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Bill
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Title II — Medicare

S. 1773 · 116th Congress · Jun 11, 2019 · Lineage

II Medicare

A Part A

Sec. 201 Calculation of Medicare DSH payments for IPPS hospitals in Puerto Rico

Section 1886(d)(9)(D)(iii) of the Social Security Act (42 U.S.C. 1395ww(d)(9)(D)(iii)) is amended to read as follows:

“(iii) Subparagraph (F) (relating to disproportionate share payments), including application of subsection (r), except that for this purpose—

“(I) the sum described in clause (ii) of this subparagraph shall be substituted for the sum referred to in paragraph (5)(F)(ii)(I); and

“(II) for discharges occurring on or after October 1, 2019, subclause (I) of paragraph (5)(F)(vi) shall be applied by substituting for the numerator described in such subclause the number of subsection (d) Puerto Rico hospital’s patient days for the cost reporting period involved which were made up of patients who (for such days) were entitled to benefits under part A of this title and were—

“(aa) entitled to supplementary security income benefits (excluding any State supplementation) under title XVI of this Act;

“(bb) eligible for medical assistance under a State plan under title XIX; or

“(cc) receiving aid or assistance under any plan of the State approved under title I, X, XIV, or XVI.”

Sec. 202 Rebasing target amount for hospitals in territories

Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)) is amended by adding at the end the following new subparagraph:

“(M)

“(i) For each cost reporting period beginning on or after October 1, 2019, in the case of a hospital located in a territory of the United States, there shall be substituted for the target amount otherwise determined under subparagraph (A) the rebased target amount (as defined in clause (ii)), if such substitution results in an amount of payment under this section to the hospital for such period that is greater than the amount of payment that would be made under this section to the hospital for such period if this subparagraph were not to apply.

“(ii) For purposes of this subparagraph, the term “rebased target amount” has the meaning given the term “target amount” in subparagraph (A), except that—

“(I) there shall be substituted for the preceding 12-month cost reporting period the 12-month cost reporting period beginning during fiscal year 2015 (or, at the option of the hospital, beginning during fiscal year 2017);

“(II) any reference in subparagraph (A)(i) to the “first such cost reporting period” is deemed a reference to the first cost reporting period following the 12-month cost reporting period beginning during fiscal year 2015 (or, at the option of the hospital, beginning during fiscal year 2017); and

“(III) the applicable percentage increase shall only be applied under subparagraph (B)(ii) for cost reporting periods beginning on or after October 1, 2019.

“(iii) Nothing in this subparagraph shall affect any pending request by a hospital for a new target amount for any cost reporting period beginning during a fiscal year before fiscal year 2020.”

Sec. 203 Medicare DSH target adjustment for hospitals in territories

Section 1886(b)(3) of the Social Security Act (42 U.S.C. 1395ww(b)(3)), as amended by section 202, is further amended by adding at the end the following new subparagraph:

“(N)

“(i) For each cost reporting period beginning on or after October 1, 2019, in the case of a hospital that is located in a territory of the United States other than Puerto Rico and that would be a subsection (d) hospital if it were located in one of the 50 States, the target amount shall be increased by—

“(I) in the case that such hospital has a disproportionate patient percentage of not less than 15 percent and not greater than 40 percent, 10 percent; and

“(II) in the case that such hospital has a disproportionate patient percentage of greater than 40 percent, 10 percent plus 60 percent of the number of percentage points by which such hospital’s disproportionate patient percentage exceeds 40 percent.

“(ii) For purposes of this subparagraph, the term “disproportionate patient percentage” has the meaning given such term in subsection (d)(5)(F)(vi), except that in applying such meaning any reference under such subsection to individuals entitled to supplementary security income under title XVI shall be deemed for purposes of this subparagraph to include individuals—

“(I) eligible for medical assistance under a State plan under title XIX; or

“(II) receiving aid or assistance under any plan of the territory approved under title I, X, XIV, or XVI.”

B Part B

Sec. 211 Application of part B deemed enrollment process to residents of Puerto Rico; special enrollment period and limit on late enrollment penalties

(a)
Application of part B deemed enrollment process to residents of Puerto Rico— Section 1837(f)(3) of the Social Security Act (42 U.S.C. 1395p(f)(3)) is amended by striking “, exclusive of Puerto Rico”.
(b)
Effective date— The amendment made by subsection (a) shall apply to individuals whose initial enrollment period under section 1837(d) of the Social Security Act begins on or after the first day of the effective month, specified by the Secretary of Health and Human Services under section 1839(j)(1)(C) of such Act, as added by subsection (c)(2).
(c)
Transition providing special enrollment period and limit on late enrollment penalties for certain Medicare beneficiaries— Section 1839 of the Social Security Act (42 U.S.C. 1395r) is amended—
(1)
in the first sentence of subsection (b), by inserting “subject to section 1839(j)(2),” after “subsection (i)(4) or (l) of section 1837,”; and
(2)
by adding at the end the following new subsection:

“(j) Special rules for certain residents of Puerto Rico

“(1) Special enrollment period, coverage period for residents who are eligible but not enrolled

“(A) In general—In the case of a transition individual (as defined in paragraph (3)) who is not enrolled under this part as of the day before the first day of the effective month (as defined in subparagraph (C)), the Secretary shall provide for a special enrollment period under section 1837 of 7 months beginning with such effective month during which the individual may be enrolled under this part.

“(B) Coverage period—In the case of such an individual who enrolls during such special enrollment period, the coverage period under section 1838 shall begin on the first day of the second month after the month in which the individual enrolls.

“(C) Effective month defined—In this section, the term effective month means a month, not earlier than October 2020 and not later than January 2021, specified by the Secretary.

“(2) Reduction in late enrollment penalties for current enrollees and individuals enrolling during transition

“(A) In general—In the case of a transition individual who is enrolled under this part as of the day before the first day of the effective month or who enrolls under this part on or after the date of the enactment of this subsection but before the end of the special enrollment period under paragraph (1)(A), the amount of the late enrollment penalty imposed under section 1839(b) shall be recalculated by reducing the penalty to 15 percent of the penalty otherwise established.

“(B) Application—Subparagraph (A) shall be applied in the case of a transition individual who—

“(i) is enrolled under this part as of the month before the effective month, for premiums for months beginning with such effective month; or

“(ii) enrolls under this part on or after the date of the enactment of this Act and before the end of the special enrollment period under paragraph (1)(A), for premiums for months during the coverage period under this part which occur during or after the effective month.

“(C) Loss of reduction if individual terminates enrollment—Subparagraph (A) shall not apply to a transition individual if the individual terminates enrollment under this part after the end of the special enrollment period under paragraph (1).

“(3) Transition individual defined—In this section, the term transition individual means an individual who resides in Puerto Rico and who would have been deemed enrolled under this part pursuant to section 1837(f) before the first day of the effective month but for the fact that the individual was a resident of Puerto Rico, regardless of whether the individual is enrolled under this part as of such first day.”

C Medicare Advantage (Part C)

Sec. 221 Adjustment in benchmark for low-base payment counties in Puerto Rico

Section 1853(n) of the Social Security Act (42 U.S.C. 1395w–23(n)) is amended—
(1)
in paragraph (1), by striking “and (5)” and inserting “(5), and (6)”;
(2)
in paragraph (4), by striking “In no case” and inserting “Subject to paragraph (6), in no case”; and
(3)
by adding at the end the following new paragraph:

“(6) Special rules for blended benchmark amount for territories

“(A) In general—Subject to subparagraph (B), the blended benchmark amount for an area in a territory for a year (beginning with 2020) shall not be less than 80 percent of the national average of the base payment amounts specified in subparagraph (2)(E) for such year for areas within the 50 States and the District of Columbia.

“(B) Limitation—In no case shall the blended benchmark amount for an area in a territory for a year under subparagraph (A) exceed the lowest blended benchmark amount for any area within the 50 States and the District of Columbia for such year.”

D Part D

Sec. 231 Improved use of allocated prescription drug funds by territories

Section 1935(e) of the Social Security Act (42 U.S.C. 1396u–5(e)) is amended by adding at the end the following new paragraph:

“(5) Improved use of funds for low-income part d eligible individuals—This subsection shall be applied beginning with fiscal year 2020 as follows, notwithstanding any other provision of this title:

“(A) Clarifying state flexibility to cover non-dual-eligible individuals—In this title, the term “medical assistance” includes financial assistance furnished by a State under this subsection to part D eligible individuals who, if they were residing in one of the 50 States or the District of Columbia, would qualify as subsidy eligible individuals under section 1860D–14(a)(3), and without regard to whether such individuals otherwise qualify for medical assistance under this title.

“(B) 100 percent fmap to reflect no state matching required for part d low income subsidies—The Federal medical assistance percentage applicable to the assistance furnished under this subsection is 100 percent.

“(C) Limited funding for special rules—Subparagraphs (A) and (B), and the provision of medical assistance for covered part D drugs to low-income part D eligible individuals for a State and period under this subsection, is limited to the amount specified in paragraph (3) for such State and period.”

Sec. 232 Report on treatment of territories under Medicare part D

Paragraph (4) of section 1935(e) of the Social Security Act (42 U.S.C. 1396u–5(e)) is amended to read as follows:

“(4) Report on application of subsection

“(A) In general—Not later than February 1, 2021, the Secretary shall submit to Congress a report on the application of this subsection during the period beginning fiscal year 2006 and ending fiscal year 2020.

“(B) Information to be included in report—Such report shall include—

“(i) program guidance issued by the Secretary to implement this subsection;

“(ii) for each territory, information on the increased amount under paragraph (3) and how the territory has applied such amount, including the territory’s program design, expenditures, and number of individuals (and dual-eligible individuals) assisted; and

“(iii) differences between how such territories are treated under part D of title XVIII and under this title compared with the treatment of the 50 States and the District of Columbia under such part and this title for different fiscal years within the period covered under the report.

“(C) Recommendations—Such report shall include recommendations for improving prescription drug coverage for low-income individuals in each territory, including recommendations regarding each of the following alternative approaches:

“(i) Adjusting the aggregate amount specified in paragraph (3)(B).

“(ii) Allowing residents of the territories to be subsidy eligible individuals under section 1860D–14, notwithstanding subsection (a)(3)(F) of such section, or providing substantially equivalent low-income prescription drug subsidies to such residents.”