S-1961 : Still Just a Bill

Improving the Treatment of the U.S. Territories Under Federal Health Programs Act of 2015

This bill amends title XIX (Medicaid) of the Social Security Act (SSAct) to: (1) terminate limitations on general Medicaid funding, as well as the specific federal medical assistance percentage, for U.S. territories; (2) extend to additional U.S. territories the authority to waive or modify certain Medicaid requirements; and (3) establish a formula for Medicaid disproportionate share hospital (DSH) payments to the territories.

Federal financial participation shall generally not be available to a territory for medical assistance for an individual whose family income exceeds 100% percent of the official poverty line for a family of that size.

The bill also amends title XVIII (Medicare) of the SSAct to: (1) revise the formula for the Medicare inpatient hospital services payment rate for hospitals in Puerto Rico to increase the applicable federal percentage from 75% to 100%, (2) apply Medicare HITECH (Health Information Technology for Economic and Clinical Health Act) payments to certain hospitals in Puerto Rico, (3) establish a formula element for calculating Medicare DSH payments under the inpatient prospective payment system for certain hospitals in Puerto Rico, (4) allow residents of Puerto Rico to enroll under Medicare hospital services, (5) increase the geographic adjustment practice expense index for Puerto Rico, and (6) alter how U.S territories are treated under Medicare Advantage and the Medicare prescription drug benefit.