1. Short title This Act may be cited as the Puerto Rico Health Care Fairness, Accountability, and Beneficiary Access Act of 2019 . 2. Adjustments to FMAP and cap for Puerto Rico (a) Adjustments to FMAP Section 1905 of the Social Security Act ( 42 U.S.C. 1396d ) is amended— (1) in subsection (b)— (A) by striking for Puerto Rico, the Virgin Islands and inserting for the Virgin Islands ; and (B) by striking and American Samoa shall be 55 percent, and inserting and America Samoa (and, for calendar quarters in a fiscal year before fiscal year 2020, Puerto Rico) shall be 55 percent, and for Puerto Rico, for calendar quarters in a fiscal year beginning with fiscal year 2020, shall be the PR specified percent under subsection (ff) for such fiscal year, ; and (2) by adding at the end the following new subsection: (ff) (1) For purposes of subsection (b), the PR specified percent under this subsection is— (A) subject to paragraph (2), for each of fiscal years 2020 through 2024, 83 percent; (B) subject to paragraph (3)(D)(iii), for each of fiscal years 2025 through 2029, 83 percent; and (C) subject to paragraph (3)(D)(iii), for fiscal year 2030 and each subsequent fiscal year, the Federal medical assistance percentage calculated in accordance with the first sentence of subsection (b), as such sentence applies to the 50 States. (2) (A) If Puerto Rico— (i) for fiscal year 2021, is in compliance with none of the program enhancement requirements described in subparagraph (B), the PR specified percent specified under paragraph (1) for such fiscal year shall be reduced by 2 percent; (ii) for fiscal year 2022, is in compliance with fewer than two of the four program enhancement requirements described in subparagraph (B), the PR specified percent specified under paragraph (1) for such fiscal year shall be reduced by 3 percent