ,calculation of ,federal and non-,federal share ,except as provided under clause 7ii7 and subparagraph 7,c71 the calculation and payment of the ,federal and non-,federal share of expenditures for medical assistance under a demonstration described in paragraph 7#a7 shall be calculated in accordance with section #aijc as if the qualifying political subdivision was a ,state4 7,c7 ,federal matching percentage ,the ,federal matching percentage specified in this subparagraph1 with respect to a participating political subdivision and the demonstration project under this subsection1 is-- 7i7 #ajj percent for calendar quarters in the first three years that such political subdivision participates in such demonstration project1 if applicable2 7ii7 with respect to a participating political subdivision which-- 7,i7 includes a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ajj percent for calendar quarters in the fourth year that such political subdivision participates in such demonstration project1 if applicable2 and 7,,ii7 does not include a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ie percent for calendar quarters in the fourth year that such political subdivision participates in such demonstration project1 if applicable2 7iii7 with respect to a participating political subdivision which-- 7,i7 includes a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ie percent for calendar quarters in the fifth year that such political subdivision participates in such demonstration project1 if applicable2 and 7,,ii7 does not include a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #id percent for calendar quarters in the fifth year that such political subdivision participates in such demonstration project1 if applicable2 7iv7 with respect to a participating political subdivision which-- 7,i7 includes a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #id percent for calendar quarters in the sixth year that such political subdivision participates in such demonstration project1 if applicable2 and 7,,ii7 does not include a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ic percent for calendar quarters in the sixth year that such political subdivision participates in such demonstration project1 if applicable2 7v7 with respect to a participating political subdivision which-- 7,i7 includes a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ic percent for calendar quarters in the seventh year that such political subdivision participates in such demonstration project1 if applicable2 and 7,,ii7 does not include a rural political subdivision 7as defined by the ,office of ,management and ,budget71 #ij percent for calendar quarters in the seventh year that such political subdivision participates in such demonstration project1 if applicable2 and 7vi7 #ij percent for calendar quarters in the eighth year and any subsequent years thereafter that such political subdivision participates in such demonstration project1 if applicable4 7#f7 ,comparability of benefits to essential health benefits ,the medical assistance made available by a participating political subdivision to individuals described in subclause 7,,viii7 of subsection 7a77#aj77;,a77i7 shall consist of coverage described in subsection 7k77#a74 7#g7 ,reduction in ,federal funding for medical assistance for states that take certain actions 7,a7 ,in general ,in the case of a ,state that does any of the prohibited items described in subparagraph 7,b71 the ,secretary shall withhold from the amount otherwise payable under section #aijc an amount equal to #be percent of the amount of administrative costs under the ,state plan under title ,,xix during a calendar4 7,b7 ,prohibited items ,for purposes of subparagraph 7,a71 a ,state may not-- 7i7 shift the costs of providing medical assistance to individuals enrolled under a ,state plan under title ,,xix to a political subdivision that establishes a demonstration project under this subsection by disenrolling such individuals from the ,state plan to the demonstration project of the political subdivision2 7ii7 withhold or reduce any kind of funding or ,state support to political subdivision on account of the political subdivision's establishment of a demonstration project2 7iii7 increase taxes on taxpayers of a political subdivision on account of the political subdivision's establishment of a demonstration project2 7iv7 require a political subdivision to increase or lower a tax rate required by the political subdivision on account of the political subdivision's establishment of a demonstration project2 7v7 prohibit a political subdivision from participating in a demonstration project pursuant to this subsection2 7vi7 prohibit a political subdivision from participating in a ,federal demonstration project1 establishing or expanding a health coverage program1 contracting or otherwise entering into an agreement with the ,centers for ,medicare ,medicaid ,services1 or receiving ,federal funding directly from a ,federal agency2 7vii7 prohibit a health care provider1 hospital1 federally qualified health center1 or rural health clinic from-- 7,i7 accepting patients with health coverage provided by a political subdivision2 7,,ii7 accepting payments from a political subdivision2 7,,iii7 making payments1 including taxes1 to a political subdivision2 or 7,,iv7 participating in the ,state ,medicaid program on account of participation in a demonstration project pursuant to this subsection2 7viii7 refuse to allow a political subdivision to rely on ,state ,medicaid systems and ,state ,medicaid agency staff to implement a demonstration project1 including-- 7,i7 the ,state's ,medicaid eligibility check and enrollment system2 7,,ii7 provider payment system2 7,,iii7 claims processing system2 7,,iv7 fair hearing system2 and 7,v7 ,federal reporting requirement system2 or 7ix7 take any other punitive action against a political subdivision that establish a demonstration project4 7#h7 ,timeline specified ,for purposes of paragraph 7#a71 the timeline specified in this paragraph shall require-- 7,a7 not later than #ahj days after the date of the enactment of this subsection1 the ,secretary to promulgate any regulations necessary to carry out this subsection1 including-- 7i7 the application requirements for a political subdivision to apply for a demonstration project1 criteria on which applications will be reviewed1 and how long political subdivisions have to begin the demonstration once an application is approved2 and 7ii7 the application of all requirements under section #aijc to a participating political subdivision as if it was a ,state2 7,b7 not later than #ahj days after receiving an application from a qualifying political subdivision described in paragraph 7#c71 the ,secretary to transmit a notice to such qualifying political subdivision of the application's approval or rejection1 and in case of a rejection an explanation for the rejection2 and 7,c7 not later than #g years after the approval of an application1 the ,secretary to transmit a notice to such qualifying political subdivision of the application's approval or rejection for an extension under this subsection4 7#i7 ,limitation on number of demonstration projects ,the ,secretary may not approve more than #ajj demonstration projects under this subsection1 which may consist of demonstration projects implemented by a single participating political subdivision or implemented as partnerships formed by multiple participating political subdivisions 7as described in paragraph 7#c77;,b774 7#aj7 ,application without regard to budget neutrality ,the ,secretary shall not require1 as a condition for carrying out the demonstration project under this subsection1 that the demonstration project ensure that such model is budget neutral initially with respect to expenditures under the applicable title4 7#aa7 ,report ,not later than #d years after the first date of the demonstration project1 the ,secretary shall submit a report to ,congress on-- 7,a7 the effect of the demonstration project on-- 7i7 the number of beneficiaries enrolled in demonstration projects under this subsection2 and 7ii7 the amount of uncompensated care costs for ,state ,medicaid plans2 and 7,b7 whether any ,states with a demonstration project under this subsection have expanded ,medicaid coverage under the ,patient ,protection and ,affordable ,care ,act4 4 7b7 ,payment to ,states ,section #aijc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77 is amended-- 7#a7 in paragraph 7#f71 by striking at the end plus2 7#b7 in paragraph 7#g71 by striking the period at the end and inserting 2 plus2 and 7#c7 by adding at the end the following new paragraph3 7#h7 an amount equal to an increase of #e percentage points to ,federal matching percentage for administrative costs for every #ajj1jjj individuals described in paragraph 7#a7 of section #aaae7;g7 who are enrolled in a demonstration project of a participating political subdivision 7as referred to in paragraph 7#d77;,a7 of such section7 during a calendar quarter4 4