/5WcPJ/s/|9W /fife ^ n 103d CONGRESS 266 1st Session S. 1 To amend title XIX of the Social Security Act to improve the Federal medical assistance percentage used under the medicaid program, and for other purposes. IN THE SENATE OF THE UNITED STATES July 20 (legislative day, June 30), 1993 Mr. Mack (for himself, Mr. Bumpers, Mr. Graham, Mr. Cochran, Mr. Pryor, and Mr. Sasser) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XLX of the Social Security Act to improve the Federal medical assistance percentage used under the medicaid program, and for other purposes. 1 Be it enacted by the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, 3 SECTION SHORT TITLE. 1. 4 This Act may be cited as the "Fairness in Medicaid 5 Funding Act of 1993". — 2 1 SEC. 2. CHANGE IN FEDERAL MEDICAL ASSISTANCE PER- 2 CENTAGE. — 3 (a) In General. Subsection (b) of section 1905 of 4 the Social Security Act (42 U.S.C. 1396d(b)) is amended 5 to read as follows: 6 "(b)(1)(A) Except as provided in paragraph (3), the 7 term 'Federal medical assistance percentage' means, for 8 each of the 50 States and the District of Columbia, 100 9 percent reduced by the product of the applicable percent- 10 age (as defined in subparagraph (B)) and the ratio of 11 "(i)(I) for each of the 50 States, the total tax- 12 able resources ratio (as defined in subparagraph 13 (C)) of the State, or 14 "(II) for the District of Columbia, the per cap- 15 ita income ratio (as defined in subparagraph (D)), 16 to— 17 "(ii) the population in poverty ratio (as defined 18 in subparagraph (E)) of the State or District. 19 "(B)(i) For purposes of this subsection, the term 'ap- 20 plicable percentage' means a percentage estimated by the 21 Secretary with the advice of the General Accounting Office 22 that, when applied under subparagraph (A), would result 23 in an amount of aggregate payments under section 24 1903(a) for calendar years 1994 through 1998 equal to 25 the amount of aggregate payments that would have been 26 made under such section for quarters in such years if this •S 1266 IS — — 3 1 subsection were applied as in effect on the day before the 2 date of the enactment of the Medicaid Fairness in Fund- 3 ingAct of 1993. 4 "(ii) The applicable percentage estimated by the Sec- 5 retary under clause (i) shall continue to apply with respect 6 to quarters beginning after calendar year 1998. 7 "(C) For purposes of this subsection, the term 'total 8 taxable resources ratio' means 9 "(i) an amount equal to the most recent 3-year 10 average of the total taxable resources of the State, 11 as determined by the Secretary of the Treasury, di- 12 vided by 13 "(ii) an amount equal to the sum of the 3-year 14 averages determined under clause (i) for each of the 15 50 States. 16 "(D) For purposes of this subsection, the term 'per 17 capita income ratio' means 18 "(i) an amount equal to the most recent 3-year 19 average of the total personal income of the District 20 of Columbia, as determined in accordance with the 21 provisions of section 1101(a)(8)(B), divided by 22 "(ii) an amount equal to the total personal in- 23 come of the continental United States (including 24 Alaska) and Hawaii, as determined under section 25 1101(a)(8)(B). S 1266 IS — 4 1 "(E) For purposes of this subsection, the term 'popu- 2 lation in poverty ratio' means 3 "(i) an amount equal to the 3-year-average of 4 the number of individuals in the State (or the Dis- 5 trict of Columbia) whose family income is below the 6 income official poverty line (as defined by the Office 7 of Management and Budget and revised annually in 8 accordance with section 673(2) of the Omnibus 9 Budget Reconciliation Act of 1981), divided by 10 "(ii) an amount equal to the sum of the aver- 11 ages determined under clause (i) for the 50 States. 12 "(2) The Federal medical assistance percentage for 13 Puerto Rico, the Virgin Islands, Guam, the Northern Mar- 14 iana Islands, and American Samoa shall be 50 percent. 15 "(3)(A) Except as provided in subparagraph (B), the 16 Federal medical assistance percentage shall in no case be 17 less than 40 percent or greater than 83 percent. 18 "(B) The Federal medical assistance percentage shall 19 be 100 percent with respect to amounts expended as medi- 20 cal assistance for services which are received through an 21 Indian Health Service facility whether operated by the In- 22 dian Health Service or by an Indian tribe or tribal organi- 23 zation (as defined in section 4 of the Indian Health Care 24 Improvement Act). S 1266 IS — 5 1 "(4) For purposes of any provision of law other than 2 a provision of this title, unless otherwise specifically pro- 3 vided, any reference to the 'Federal medical assistance 4 percentage' as defined in this section shall be considered 5 a reference to such term as defined under this subsection 6 as in effect on the day before the date of the enactment 7 of the Medicaid Fairness in Funding Act of 1993.". — 8 (b) Conforming Amendment. Section 1118 of the 9 Social Security Act (42U.S.C. 1318) is amended by strik- 10 ing "(as defined in section 1905)" and inserting "(as de- ll fined in section 1905(b), as in effect on the day before 12 the date of the enactment of the Medicaid Fairness in 13 Funding Act of 1993)". — 14 (c) Effective Date. The amendments made by 15 this section shall apply to payments made to States with 16 respect to calendar quarters beginning on or after January 17 1, 1994. 18 SEC. 3. ADMINISTRATION EXPENDITURES. — 19 (a) In General. Section 1903(a) of the Social Se- 20 curityAct (42 U.S.C. 1396b(a)) is amended— 21 (1) in paragraph (2) 22 (A) in subparagraph (A), by striking "75 23 per centum" and inserting "the Federal medical 24 assistance percentage"; •S 1266 is 6 1 (B) by striking subparagraph (B) and in- 2 serting the following new subparagraph: 3 "(B) with respect to amounts expended for 4 nursing aide training and competency evaluation 5 programs, and competency evaluation programs de- 6 scribed in section 1919(e)(1) (including the costs for 7 nurses aides to complete such competency evaluation 8 programs) regardless of whether the programs are 9 provided in or outside nursing facilities or the skill 10 of the personnel involved in such programs, an 11 amount equal to the Federal medical assistance per- 12 centage of so much of the sums expended during 13 such quarter (as found necessary by the Secretary 14 for the proper and efficient administration of the 15 State plan) as are attributable to such programs; 16 plus"; 17 (C) in subparagraph (C), by striking "75 18 percent" and inserting "the Federal medical as- 19 sistance percentage"; and 20 (D) by striking subparagraph (D) and in- 21 serting the following new subparagraph: 22 "(D) an amount equal to the Federal medical 23 assistance percentage of so much of the sums ex- 24 pended (as found necessary by the Secretary for the 25 proper and efficient administration of the State •S 1266 is — — 7 1 plan) as are attributable to State activities under 2 section 1919(g); plus"; 3 (2) in paragraph (3) 4 (A) in subparagraph (A) 5 (i) by striking "(A)(i)" and inserting 6 "(A)"; 7 (ii) by striking "90 per centum" and 8 inserting "the Federal medical assistance 9 percentage"; 10 (hi) by striking "under this title, and" 11 and inserting "under this title; plus"; and 12 (iv) by striking clause (ii); 13 (B) in subparagraph (B), by striking "75 14 per centum" and inserting "the Federal medical 15 assistance percentage"; 16 (C) in subparagraph (C), by striking "75 17 per centum" and inserting "the Federal medical 18 assistance percentage"; and 19 (D) in subparagraph (D), by striking "75 20 percent" and inserting "the Federal medical as- 21 sistance percentage"; 22 (3) in paragraph (4), by striking "100 percent" 23 and inserting "the Federal medical assistance per- 24 centage"; •S 1266 IS 1 (4) in paragraph (5), by striking "90 per cen- 2 turn" and inserting "the Federal medical assistance 3 percentage"; 4 (5) by striking paragraph (6) and inserting the 5 following new paragraph: 6 "(6) subject to subsection (b)(3), an amount 7 equal to the Federal medical assistance percentage 8 of the sums expended with respect to costs incurred 9 during such quarter (as found necessary by the Sec- 10 retary for the elimination of fraud in the provision 11 and administration of medical assistance provided 12 under the State plan) which are attributable to the 13 establishment and operation of (including the train- 14 ing of personnel employed by) a State medicaid 15 fraud control unit (described in subsection (q)); 16 plus"; and 17 (6) in paragraph (7), by striking "subject to 18 section 1919(g)(3)(B), an amount equal to 50 per 19 centum" and inserting "subject to section 20 1919(g)(3)(C), an amount equal to the Federal med- 21 ical assistance percentage". — 22 (b) Effective Date. The amendments made by 23 this section shall apply to payments made to States with 24 respect to calendar quarters beginning on or after January 25 1994. 1, o •S 1266 IS