On February 9, 2018, the President signed into law the Bipartisan Budget Act of 2018 (BBA), which includes Medicaid disaster relief funding for Puerto Rico and United States Virgin Islands (USVI). The BBA provides $3.6 billion in additional Medicaid funding to Puerto Rico and approximately $106.9 million in additional Medicaid funding to USVI for the period from January 1, 2018, through September 30, 2019. The law provides an additional $1.2 billion to Puerto Rico and approximately $35.6 million to USVI if the U.S. Department of Health and Human Services (HHS) Secretary certifies that each territory, respectively, has taken reasonable and appropriate steps to implement methods for collecting and reporting reliable data for Transformed Medicaid Statistical Information System (T-MSIS) and to demonstrate progress in establishing a Medicaid Fraud Control Unit (MFCU).
Puerto Rico and USVI expenditures of these additional BBA funds receive a federal match of 100%, notwithstanding the federal medical assistance percentage (FMAP) or other matching rate that otherwise would apply. Additionally, Puerto Rico and USVI may receive this funding before accessing other available allotment amounts. Puerto Rico and USVI expenditures in excess of the BBA funds are subject to standard federal matching rates (e.g., the FMAP applicable to the territories is 55%) and existing statutory spending caps.
The BBA also requires the Secretary of HHS to submit a report (PDF, 86.02 KB) by July 1, 2018, to the House Energy and Commerce Committee and the Senate Finance Committee that describes the steps taken by Puerto Rico and USVI to meet the certification requirements to receive the additional funding conditioned upon efforts to implement T-MSIS and establish a MFCU, and specifies timelines for Puerto Rico and USVI to complete T-MSIS implementation and MFCU establishment activities. This report provides information as to the work performed by HHS agencies that collaborate with both Puerto Rico and the USVI to implement T-MSIS and establish a MFCU. The report also provides background focusing on the steps taken by Puerto Rico and the USVI to implement T-MSIS and establish a MFCU and the guidance and technical assistance provided by the federal agencies with responsibility for implementation and oversight of these programs. Specifically, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have provided and will continue to provide assistance to PR and USVI with the planning and implementation of these programs, as well as program oversight and potential compliance activities, where appropriate, for which each respective federal agency is responsible to ensure program compliance by the territories.
Finally, this report specifies milestones and timelines outlined by CMS and OIG for each territory, as a condition of eligibility for any additional increases in the amounts determined for Puerto Rico and the USVI, respectively, under section 1108(g) of the Social Security Act (the Act) (42 U.S.C. § 1308(g)) for payments under title XIX of the Act for fiscal year 2019, to complete (A) implementation of methods, satisfactory to the Secretary, for the collection and reporting of reliable data to the Transformed Medicaid Statistical Information System (T–MSIS).