S.Amdt. 2989

SA 2989. Mr. MENENDEZ (for himself, Mr. Schumer, Mr. Dodd, Mrs.
Gillibrand, Mr. Kerry, and Mr. Bingaman) submitted an amendment
intended to be proposed to amendment SA 2786 proposed by Mr. Reid (for
himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) to the bill H.R. 3590,
to amend the Internal Revenue Code of 1986 to modify the first-time
homebuyers credit in the case of members of the Armed Forces and
certain other Federal employees, and for other purposes; which was
ordered to lie on the table; as follows:

On page 128, line 6, insert ``, and includes, as elected
under and subject to section 10001, Puerto Rico, the Virgin
Islands, Guam, American Samoa, and the Northern Mariana
Islands''.
Strike section 2005.
On page 2074, after line 25, add the following:

TITLE X--PROVISIONS RELATING TO THE TERRITORIES

SEC. 10001. SPECIAL RULES FOR APPLICATION OF TITLE I TO
TERRITORIES.

(a) One-Time Election for Treatment and Application of
Funding.--
(1) In general.--A territory may elect, in a form and
manner specified by the Secretary of Health and Human
Services jointly with the Secretary of the Treasury, and not
later than October 1, 2013, either--
(A) to be treated as a State for purposes of applying title
I (including establishing an Exchange for such territory); or
(B) not to be so treated but instead, to have the dollar
limitation otherwise applicable to the territory under
subsections (f) and (g) of section 1108 of the Social
Security Act (42 U.S.C. 1308) for a fiscal year increased by
a dollar amount equivalent to the cap amount determined under
subsection (c)(2) for the territory as applied by the
Secretary for the fiscal year involved.
(2) Conditions for acceptance.--The Secretary of Health and
Human Services has the nonreviewable authority to accept or
reject an election described in paragraph (1)(A). Any such
acceptance is--
(A) contingent upon entering into an agreement described in
subsection (b) between the Secretary of Health and Human
Services and the territory and subsection (c); and
(B) subject to the approval of the Secretary of Health and
Human Services and the Secretary of the Treasury and subject
to such other terms and conditions as the Secretaries may
specify.
(3) Default rule.--A territory failing to make such an
election (or having an election under paragraph (1)(A) not
accepted under paragraph (2)) shall be treated as having made
the election described in paragraph (1)(B).
(b) Agreement for Substitution of Percentages for Reduction
in Cost-Sharing.--
(1) Negotiation.--In the case of a territory making an
election under subsection (a)(1)(A) (in this section referred
to as an ``electing territory''), the Secretaries of Health
and Human Services and the Treasury shall enter into
negotiations with the government of such territory so that,
prior to January 1, 2014, there is an agreement reached
between the parties on the percentages that shall be applied
under paragraph (2) for that territory. The Secretary of
Health and Human Services shall not enter into such an
agreement unless--
(A) payments made under title I (and the amendments made by
such title) with respect to residents of the territory are
consistent with the cap established under subsection (c) for
such territory and with subsection (d); and
(B) the requirements of paragraphs (3) and (4) are met.
(2) Application of substitute percentages and dollar
amounts.--In the case of an electing territory, there shall
be substituted in section 1402(b)(2) and section 36B of the
Internal Revenue Code of 1986 for 400 percent, 133 percent,
and other percentages and dollar amounts specified in such
sections, such respective percentages and dollar amounts as
are established under the agreement under paragraph (1)
consistent with the following:
(A) No income gap between medicaid and reduction in cost-
sharing.--The substituted percentages shall be specified in a
manner so as to prevent any gap in coverage for individuals
between the income level at which medical assistance is
available through Medicaid and the income level at which
reduced cost-sharing is available under section 1402.
(B) Adjustment for out-of-pocket responsibility for
premiums and cost-sharing in relation to income.--The
substituted percentages of the Federal poverty line for
income tiers under such sections shall be specified in a
manner so that--
(i) individuals eligible for reduced cost-sharing under
section 1402 residing in the territory bear the same out-of-
pocket responsibility for premiums and cost-sharing in
relation to average income for residents in that territory,
as
(ii) the out-of-pocket responsibility for premiums and
cost-sharing for individuals eligible for reduced cost-
sharing under section 1402 residing in the 50 States or the
District of Columbia in relation to average income for such
residents.

In the case of a territory with a mirror code tax system, the
Internal Revenue Code of 1986 shall be applied as if the
substitutions permitted under this paragraph were included in
such Code.
(3) Special rules with respect to application of tax and
penalty provisions.--The electing territory shall enact one
or more laws under which provisions similar to the following
provisions apply with respect to such territory:
(A) Section 5000A of the Internal Revenue Code of 1986,
except that any resident of the territory who is not eligible
for reduced cost-sharing under section 1402 but who would be
so eligible if such resident were a resident of one of the 50
States (and any qualifying child residing with such
individual) may be treated as covered by minimum essential
coverage.
(B) Section 502(c)(11) of the Employee Retirement Income
Security Act of 1974.
(C) Section 3121(c) of the Internal Revenue Code of 1986.
(4) Implementation of insurance reform and consumer
protection requirements.--The electing territory shall enact
and implement such laws and regulations as may be required to
apply the requirements of subtitles A and C of title I (and
the amendments made by such subtitles) with respect to health
insurance coverage offered in the territory.
(c) Cap on Additional Expenditures.--
(1) In general.--In entering into an agreement with an
electing territory under subsection (b), the Commissioner
shall ensure that the aggregate expenditures under this
section with respect to residents of such territory during
the period beginning on January 1, 2014 and ending with 2019
will not exceed the cap amount specified in paragraph (2) for
such territory. The Commissioner shall adjust from time to
time the percentages applicable under such agreement as
needed in order to carry out the previous sentence.
(2) Cap amount.--
(A) In general.--The cap amount specified in this
paragraph--
(i) for Puerto Rico is $3,700,000,000 increased by the
amount (if any) elected under subparagraph (C); or
(ii) for another territory is the portion of $300,000,000
negotiated for such territory under subparagraph (B).
(B) Negotiation for certain territories.--The Secretary of
Health and Human Services shall negotiate with the
governments of the territories (other than Puerto Rico) to
allocate the amount specified in subparagraph (A)(ii) among
such territories.
(C) Optional supplementation for puerto rico.--
(i) In general.--Puerto Rico may elect, in a form and
manner specified by the Secretary of Health and Human
Services to increase the dollar amount specified in
subparagraph (A)(i) by up to $1,000,000,000.
(ii) Offset in medicaid cap.--If Puerto Rico makes the
election described in clause (i), the Secretary shall
decrease the dollar

[[Page S12638]]

limitation otherwise applicable to Puerto Rico under
subsections (f) and (g) of section 1108 of the Social
Security Act (42 U.S.C. 1308) for a fiscal year by the
additional aggregate payments the Secretary estimates will be
payable under this section for the fiscal year because of
such election.
(d) Limitation on Funding.--In no case shall this section
(including the agreement under subsection (b)) permit--
(1) the obligation of funds for expenditures under this
section for periods beginning on or after January 1, 2020; or
(2) any increase in the dollar limitation described in
subsection (a)(1)(B) for any portion of any fiscal year
occurring on or after such date.

SEC. 10002. MEDICAID PAYMENTS TO TERRITORIES.

(a) Increase in Cap.--Section 1108 of the Social Security
Act (42 U.S.C. 1308) is amended--
(1) in subsection (f), by striking ``subsection (g)'' and
inserting ``subsections (g) and (h)'';
(2) in subsection (g)(1), by striking ``With respect to''
and inserting ``Subject to subsection (h), with respect to'';
and
(3) by adding at the end the following new subsection:
``(h) Additional Increase for Fiscal Years 2011 Through
2019.--Subject to section 10002(b)(1) of the Patient
Protection and Affordable Care Act, with respect to fiscal
years 2011 through 2019, the amounts otherwise determined
under subsections (f) and (g) for Puerto Rico, the Virgin
Islands, Guam, the Northern Mariana Islands and American
Samoa shall be increased by the following amounts:
``(1) For Puerto Rico, for fiscal year 2011, $727,600,000;
for fiscal year 2012, $775,000,000; for fiscal year 2013,
$850,000,000; for fiscal year 2014, $925,000,000; for fiscal
year 2015, $1,000,000,000; for fiscal year 2016,
$1,075,000,000; for fiscal year 2017, $1,150,000,000; for
fiscal year 2018, $1,225,000,000; and for fiscal year 2019,
$1,396,400,000.
``(2) For the Virgin Islands, for fiscal year 2011,
$34,000,000; for fiscal year 2012, $37,000,000; for fiscal
year 2013, $40,000,000; for fiscal year 2014, $43,000,000;
for fiscal year 2015, $46,000,000; for fiscal year 2016,
$49,000,000; for fiscal year 2017, $52,000,000; for fiscal
year 2018, $55,000,000; and for fiscal year 2019,
$58,000,000.
``(3) For Guam, for fiscal year 2011, $34,000,000; for
fiscal year 2012, $37,000,000; for fiscal year 2013,
$40,000,000; for fiscal year 2014, $43,000,000; for fiscal
year 2015, $46,000,000; for fiscal year 2016, $49,000,000;
for fiscal year 2017, $52,000,000; for fiscal year 2018,
$55,000,000; and for fiscal year 2019, $58,000,000.
``(4) For the Northern Mariana Islands, for fiscal year
2011, $13,500,000; fiscal year 2012, $14,500,000; for fiscal
year 2013, $15,500,000; for fiscal year 2014, $16,500,000;
for fiscal year 2015, $17,500,000; for fiscal year 2016,
$18,500,000; for fiscal year 2017, $19,500,000; for fiscal
year 2018, $21,000,000; and for fiscal year 2019,
$22,000,000.
``(5) For American Samoa, fiscal year 2011, $22,000,000;
fiscal year 2012, $23,687,500; for fiscal year 2013,
$24,687,500; for fiscal year 2014, $25,687,500; for fiscal
year 2015, $26,687,500; for fiscal year 2016, $27,687,500;
for fiscal year 2017, $28,687,500; for fiscal year 2018,
$29,687,500; and for fiscal year 2019, $30,687,500.''.
(b) Report on Achieving Medicaid Parity Payments Beginning
With Fiscal Year 2020.--
(1) In general.--Not later than October 1, 2013, the
Secretary of Health and Human Services shall submit to
Congress a report that details a plan for the transition of
each territory to full parity in Medicaid with the 50 States
and the District of Columbia in fiscal year 2020 by modifying
their existing Medicaid programs and outlining actions the
Secretary and the governments of each territory must take by
fiscal year 2020 to ensure parity in financing. Such report
shall include what the Federal medical assistance percentages
would be for each territory if the formula applicable to the
50 States were applied. Such report shall also include any
recommendations that the Secretary may have as to whether the
mandatory ceiling amounts for each territory provided for in
section 1108 of the Social Security Act (42 U.S.C. 1308)
should be increased any time before fiscal year 2020 due to
any factors that the Secretary deems relevant.
(2) Per capita data.--As part of such report the Secretary
shall include information about per capita income data that
could be used to calculate Federal medical assistance
percentages under section 1905(b) of the Social Security Act,
under section 1108(a)(8)(B) of such Act, for each territory
on how such data differ from the per capita income data used
to promulgate Federal medical assistance percentages for the
50 States. The report under this subsection shall include
recommendations on how the Federal medical assistance
percentages can be calculated for the territories beginning
in fiscal year 2020 to ensure parity with the 50 States.
(3) Subsequent reports.--The Secretary shall submit
subsequent reports to Congress in 2015, 2017, and 2019
detailing the progress that the Secretary and the governments
of each territory have made in fulfilling the actions
outlined in the plan submitted under paragraph (1).
(c) Application of FMAP for Additional Funds.--Section
1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by adding
at the end the following sentence: ``Notwithstanding the
first sentence of this subsection and any other provision of
law, for fiscal years 2011 through 2019, the Federal medical
assistance percentage for Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa shall
be the highest Federal medical assistance percentage
applicable to any of the 50 States or the District of
Columbia for the fiscal year involved, taking into account
the application of subsections (a) and (b)(1) of section 5001
of division B of the American Recovery and Reinvestment Act
of 2009 (Public Law 111-5) to such States and the District
for calendar quarters during such fiscal years for which such
subsections apply.''.
(d) Waivers.--
(1) In general.--Section 1902(j) of the Social Security Act
(42 U.S.C. 1396a(j)) is amended--
(A) by striking ``American Samoa and the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, and American Samoa''; and
(B) by striking ``American Samoa or the Northern Mariana
Islands'' and inserting ``Puerto Rico, the Virgin Islands,
Guam, the Northern Mariana Islands, or American Samoa''.
(2) Effective date.--The amendments made by paragraph (1)
shall apply beginning with fiscal year 2011.
(e) Technical Assistance.--The Secretary shall provide
nonmonetary technical assistance to the governments of Puerto
Rico, the Virgin Islands, Guam, the Northern Mariana Islands,
and American Samoa in upgrading their existing computer
systems in order to anticipate meeting reporting requirements
necessary to implement the plan contained in the report under
subsection (b)(1).

SEC. 10003. MEDICARE PROVISIONS RELATING TO PUERTO RICO.

(a) Modification of Medicare Inpatient Hospital Payment
Rate for Puerto Rico Hospitals.--Section 1886(d)(9)(E) of the
Social Security Act (42 U.S.C. 1395ww(d)(9)(E)) is amended--
(1) by striking ``and'' at the end of clause (iii);
(2) in clause (iv), by inserting ``and before April 1,
2010,'' after ``2004,'' and by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following new clause:
``(v) on or after April 1, 2010, the applicable Puerto Rico
percentage is 0 percent and the applicable Federal percentage
is 100 percent.''.
(b) Application of Deemed Part B Medicare Enrollment Rules
to Residents of Puerto Rico.--
(1) In general.--Section 1837(f)(3) of the Social Security
Act (42 U.S.C. 1395p(f)(3)) is amended by striking ``,
exclusive of Puerto Rico''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to individuals whose initial enrollment period
under section 1837(d) of the Social Security Act (42 U.S.C.
1395p(d)) begins on or after the first day of the first month
that begins more than 60 days after the date of the enactment
of this Act.
______