S.Amdt. 532

SA 532. Mr. RUBIO submitted an amendment intended to be proposed by
him to the bill H.R. 1628, to provide for reconciliation pursuant to
title II of the concurrent resolution on the budget for fiscal year
2017; which was ordered to lie on the table; as follows:

On page 37, insert the following after line 13:
``(5) Adjustments to state expenditures targets to promote
program equity across states.--
``(A) In general.--Beginning with fiscal year 2020, the
target per capita medical assistance expenditures for a 1903A
enrollee category, State, and fiscal year, as determined
under paragraph (2), shall be adjusted (subject to
subparagraph (C)(i)) in accordance with this paragraph.
``(B) Adjustment based on level of per capita spending for
1903a enrollee categories.--Subject to subparagraph (C), with
respect to a State, fiscal year, and 1903A enrollee category,
if the State's per capita categorical medical assistance
expenditures (as defined in subparagraph (D)) for the State
and category in the preceding fiscal year--
``(i) exceed the mean per capita categorical medical
assistance expenditures for the category for all States for
such preceding year by not less than 25 percent, the State's
target per capita medical assistance expenditures for such
category for the fiscal year involved shall be reduced by a
percentage that shall be determined by the Secretary but
which shall not be less than 0.5 percent or greater than 3
percent; or
``(ii) are less than the mean per capita categorical
medical assistance expenditures for the category for all
States for such preceding year by not less than 25 percent,
the State's target per capita medical assistance expenditures
for such category for the fiscal year involved shall be
increased by a percentage that shall be determined by the
Secretary but which shall not be less than 0.5 percent or
greater than 3 percent.
``(C) Rules of application.--
``(i) Budget neutrality requirement.--In determining the
appropriate percentages by which to adjust States' target per
capita medical assistance expenditures for a category and
fiscal year under this paragraph, the Secretary shall make
such adjustments in a manner that does not result in a net
increase in Federal payments under this section for such
fiscal year, and if the Secretary cannot adjust such
expenditures in such a manner there shall be no adjustment
under this paragraph for such fiscal year.
``(ii) Assumption regarding state expenditures.--For
purposes of clause (i), in the case of a State that has its
target per capita medical assistance expenditures for a 1903A
enrollee category and fiscal year increased under this
paragraph, the Secretary shall assume that the categorical
medical assistance expenditures (as defined in subparagraph
(D)(ii)) for such State, category, and fiscal year will equal
such increased target medical assistance expenditures.
``(iii) Nonapplication to low-density states.--This
paragraph shall not apply to any State that has a population
density of less than 15 individuals per square mile, based on
the most recent data available from the Bureau of the Census.
``(iv) Disregard of adjustment.--Any adjustment under this
paragraph to target medical assistance expenditures for a
State, 1903A enrollee category, and fiscal year shall be
disregarded when determining the target medical assistance
expenditures for such State and category for a succeeding
year under paragraph (2).
``(v) Application for fiscal years 2020 and 2021.--In
fiscal years 2020 and 2021, the Secretary shall apply this
paragraph by deeming all categories of 1903A enrollees to be
a single category.
``(D) Per capita categorical medical assistance
expenditures.--
``(i) In general.--In this paragraph, the term `per capita
categorical medical assistance expenditures' means, with
respect to a State, 1903A enrollee category, and fiscal year,
an amount equal to--

``(I) the categorical medical expenditures (as defined in
clause (ii)) for the State, category, and year; divided by
``(II) the number of 1903A enrollees for the State,
category, and year.

``(ii) Categorical medical assistance expenditures.--The
term `categorical medical assistance expenditures' means,
with respect to a State, 1903A enrollee category, and fiscal
year, an amount equal to the total medical assistance
expenditures (as defined in paragraph (2)) for the State and
fiscal year that are attributable to 1903A enrollees in the
category, excluding any excluded expenditures (as defined in
paragraph (3)) for the State and fiscal year that are
attributable to 1903A enrollees in the category.
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