This bill would eliminate disparities in Medicare and Medicaid coverage that disadvantage U.S. territories (like Puerto Rico, American Samoa, and Guam) when funds are disbursed to territorial governments and health care providers.
The cap on Medicaid funding for territories, and the limitation on the percentage of medical assistance the federal government can provide through Medicaid would be eliminated. All territories would be granted waiver authority for Medicaid, and the 100 percent of the federal poverty line limitation would be applied to all territories.
Territories would be included in the Medicaid disproportionate share hospital (DSH) program which provides additional funding to hospitals that treat a high percentage of low-income and uninsured patients. The formula used to compute DSH funding would also be changed for Puerto Rico to exclude the number patients enrolled in the federal Supplemental Security Income program which doesn’t cover the territory.
Base Medicare payment rates to hospitals in Puerto Rico would be adjusted upwards to ensure uniformity in base rates, as states all receive the same base rate. Puerto Rican hospitals would no longer be excluded from Medicare’s HITECH program, which allows hospitals that adopt electronic health records to receive bonus payments.
Physician compensation rates under Medicare would be subject to a new formula for calculating the geographic practice cost index (GCPI). A floor on Medicare payments under the GCPI would be established to help fairly compensate physicians in Puerto Rico.
Puerto Rico’s Medicare Advantage (MA) beneficiaries would receive additional compensation, as the territory’s MA plans would be covered by a payment floor.