Affordable Care Coverage Expansion and Support for States Act or the ACCESS Act
This bill temporarily expands the health insurance premium tax credit. It also establishes a Federal Medicaid Program for states that have not yet expanded Medicaid to certain populations.
Currently, in order to qualify for the health insurance premium tax credit, an individual must, among other criteria, have an annual household income of at least 100% and up to 400% of the federal poverty level and not be eligible for minimum essential coverage, such as affordable coverage through an employer.
The bill removes the income limitations, and it allows individuals with income of up to 138% of the federal poverty level and who are eligible for employer-provided health insurance or small employer health reimbursement arrangements to qualify for the tax credit. The bill's changes apply for tax years 2024-2026.
The bill also establishes and provides funds for a Federal Medicaid Program beginning in 2027 to provide coverage to the Medicaid expansion population in states that have not expanded Medicaid pursuant to the Patient Protection and Affordable Care Act. (The act allows states to extend Medicaid coverage to all adults under the age of 65 with incomes of up to 138% of the federal poverty level.)
The program must offer at least the same benchmark coverage as under Medicaid. The Centers for Medicare & Medicaid Services must contract with Medicaid managed care organizations or other third-party plan administrators to administer the program.
[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3004 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 3004
To amend the Internal Revenue Code of 1986 to provide for a temporary
expansion of health insurance premium tax credits for certain low-
income populations, and to amend title XIX of the Social Security Act
to establish a Federal Medicaid program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 28, 2023
Mrs. Fletcher introduced the following bill; which was referred to the
Committee on Ways and Means, and in addition to the Committee on Energy
and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend the Internal Revenue Code of 1986 to provide for a temporary
expansion of health insurance premium tax credits for certain low-
income populations, and to amend title XIX of the Social Security Act
to establish a Federal Medicaid program.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Affordable Care Coverage Expansion
and Support for States Act'' or the ``ACCESS Act''.
SEC. 2. TEMPORARY EXPANSION OF HEALTH INSURANCE PREMIUM TAX CREDITS FOR
CERTAIN LOW-INCOME POPULATIONS.
(a) In General.--Section 36B of the Internal Revenue Code of 1986
is amended by redesignating subsection (h) as subsection (i) and by
inserting after subsection (g) the following new subsection:
``(h) Certain Temporary Rules Beginning in 2024.--With respect to
any taxable year beginning after December 31, 2023, and before January
1, 2027--
``(1) Eligibility for credit not limited based on income.--
Subsection (c)(1)(A) shall be disregarded in determining
whether a taxpayer is an applicable taxpayer.
``(2) Credit allowed to certain low-income employees
offered employer-provided coverage.--Subclause (II) of
subsection (c)(2)(C)(i) shall not apply if the taxpayer's
household income does not exceed 138 percent of the poverty
line for a family of the size involved. Subclause (II) of
subsection (c)(2)(C)(i) shall also not apply to an individual
described in the last sentence of such subsection if the
taxpayer's household income does not exceed 138 percent of the
poverty line for a family of the size involved.
``(3) Credit allowed to certain low-income employees
offered qualified small employer health reimbursement
arrangements.--A qualified small employer health reimbursement
arrangement shall not be treated as constituting affordable
coverage for an employee (or any spouse or dependent of such
employee) for any months of a taxable year if the employee's
household income for such taxable year does not exceed 138
percent of the poverty line for a family of the size involved.
``(4) Limitations on recapture.--
``(A) In general.--In the case of a taxpayer whose
household income is less than 200 percent of the
poverty line for the size of the family involved for
the taxable year, the amount of the increase under
subsection (f)(2)(A) shall in no event exceed $300
(one-half of such amount in the case of a taxpayer
whose tax is determined under section 1(c) for the
taxable year).
``(B) Limitation on increase for certain non-
filers.--In the case of any taxpayer who would not be
required to file a return of tax for the taxable year
but for any requirement to reconcile advance credit
payments under subsection (f), if an Exchange
established under title I of the Patient Protection and
Affordable Care Act has determined that--
``(i) such taxpayer is eligible for advance
payments under section 1412 of such Act for any
portion of such taxable year, and
``(ii) such taxpayer's household income for
such taxable year is projected to not exceed
138 percent of the poverty line for a family of
the size involved,
subsection (f)(2)(A) shall not apply to such taxpayer
for such taxable year and such taxpayer shall not be
required to file such return of tax.
``(C) Information provided by exchange.--The
information required to be provided by an Exchange to
the Secretary and to the taxpayer under subsection
(f)(3) shall include such information as is necessary
to determine whether such Exchange has made the
determinations described in clauses (i) and (ii) of
subparagraph (B) with respect to such taxpayer.''.
(b) Employer Shared Responsibility Provision Not Applicable With
Respect to Certain Low-Income Taxpayers Receiving Premium Assistance.--
Section 4980H(c)(3) is amended to read as follows:
``(3) Applicable premium tax credit and cost-sharing
reduction.--
``(A) In general.--The term `applicable premium tax
credit and cost-sharing reduction' means--
``(i) any premium tax credit allowed under
section 36B,
``(ii) any cost-sharing reduction under
section 1402 of the Patient Protection and
Affordable Care Act, and
``(iii) any advance payment of such credit
or reduction under section 1412 of such Act.
``(B) Exception with respect to certain low-income
taxpayers.--Such term shall not include any premium tax
credit, cost-sharing reduction, or advance payment
otherwise described in subparagraph (A) if such credit,
reduction, or payment is allowed or paid for a taxable
year of an employee (beginning after December 31, 2023,
and before January 1, 2027) with respect to which--
``(i) an Exchange established under title I
of the Patient Protection and Affordable Care
Act has determined that such employee's
household income for such taxable year is
projected to not exceed 138 percent of the
poverty line for a family of the size involved,
or
``(ii) such employee's household income for
such taxable year does not exceed 138 percent
of the poverty line for a family of the size
involved.''.
(c) Effective Date.--The amendments made by this section shall
apply to taxable years beginning after December 31, 2023.
SEC. 3. CLOSING THE MEDICAID COVERAGE GAP.
(a) Federal Medicaid Program To Close Coverage Gap in Nonexpansion
States.--Title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
is amended by adding at the end the following new section:
``SEC. 1948. FEDERAL MEDICAID PROGRAM TO CLOSE COVERAGE GAP IN
NONEXPANSION STATES.
``(a) Establishment.--In the case of a State that the Secretary
determines (based on the State plan under this title, waiver of such
plan, or other relevant information) is not expected to expend amounts
under the State plan (or waiver of such plan) for all individuals
described in section 1902(a)(10)(A)(i)(VIII) during a year (beginning
with 2027) (in this section defined as `a coverage gap State', with
respect to such year), the Secretary shall (including through contract
with eligible entities (as specified by the Secretary), consistent with
subsection (b)) provide for the offering to such individuals residing
in such State of a health benefits plan (in this section referred to as
the `Federal Medicaid program' or the `Program'), for each quarter
during the period beginning on January 1 of such year, and ending with
the last day of the first quarter during which the State provides
medical assistance to all such individuals under the State plan (or
waiver of such plan). Under the Federal Medicaid program, the
Secretary--
``(1) may use the Federally Facilitated Marketplace to
facilitate eligibility determinations and enrollments under the
Federal Medicaid Program and shall establish a set of
eligibility rules to be applied under the Program in a manner
consistent with section 1902(e)(14); and
``(2) shall establish benefits, beneficiary protections,
and access to care standards by, at a minimum--
``(A) establishing a minimum set of benefits to be
provided (and providing such benefits) under the
Federal Medicaid program, which shall be in compliance
with the requirements of section 1937 and shall consist
of benchmark coverage described in section 1937(b)(1)
or benchmark equivalent coverage described in section
1937(b)(2) to the same extent as medical assistance
provided to such an individual under this title
(without application of this section) is required under
section 1902(k)(1) to consist of such benchmark
coverage or benchmark equivalent coverage;
``(B) applying the provisions of sections
1902(a)(8), 1902(a)(34) (which may be applied in
accordance with such phased-in implementation as the
Secretary deems necessary, but beginning as soon as
practicable), and 1943 with respect to such an
individual, benefits under the Federal Medicaid
program, and making application for such benefits
(which may be in accordance with a phased-in
implementation as the Secretary deems necessary, but
beginning as soon as practicable) in the same manner as
such provisions would apply to such an individual,
medical assistance under this title (other than
pursuant to this section), and making application for
such medical assistance under this title (other than
pursuant to this section); and providing that
redeterminations and appeals of eligibility and
coverage determinations of services (including benefit
reductions, terminations, and suspension) shall be
conducted under the Federal Medicaid program in
accordance with a Federal fair hearing process
established by the Secretary that is subject to the
same requirements as applied with respect to
redeterminations and appeals of eligibility, and with
respect to coverage of services (including benefit
reductions, terminations, and suspension), under a
State plan under this title and that may provide for
such fair hearings related to denials of eligibility
(based on modified adjusted gross income eligibility
determinations) to be conducted through the Federally
Facilitated Marketplace for Exchanges;
``(C) applying, in accordance with subsection (d),
the provisions of section 1927 (other than
subparagraphs (B) and (C) of subsection (b)(1) of such
section) with respect to the Secretary and payment
under the Federal Medicaid program for covered
outpatient drugs with respect to a rebate period in the
same manner and to the same extent as such provisions
apply with respect to a State and payment under the
State plan for covered outpatient drugs with respect to
the rebate period; and
``(D) applying the provisions of sections
1902(a)(14), 1902(a)(23), 1902(a)(47), and 1920 through
1920C (as applicable) to the Federal Medicaid program
and such individuals enrolled in such program in the
same manner and to the same extent as such provisions
apply to a State plan and such individuals eligible for
medical assistance under the State plan, and applying
the provisions of section 1902(a)(30)(A) with respect
to medical assistance available under the Federal
Medicaid program in the same manner and to the same
extent as such provisions apply to medical assistance
under a State plan under this title, except that--
``(i) the Secretary shall provide that no
cost sharing shall be applied under the Federal
Medicaid program;
``(ii) the Secretary may waive the
provisions of subparagraph (A) of section
1902(a)(23) to the extent deemed appropriate to
facilitate the implementation of managed care;
and
``(iii) in applying the provisions of
section 1902(a)(47) and sections 1920 through
1920C, the Secretary--
``(I) shall establish a single
presumptive eligibility process for
individuals eligible under the Federal
Medicaid program, under which the
Secretary may contract with entities to
carry out such process; and
``(II) may apply such provisions
and process in accordance with such
phased-in implementation as the
Secretary deems necessary, but
beginning as soon as practicable.
``(b) Administration of Federal Medicaid Program Through Contracts
With Medicaid Managed Care Organization and Third Party Plan
Administrator Requirements.--
``(1) In general.--For the purpose of administering the
benefits under the Program (across all coverage gap geographic
areas (as defined in paragraph (8))) to provide medical
assistance to individuals described in section
1902(a)(10)(A)(i)(VIII) enrolled under the Federal Medicaid
program and residing in such areas, the Secretary shall solicit
bids described in paragraph (2) and enter into contracts with a
total of at least 2 eligible entities (as specified by the
Secretary, which may be a medicaid managed care organization
(in this section defined as including a managed care
organization described in section 1932(a)(1)(B)(i), a prepaid
inpatient health plan, and a prepaid ambulatory health plans
(as defined in section 438.2 of title 42, Code of Federal
Regulations)), a third party plan administrator, or both). An
eligible entity entering into a contract with the Secretary
under this paragraph may administer such benefits as a Medicaid
managed care organization (as so defined), in which case such
contract shall be in accordance with paragraph (3) with respect
to such geographic area, or as a third-party administrator, in
which case such contract shall be in accordance with paragraph
(4) with respect to such geographic area. The Secretary may so
contract with a Medicaid managed care organization or third
party plan administrator in each coverage gap geographic area
(and may specify which type of eligible entity may bid with
respect to a coverage gap geographic area or areas) and may
contract with more than one such eligible entity in the same
coverage gap geographic area.
``(2) Bids.--
``(A) In general.--To be eligible to enter into a
contract under this subsection, for a year, an entity
shall submit (at such time, in such manner, and
containing such information as specified by the
Secretary) one or more bids to administer the Program
in one or more coverage gap geographic areas, which
reflects the projected monthly cost to the entity of
furnishing benefits under the Program to an individual
enrolled under the Program in such a geographic area
(or areas) for such year.
``(B) Selection.--In selecting from bids submitted
under subparagraph (A) for purposes of entering into
contracts with eligible entities under this subsection,
with respect to a coverage gap geographic area, the
Secretary shall take into account at least each of the
following, with respect to each such bid:
``(i) Network adequacy (as proposed in the
submitted bid).
``(ii) The amount, duration, and scope of
benefits (such as value-added services offered
in the submitted bid), as compared to the
minimum set of benefits established by the
Secretary under subsection (a)(2)(A).
``(iii) The amount of the bid, taking into
account the average per member cost of
providing medical assistance under State plans
under this title (or waivers of such plans) to
individuals enrolled in such plans (or waivers)
who are at least 18 years of age and residing
in the coverage gap geographic area, as well as
the average cost of providing medical
assistance under State plans under this title
(and waivers of such plans) to individuals
described in section 1902(a)(10)(A)(i)(VIII).
``(3) Contract with medicaid managed care organization.--In
the case of a contract under paragraph (1) between the
Secretary and an eligible entity administering benefits under
the Program as a Medicaid managed care organization, with
respect to one or more coverage gap geographic areas, the
following shall apply:
``(A) The provisions of clauses (i) through (xi) of
section 1903(m)(2)(A), clause (xii) of such section (to
the extent such clause relates to subsections (b) and
(f) of section 1932), and clause (xiii) of such section
1903(m)(2)(A) shall, to the greatest extent
practicable, apply to the contract, to the Secretary,
and to the Medicaid managed care organization, with
respect to providing medical assistance under the
Federal Medicaid program with respect to such area, in
the same manner and to the same extent as such
provisions apply to a contract under section 1903(m)
between a State and an entity that is a Medicaid
managed care organization (as defined in section
1903(m)(1)), to the State, and to the entity, with
respect to providing medical assistance to individuals
eligible for benefits under this title.
``(B) The provisions of section 1932(h) shall apply
to the contract, Secretary, and Medicaid managed care
organization.
``(C) The contract shall provide that the entity
pay claims in a timely manner and in accordance with
the provisions of section 1902(a)(37).
``(D) The contract shall provide that the Secretary
shall make payments under this section to the entity,
with respect to coverage of each individual enrolled
under the Program in such a coverage gap geographic
area with respect to which the entity administers the
Program in an amount specified in the contract, subject
to subparagraph (D)(ii) and paragraph (6).
``(E) The contract shall require--
``(i) the application of a minimum medical
loss ratio (as calculated under subsection (d)
of section 438.8 of title 42, Code of Federal
Regulations (or any successor regulation)) for
payment for medical assistance administered by
the managed care organization under the
Program, with respect to a year, that is equal
to or greater than 85 percent (or such higher
percent as specified by the Secretary); and
``(ii) in the case, with respect to a year,
the minimum medical loss ratio (as so
calculated) for payment for services under the
benefits so administered is less than 85
percent (or such higher percent as specified by
the Secretary under clause (i)), remittance by
the organization to the Secretary of any
payments (or portions of payments) made to the
organization under this section in an amount
equal to the difference in payments for medical
assistance, with respect to the year, resulting
from the organization's failure to meet such
ratio for such year.
``(F) The contract shall require that the eligible
entity submit to the Secretary the number of
individuals enrolled in the Program with respect to
each coverage gap geographic area and month with
respect to which the contract applies and such
additional information as specified by the Secretary
for purposes of payment, program integrity, oversight,
quality measurement, or such other purpose specified by
the Secretary.
``(G) The contract shall require that the eligible
entity perform any other activity identified by the
Secretary.
``(4) Contract with a third party plan administrator.--
``(A) In general.--In the case of a contract under
paragraph (1) between the Secretary and an eligible
entity to administer the Program as a third party plan
administrator, with respect to one or more coverage gap
geographic areas, such contract shall provide that,
with respect to medical assistance provided under the
Federal Medicaid program to individuals who are
enrolled in the Program with respect to such area (or
areas)--
``(i) the third party plan administrator
shall, consistent with such requirements as may
be established by the Secretary--
``(I) establish provider networks,
payment rates, and utilization
management, consistent with the
provisions of section 1902(a)(30)(A),
as applied by subsection (a)(4);
``(II) pay claims in a timely
manner and in accordance with the
provisions of section 1902(a)(37);
``(III) submit to the Secretary the
number of individuals enrolled in the
Program with respect to each coverage
gap geographic area and month with
respect to which the contract applies
and such additional information as
specified by the Secretary for purposes
of payment, program integrity,
oversight, quality measurement, or such
other purpose specified by the
Secretary; and
``(IV) perform any other activity
identified by the Secretary; and
``(ii) the Secretary shall make payments
(for the claims submitted by the third party
plan administrator and for an economic and
efficient administrative fee) under this
section to the third party plan administrator,
with respect to coverage of each individual
enrolled under the Program in a coverage gap
geographic area with respect to which the third
party plan administrator administers the
Program in an amount determined under the
contract, subject to subclause (VI)(bb) and
paragraph (7).
``(B) Third party plan administrator defined.--For
purposes of this section, the term `third party plan
administrator' means an entity that satisfies such
requirements as established by the Secretary, which
shall include at least that such an entity administers
health plan benefits, pays claims under the plan,
establishes provider networks, sets payment rates, and
are not risk-bearing entities.
``(5) Administrative authority.--The Secretary may take
such actions as are necessary to administer this subsection,
including by setting payment rates, setting network adequacy
standards, establishing quality requirements, establishing
reporting requirements, and specifying any other program
requirements or standards necessary in contracting with
specified entities under this subsection, and overseeing such
entities, with respect to the administration of the Federal
Medicaid program.
``(6) Preemption.--In carrying out the duties under a
contract entered into under paragraph (1) between the Secretary
and a Medicaid managed care organization or a third party plan
administrator, with respect to a coverage gap State--
``(A) the Secretary may establish minimum standards
and licensure requirements for such a Medicaid managed
care organization or third party plan administrator for
purposes of carrying out such duties; and
``(B) any provisions of law of that State which
relate to the licensing of the organization or
administrator and which prohibit the organization or
administrator from providing coverage pursuant to a
contract under this section shall be superseded.
``(7) Penalties.--In the case of an eligible entity with a
contract under this section that fails to comply with the
requirements of such entity pursuant to this section or such
contract, the Secretary may withhold payment (or any portion of
such payment) to such entity under this section in accordance
with a process specified by the Secretary, impose a corrective
action plan on such entity, or impose a civil monetary penalty
on such entity in an amount not to exceed $10,000 for each such
failure. In implementing this paragraph, the Secretary shall
have the authorities provided the Secretary under section
1932(e) and subparts F and I of part 438 of title 42, Code of
Federal Regulations.
``(8) Coverage gap geographic area.--For purposes of this
section, the term `coverage gap geographic area' means an area
of one or more coverage gap States, as specified by the
Secretary, or any area within such a State, as specified by the
Secretary.
``(c) Periodic Data Matching.--The Secretary shall, including
through contract, periodically verify the income of an individual
enrolled in the Federal Medicaid program for a year, before the end of
such year, to determine if there has been any change in the
individual's eligibility for benefits under the program. For purposes
of the previous sentence, the Secretary may verify income of an
individual based on the prospective income of the individual for such
year or based on current monthly income of the individual, as specified
by the Secretary. In the case that, pursuant to such verification, an
individual is determined to have had a change in income that results in
such individual no longer be included as an individual described in
section 1902(a)(10)(A)(i)(VIII), the Secretary shall apply the same
processes and protections as States are required under this title to
apply with respect to an individual who is determined to have had a
change in income that results in such individual no longer being
included as eligible for medical assistance under this title (other
than pursuant to this section).
``(d) Drug Rebates.--For purposes of subsection (a)(2)(B), in
applying section 1927, the Secretary shall (either directly or through
contracts)--
``(1) require an eligible entity with a contract under
subsection (b) to report the data required to be reported under
section 1927(b)(2) by a State agency and require such entity to
submit to the Secretary rebate data, utilization data, and any
other information that would otherwise be required under
section 1927 to be submitted to the Secretary by a State;
``(2) shall take such actions as are necessary and develop
or adapt such processes and mechanisms as are necessary to
report and collect data as is necessary and to bill and track
rebates under section 1927, as applied pursuant to subsection
(a)(2)(B) for drugs that are provided under the Federal
Medicaid program;
``(3) provide that the coverage requirements of
prescription drugs under the Federal Medicaid program comply
with the coverage requirements section 1927; and
``(4) require that in order for payment to be available
under the Federal Medicaid program or under section 1903(a) for
covered outpatient drugs of a manufacturer, the manufacturer
must have entered into and have in effect a rebate agreement to
provide rebates under section 1927 to the Federal Medicaid
program in the same form and manner as the manufacturer is
required to provide rebates under an agreement described in
section 1927(b) to a State Medicaid program under this title.
``(e) Transitions.--
``(1) From exchange plans onto federal medicaid program.--
The Secretary shall provide for a process under which, in the
case of individuals described in section
1902(a)(10)(A)(i)(VIII) who are enrolled in qualified health
plans through an Exchange in a coverage gap State, the
Secretary takes such steps as are necessary to transition such
individuals to coverage under the Federal Medicaid program.
Such process shall apply procedures described in section
1943(b)(1)(C) to screen for eligibility and enrollment under
the Federal Medicaid program in the same manner as such
procedures screen for eligibility and enrollment under
qualified health plans through an Exchange established under
title I of the Patient Protection and Affordable Care Act.
``(2) In case coverage gap state begins providing coverage
under state plan.--The Secretary shall provide for a process
for, in the case of a coverage gap State in which the State
begins to provide medical assistance to individuals described
in section 1902(a)(10)(A)(i)(VIII) under the State plan (or
waiver of such plan) and the Federal Medicaid program ceases to
be offered, transitioning individuals from such program to the
State plan (or waiver), as eligible, including a process for
transitioning all eligibility redeterminations.
``(f) Coordination With and Enrollment Through Exchanges.--The
Secretary shall take such actions as are necessary to provide, in the
case of a coverage gap State in which the Federal Medicaid program is
offered, for the availability of information on, determinations of
eligibility for, and enrollment in such program through and coordinated
with the Exchange established with respect to such State under title I
of the Patient Protection and Affordable Care Act.
``(g) Third Party Liability.--The provisions of section 1902(a)(25)
shall apply with respect to the Federal Medicaid program, the
Secretary, and the eligible entities with a contract under subsection
(b) in the same manner as such provisions apply with respect to State
plans under this title (or waiver of such plans) and the State or local
agency administering such plan (or waiver). The Secretary may specify a
timeline (which may include a phase-in) for implementing this
subsection.
``(h) Fraud And Abuse Provisions.--Provisions of law (other than
criminal law provisions) identified by the Secretary by regulation, in
consultation (as appropriate) with the Inspector General of the
Department of Health and Human Services, that impose sanctions with
respect to waste, fraud, and abuse under this title or title XI, such
as the False Claims Act, as well as provisions of law (other than
criminal law provisions) identified by the Secretary that provide
oversight authority, shall also apply to the Federal Medicaid program.
``(i) Maintenance of Effort.--
``(1) Payment.--
``(A) In general.--In the case of a State that, as
of January 1, 2027, is expending amounts for all
individuals described in section
1902(a)(10)(A)(i)(VIII) under the State plan (or waiver
of such plan) and that stops expending amounts for all
such individuals under the State plan (or waiver of
such plan), such State shall for each quarter beginning
after January 1, 2027, during which such State does not
expend amounts for all such individuals provide for
payment under this subsection to the Secretary of the
product of--
``(i) 10 percent of, subject to
subparagraph (B), the average monthly per
capita costs expended under the State plan (or
waiver of such plan) for such individuals
during the most recent previous quarter with
respect to which the State expended amounts for
all such individuals; and
``(ii) the sum, for each month during such
quarter, of the number of individuals enrolled
under such program in such State.
``(B) Annual increase.--For purposes of
subparagraph (A), in the case of a State with respect
to which such subparagraph applies with respect to a
period of consecutive quarters occurring during more
than one calendar year, for such consecutive quarters
occurring during the second of such calendar years or a
subsequent calendar year, the average monthly per
capita costs for each such quarter for such State
determined under subparagraph (A)(i), or this
subparagraph, shall be annually increased by the
Secretary by the percentage increase in Medicaid
spending under this title during the preceding year (as
determined based on the most recent National Health
Expenditure data with respect to such year).
``(2) Form and manner of payment.--Payment under paragraph
(1) shall be made in a form and manner specified by the
Secretary.
``(3) Compliance.--If a State fails to pay to the Secretary
an amount required under paragraph (1), interest shall accrue
on such amount at the rate provided under section 1903(d)(5).
The amount so owed and applicable interest shall be immediately
offset against amounts otherwise payable to the State under
section 1903(a), in accordance with the Federal Claims
Collection Act of 1996 and applicable regulations.
``(4) Data match.--The Secretary shall perform such
periodic data matches as may be necessary to identify and
compute the number of individuals enrolled under the Federal
Medicaid program under section 1948 in a coverage gap State (as
referenced in subsection (a) of such section) for purposes of
computing the amount under paragraph (1).
``(5) Notice.--The Secretary shall notify each State
described in paragraph (1) not later than a date specified by
the Secretary that is before the beginning of each quarter
(beginning with 2027) of the amount computed under paragraph
(1) for the State for that year.
``(j) Appropriations.--There is appropriated, out of any funds in
the Treasury not otherwise appropriated, for each fiscal year such sums
as are necessary to carry out subsections (a) through (i) of this
section.''.
(b) Drug Rebate Conforming Amendment.--Section 1927(a)(1) of the
Social Security Act (42 U.S.C. 1396r-8(a)(1)) is amended in the first
sentence--
(1) by striking ``or under part B of title XVIII'' and
inserting ``, under the Federal Medicaid program under section
1948, or under part B of title XVIII''; and
(2) by inserting ``including as such subsection is applied
pursuant to subsections (a)(2)(C) and (d) of section 1948 with
respect to the Federal Medicaid program,'' before ``and must
meet''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health.
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