115 HR 3922 EH: CHAMPIONING HEALTHY KIDS Act
U.S. House of Representatives
text/xml
EN
Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.
1.This Act may be cited as the Continuing Community Health And Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017
or the CHAMPIONING HEALTHY KIDS Act
. 2.The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
Division A—CHAMPION Act
Sec. 100. Short title.
Title I—Extension of Public Health Programs
Sec. 101. Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Extension for family-to-family health information centers.
Sec. 104. Youth empowerment program; personal responsibility education.
Title II—Offsets
Sec. 201. Providing for qualified health plan grace period requirements for issuer receipt of advance payments of cost-sharing reductions and premium tax credits that are more consistent with State law grace period requirements.
Sec. 202. Prevention and Public Health Fund.
Division B—HEALTHY KIDS Act
Sec. 300. Short title.
Title I—CHIP Extension and Other Medicaid and CHIP Provisions
Sec. 301. Five-year funding extension of the Children’s Health Insurance Program.
Sec. 302. Extension of certain programs and demonstration projects.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension and reduction of additional Federal financial participation for CHIP.
Sec. 305. Modifying reductions in Medicaid DSH allotments.
Sec. 306. Puerto Rico and the Virgin Islands Medicaid payments.
Title II—Offsets
Sec. 401. Medicaid third party liability provisions.
Sec. 402. Treatment of lottery winnings and other lump-sum income for purposes of income eligibility under Medicaid.
Sec. 403. Adjustments to Medicare part B and part D premium subsidies for higher income individuals.
A
100.This division may be cited as the Community Health And Medical Professionals Improve Our Nation Act of 2017
or the CHAMPION Act
. <enum>I</enum><header>Extension of Public Health Programs</header> <section id="HB99F28147DD444BF9EDEB8A74BB4A16C"><enum>101.</enum><header>Extension for community health centers, the National Health Service Corps, and teaching health centers that operate GME programs</header> <subsection id="H4E37EFF1F4654255825B7CB0E9A98367"><enum>(a)</enum><header>Community health centers funding</header><text display-inline="yes-display-inline">Section 10503(b)(1)(E) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b-2">42 U.S.C. 254b–2(b)(1)(E)</external-xref>) is amended by striking <quote>2017</quote> and inserting <quote>2019</quote>.</text></subsection>
<subsection id="H8053EEB4F3114E848B88FC363906A419"><enum>(b)</enum><header>Other community health centers provisions</header><text>Section 330 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b">42 U.S.C. 254b</external-xref>) is amended—</text> <paragraph id="H20AED1B27630428E98A0D0E219DA9951"><enum>(1)</enum><text>in subsection (b)(1)(A)(ii), by striking <quote>abuse</quote> and inserting <quote>use disorder</quote>;</text></paragraph>
<paragraph id="HEFC35E9752E149E1B3B76BAEEE820C32"><enum>(2)</enum><text>in subsection (b)(2)(A), by striking <quote>abuse</quote> and inserting <quote>use disorder</quote>;</text></paragraph> <paragraph id="HB5B7DD12D29E4969BAA6C6A0CE1522D8"><enum>(3)</enum><text>in subsection (c)—</text>
<subparagraph id="HDE677B9BBB5444F19E535B3C099BFABF"><enum>(A)</enum><text>in paragraph (1), by striking subparagraphs (B) through (D);</text></subparagraph> <subparagraph id="H9FD209F8487F4CF5A8E3258A46A42BB4"><enum>(B)</enum><text>by striking <quote>(1) <header-in-text level="paragraph" style="OLC">In general</header-in-text></quote> and all that follows through <quote>The Secretary</quote> and inserting the following:</text>
<quoted-block style="OLC" id="H0D120DCE4A77402EB704B33866028C6C" display-inline="no-display-inline">
<paragraph id="HEDA2285D30FC4FB09F56B7089747712C"><enum>(1)</enum><header>Centers</header><text display-inline="yes-display-inline">The Secretary</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph> <subparagraph id="HDE4E8AA54353444F8D21DDEBC7714383"><enum>(C)</enum><text>in paragraph (1), as amended, by redesignating clauses (i) through (v) as subparagraphs (A) through (E) and moving the margin of each of such redesignated subparagraph 2 ems to the left;</text></subparagraph></paragraph>
<paragraph id="HB177AA2BB7DF4C659CA35BC94C56C7C2" commented="no" display-inline="no-display-inline"><enum>(4)</enum><text display-inline="yes-display-inline">by striking subsection (d) and inserting the following:</text> <quoted-block display-inline="no-display-inline" id="H19FB53479B11451F84A4A6FDA147DE2C" style="OLC"> <subsection id="H62F62C5227FC45D0996EFB5445B018B3"><enum>(d)</enum><header>Improving quality of care</header> <paragraph id="H5B8F95EFEBB647D0B605B65F1B3C37BA"><enum>(1)</enum><header>Supplemental awards</header><text>The Secretary may award supplemental grant funds to health centers funded under this section to implement evidence-based models for increasing access to high-quality primary care services, which may include models related to—</text>
<subparagraph id="H57D46B3DD1D24E118661E69F748C5C49"><enum>(A)</enum><text>improving the delivery of care for individuals with multiple chronic conditions;</text></subparagraph> <subparagraph id="H9D3D1D8F52034D8F8A88D7FF813E65B5"><enum>(B)</enum><text>workforce configuration;</text></subparagraph>
<subparagraph id="H11D4006A4B1D43D4AC4F5CC98CE64FD4"><enum>(C)</enum><text>reducing the cost of care;</text></subparagraph> <subparagraph id="HD4EEAAF391C34F72ACB11A639760800E"><enum>(D)</enum><text>enhancing care coordination;</text></subparagraph>
<subparagraph id="HDBF3DD35B3C1463ABBE78DB3B177C4A7"><enum>(E)</enum><text>expanding the use of telehealth and technology-enabled collaborative learning and capacity building models;</text></subparagraph> <subparagraph id="H3CC3D1DAB824492BA7309B9AF0328CC1"><enum>(F)</enum><text>care integration, including integration of behavioral health, mental health, or substance use disorder services; and</text></subparagraph>
<subparagraph id="H21EA4A3F0F804D43AAA396738F198F35"><enum>(G)</enum><text>addressing emerging public health or substance use disorder issues to meet the health needs of the population served by the health center.</text></subparagraph></paragraph> <paragraph id="H3CF6A4A0F3004C6B9D59DD57E6C7CDEA"><enum>(2)</enum><header>Sustainability</header><text>In making supplemental awards under this subsection, the Secretary may consider whether the health center involved has submitted a plan for continuing the activities funded under this subsection after supplemental funding is expended.</text></paragraph>
<paragraph id="H5BB9634F10D64886B227326CD4F89E3F"><enum>(3)</enum><header>Special consideration</header><text>The Secretary may give special consideration to applications for supplemental funding under this subsection that seek to address significant barriers to access to care in areas with a greater shortage of health care providers and health services relative to the national average.</text></paragraph></subsection><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph id="H374A5805CF7C40A7A2BFBA3FFADE7932"><enum>(5)</enum><text>in subsection (e)(1)—</text>
<subparagraph id="H32EB6D670CAE450F9C88953E5C46A64A"><enum>(A)</enum><text>in subparagraph (B)—</text> <clause id="H4AF285B7D2F6495CB0C8619B23E2647E"><enum>(i)</enum><text>by striking <quote>2 years</quote> and inserting <quote>1 year</quote>; and</text></clause>
<clause id="HD0B001CF2F384DA3BDCD1252E9293D03"><enum>(ii)</enum><text>by adding at the end the following: <quote>The Secretary shall not make a grant under this paragraph unless the applicant provides assurances to the Secretary that within 120 days of receiving grant funding for the operation of the health center, the applicant will submit, for approval by the Secretary, an implementation plan to meet the requirements of subsection (k)(3). The Secretary may extend such 120-day period for achieving compliance upon a demonstration of good cause by the health center.</quote>; and</text></clause></subparagraph> <subparagraph id="H73CF0A4ECD0D44008E797A297D85F8C4"><enum>(B)</enum><text>in subparagraph (C)—</text>
<clause id="H11F02C3ED605408F9A56F760C2359D1C"><enum>(i)</enum><text>in the subparagraph heading, by striking <quote><header-in-text level="subparagraph" style="OLC">and plans</header-in-text></quote>;</text></clause> <clause id="H92ECDC1D3B57457382132FE48D0697CF"><enum>(ii)</enum><text>by striking <quote>or plan (as described in subparagraphs (B) and (C) of subsection (c)(1))</quote>;</text></clause>
<clause id="H0CDD9E40D97A4B0ABC1901022C773E16"><enum>(iii)</enum><text>by striking <quote>or plan, including the purchase</quote> and inserting the following: “including—</text> <quoted-block display-inline="no-display-inline" id="H9987F33D5F1A4B698D9ED9DF3A78C52D" style="OLC"> <clause id="HEF92012E6BFC4F79B19C70DBB4044A5A"><enum>(i)</enum><text>the purchase</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause>
<clause id="HBAFBE81698714DE4B31A99A5C93B2782"><enum>(iv)</enum><text>by inserting <quote>, which may include data and information systems </quote> after <quote>of equipment</quote>;</text></clause> <clause id="H2095312E162147BF9B948C08DFF754D5"><enum>(v)</enum><text>by striking the period at the end and inserting a semicolon; and</text></clause>
<clause id="HEF5290749F364222B12372305B73B0D2"><enum>(vi)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H2528AA8B5DFA443A9C1BF9CA66A4B4DD" style="OLC"> <clause id="HB892152A9C004F4BAE2FD4336433ACED"><enum>(ii)</enum><text>the provision of training and technical assistance; and</text></clause>
<clause id="H2EF07F6CA33D4A618CA3CB25BA35043C"><enum>(iii)</enum><text>other activities that—</text> <subclause id="H2200B9CFE257467D9F45490FC1FB2A78"><enum>(I)</enum><text>reduce costs associated with the provision of health services;</text></subclause>
<subclause id="H8426CE25416D46588331B642C641DA8E"><enum>(II)</enum><text>improve access to, and availability of, health services provided to individuals served by the centers;</text></subclause> <subclause id="H732CD3AD87A44BDEB5F324F16488E51F"><enum>(III)</enum><text>enhance the quality and coordination of health services; or</text></subclause>
<subclause id="H142C98E6ADAD4346ACF3CE9DAFD854E5"><enum>(IV)</enum><text>improve the health status of communities.</text></subclause></clause><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph></paragraph> <paragraph id="H726F171F10A840EE91E865E67D2BC4BA" display-inline="no-display-inline"><enum>(6)</enum><text display-inline="yes-display-inline">in subsection (e)(5)(B)—</text>
<subparagraph id="H201354A7EB4B405297FB20BCB4FE29E2"><enum>(A)</enum><text>in the heading of subparagraph (B), by striking <quote><header-in-text level="subparagraph" style="OLC">and plans</header-in-text></quote>; and</text></subparagraph> <subparagraph id="HC3B3D7AE81804061AE8F3E7BA45CF070"><enum>(B)</enum><text>by striking <quote>and subparagraphs (B) and (C) of subsection (c)(1) to a health center or to a network or plan</quote> and inserting <quote>to a health center or to a network</quote>;</text></subparagraph></paragraph>
<paragraph id="H16995DEFE29E4EFBA6980C27C49643C9"><enum>(7)</enum><text>in subsection (e), by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H1A8EB4BE1BAC459980F50250A11995A1" style="OLC"> <paragraph id="H329713AB7A4740338BE7089228577470"><enum>(6)</enum><header>New access points and expanded services</header> <subparagraph id="H97718E53DA404938A58149FC2E0EB271"><enum>(A)</enum><header>Approval of new access points</header> <clause id="H0FB7E8890DF34F8EB793A308DCF2C0B7"><enum>(i)</enum><header>In general</header><text>The Secretary may approve applications for grants under subparagraph (A) or (B) of paragraph (1) to establish new delivery sites.</text></clause>
<clause id="H5F24F2EC444C46259FE90006F7FB6721"><enum>(ii)</enum><header>Special consideration</header><text>In carrying out clause (i), the Secretary may give special consideration to applicants that have demonstrated the new delivery site will be located within a sparsely populated area, or an area which has a level of unmet need that is higher relative to other applicants.</text></clause> <clause id="H0577E245978B40F29FEFE12AA6810D2B"><enum>(iii)</enum><header>Consideration of applications</header><text display-inline="yes-display-inline">In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by the applicants is not less than two to three or greater than three to two.</text></clause>
<clause id="H67712DB3092C460BBF91D227DA7E7176"><enum>(iv)</enum><header>Service area overlap</header><text>If in carrying out clause (i) the applicant proposes to serve an area that is currently served by another health center funded under this section, the Secretary may consider whether the award of funding to an additional health center in the area can be justified based on the unmet need for additional services within the catchment area.</text></clause></subparagraph> <subparagraph id="HAD640510C2EC4E4EBA81220BC0FF45EE"><enum>(B)</enum><header>Approval of expanded service applications</header> <clause id="HCA458E0932544964ADCB61061C4F4D91"><enum>(i)</enum><header>In general</header><text>The Secretary may approve applications for grants under subparagraph (A) or (B) of paragraph (1) to expand the capacity of the applicant to provide required primary health services described in subsection (b)(1) or additional health services described in subsection (b)(2).</text></clause>
<clause id="H9B041D9400D54A0FAFE139D0F88ED5DA"><enum>(ii)</enum><header>Priority expansion projects</header><text>In carrying out clause (i), the Secretary may give special consideration to expanded service applications that seek to address emerging public health or behavioral health, mental health, or substance abuse issues through increasing the availability of additional health services described in subsection (b)(2) in an area in which there are significant barriers to accessing care.</text></clause> <clause id="HE9420694691C472CA7A07145D4D87008"><enum>(iii)</enum><header>Consideration of applications</header><text>In carrying out clause (i), the Secretary shall approve applications for grants in such a manner that the ratio of the medically underserved populations in rural areas which may be expected to use the services provided by the applicants involved to the medically underserved populations in urban areas which may be expected to use the services provided by such applicants is not less than two to three or greater than three to two.</text></clause></subparagraph></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph>
<paragraph id="H0F4A65CA977E42DDBA3249481EBF3025"><enum>(8)</enum><text>in subsection (h)—</text> <subparagraph id="H1FF3E7F7A031487C990BB93AD5C9AC54"><enum>(A)</enum><text>in paragraph (1), by striking <quote>and children and youth at risk of homelessness</quote> and inserting <quote>, children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness</quote>; and</text></subparagraph>
<subparagraph id="HF48E987DF04F4F12955F870C41A2DEF8"><enum>(B)</enum><text>in paragraph (5)—</text> <clause id="H8784CF137A2D4C8C874BDA27159DDF0A"><enum>(i)</enum><text>by striking subparagraph (B);</text></clause>
<clause id="HE2433597AEEC45C4804989241BBFF0DE"><enum>(ii)</enum><text>by redesignating subparagraph (C) as subparagraph (B); and</text></clause> <clause id="H102B82178CEC4410AC54C1A168E5A630"><enum>(iii)</enum><text>in subparagraph (B) (as so redesignated)—</text>
<subclause id="H613AA24200954E5DBD2BB801750A692D"><enum>(I)</enum><text>in the subparagraph heading, by striking <quote><header-in-text level="subparagraph" style="OLC">abuse</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">use disorder</header-in-text></quote>; and</text></subclause> <subclause id="HEB7E8C9197844BC9B11CC6263D8702BC"><enum>(II)</enum><text>by striking <quote>abuse</quote> and inserting <quote>use disorder</quote>;</text></subclause></clause></subparagraph></paragraph>
<paragraph id="HC5F05906D6324FAE8DAA94379617B5E2"><enum>(9)</enum><text>in subsection (k)—</text> <subparagraph id="H94C29D7CA0C84B70A5E354C5DBDA349D"><enum>(A)</enum><text>in paragraph (2)—</text>
<clause id="H7A04B66ED7534DA69E87087A0B329312"><enum>(i)</enum><text>in the paragraph heading, by inserting <quote><header-in-text level="paragraph" style="OLC">unmet</header-in-text></quote> before <quote><header-in-text level="paragraph" style="OLC">need</header-in-text></quote>;</text></clause> <clause id="H27173149C12447868F2B3305D290BCD0"><enum>(ii)</enum><text>in the matter preceding subparagraph (A), by inserting <quote>or subsection (e)(6)</quote> after <quote>subsection (e)(1)</quote>;</text></clause>
<clause id="H9D4BB519D8794A09938114DBA942A97F"><enum>(iii)</enum><text>in subparagraph (A), by inserting <quote>unmet</quote> before <quote>need for health services</quote>;</text></clause> <clause id="H28E9B7E7791B4A8BAE44A3128F8E11CF"><enum>(iv)</enum><text>in subparagraph (B), by striking <quote>and</quote> at the end;</text></clause>
<clause id="HCF7474FA6C3444F1B412AE1040A76571"><enum>(v)</enum><text>in subparagraph (C), by striking the period at the end and inserting <quote>; and</quote>; and </text></clause> <clause id="HC9103E7AE35A47BABE77C6B13522492F"><enum>(vi)</enum><text>by adding after subparagraph (C) the following:</text>
<quoted-block display-inline="no-display-inline" id="H7AB45CF3957E48E0A8F0D9EC46CBAD67" style="OLC">
<subparagraph id="HB6187EFC149348B58FA5B70948068DE1"><enum>(D)</enum><text>in the case of an application for a grant pursuant to subsection (e)(6), a demonstration that the applicant has consulted with appropriate State and local government agencies, and health care providers regarding the need for the health services to be provided at the proposed delivery site.</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H74FFD66B99324FB387C41C33EB686594"><enum>(B)</enum><text>in paragraph (3)—</text>
<clause id="H4EB31FCC4B6C4AA7B14A3E3B9FEDC1B2"><enum>(i)</enum><text>in the matter preceding subparagraph (A), by inserting <quote>or subsection (e)(6)</quote> after <quote>subsection (e)(1)(B)</quote>;</text></clause> <clause id="HA7058865E2BB4BF8B2369D6FC71E2D49"><enum>(ii)</enum><text>in subparagraph (B), by striking <quote>in the catchment area of the center</quote> and inserting <quote>, including other health care providers that provide care within the catchment area, local hospitals, and specialty providers in the catchment area of the center, to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments</quote>;</text></clause>
<clause id="HBF6A5D02DD1C4049A2B1D9EB5E4BD9DD"><enum>(iii)</enum><text>in subparagraph (H)(ii), by inserting <quote>who shall be directly employed by the center</quote> after <quote>approves the selection of a director for the center</quote>;</text></clause> <clause id="H4A9214A8C06A4EBAB85BAB6D84CE0023"><enum>(iv)</enum><text>in subparagraph (L), by striking <quote>and</quote> at the end;</text></clause>
<clause id="HB65C8AB9C1AC4E128787B673608DA42F"><enum>(v)</enum><text>in subparagraph (M), by striking the period and inserting <quote>; and</quote>; and</text></clause> <clause id="HE69A6D33783549BDA8ABEF9CAD112FE0"><enum>(vi)</enum><text>by inserting after subparagraph (M), the following:</text>
<quoted-block display-inline="no-display-inline" id="HB077E846678D44839D8C6FCB3F127BDE" style="OLC">
<subparagraph id="H5DB9AE4A7400417295D61E7F0BFD143A"><enum>(N)</enum><text>the center has written policies and procedures in place to ensure the appropriate use of Federal funds in compliance with applicable Federal statutes, regulations, and the terms and conditions of the Federal award.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></clause></subparagraph> <subparagraph id="H6B9825DBE515416FBC22CE8800777CB3"><enum>(C)</enum><text>by striking paragraph (4);</text></subparagraph></paragraph>
<paragraph id="H06225A5377064464B4C4CEF6030C65EF"><enum>(10)</enum><text>in subsection (l), by adding at the end the following: <quote>Funds expended to carry out activities under this subsection and operational support activities under subsection (m) shall not exceed 3 percent of the amount appropriated for this section for the fiscal year involved.</quote>;</text></paragraph> <paragraph id="H431F0CCAEAE84E879B4904A086943EC5"><enum>(11)</enum><text>in subsection (q)(4), by adding at the end the following: <quote>A waiver provided by the Secretary under this paragraph may not remain in effect for more than 1 year and may not be extended after such period. An entity may not receive more than one waiver under this paragraph in consecutive years.</quote>;</text></paragraph>
<paragraph id="H7A60E978BC7C4FC0847828B39CCF5DD3"><enum>(12)</enum><text>in subsection (r)(3)—</text> <subparagraph id="H390370DDD9F84E0AA06BE9776B16DEFB"><enum>(A)</enum><text>by striking <quote>appropriate committees of Congress a report concerning the distribution of funds under this section</quote> and inserting the following: “Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce of the House of Representatives, a report including, at a minimum—</text>
<quoted-block display-inline="no-display-inline" id="HFDD262EA985E4BCC89A5E3BF07C53189" style="OLC">
<subparagraph id="H16612B73FDB74D1590946D6D2CE74BCF"><enum>(A)</enum><text>the distribution of funds for carrying out this section</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph id="H6E069CC30420458292563B70187AB6AA"><enum>(B)</enum><text>by striking <quote>populations. Such report shall include an assessment</quote> and inserting the following: “populations;</text>
<quoted-block display-inline="no-display-inline" id="H2BD4CCC3B2B348B398BAD4E2DC5BC4DC" style="OLC">
<subparagraph id="HAABEF8EE67954438A64D44A62981EEBC"><enum>(B)</enum><text>an assessment</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph id="HAC7CD7DF865049759E8D7D4130B1C4FE"><enum>(C)</enum><text>by striking <quote>and the rationale for any substantial changes in the distribution of funds.</quote> and inserting a semicolon; and</text></subparagraph>
<subparagraph id="H7A690CA5BD8346A7877238563207B96C"><enum>(D)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H63EBF72923F4475A890600F609057472" style="OLC"> <subparagraph id="HC4A7BD6FEA4142118823AA69AD683CC1"><enum>(C)</enum><text>the distribution of awards and funding for new or expanded services in each of rural areas and urban areas;</text></subparagraph>
<subparagraph id="HC33CB927587C467B9CCB48932E0A1785"><enum>(D)</enum><text>the distribution of awards and funding for establishing new access points, and the number of new access points created;</text></subparagraph> <subparagraph id="H2555E7E132464BBB91F31203A0CAF10F"><enum>(E)</enum><text>the amount of unexpended funding for loan guarantees and loan guarantee authority under title XVI;</text></subparagraph>
<subparagraph id="HCA2C0C48356D457C9C02A71890DDA7D7"><enum>(F)</enum><text>the rationale for any substantial changes in the distribution of funds;</text></subparagraph> <subparagraph id="H9D2CED790C3D4768965E73B86C5D2241"><enum>(G)</enum><text>the rate of closures for health centers and access points;</text></subparagraph>
<subparagraph id="H60A72FF2DF1A4B0CB096A37472A22209"><enum>(H)</enum><text>the number and reason for any grants awarded pursuant to subsection (e)(1)(B); and</text></subparagraph> <subparagraph id="H6A296D1CB19C47B7AF289C041F67CAF3"><enum>(I)</enum><text>the number and reason for any waivers provided pursuant to subsection (q)(4).</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H8D04738640D445D79605FA617CBFB515"><enum>(13)</enum><text display-inline="yes-display-inline">in subsection (r), by adding at the end the following new paragraph:</text> <quoted-block style="OLC" id="H1BA690C52E7A49D0B0441921F36BD882" display-inline="no-display-inline"> <paragraph id="HB6ECCCE90BCE4434B0C1A47221D9A03F"><enum>(5)</enum><header>Funding for participation of health centers in All of Us Research Program</header><text display-inline="yes-display-inline">In addition to any amounts made available pursuant to paragraph (1) of this subsection, section 402A of this Act, or section 10503 of the Patient Protection and Affordable Care Act, there is authorized to be appropriated, and there is appropriated, out of any monies in the Treasury not otherwise appropriated, to the Secretary $25,000,000 for fiscal year 2018 to support the participation of health centers in the All of Us Research Program under the Precision Medicine Initiative under section 498E of this Act.</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph id="H7648AB0C0EDC481B8255454BB780F04E"><enum>(14)</enum><text>by striking subsection (s).</text></paragraph></subsection> <subsection id="H0C0097E1B0E544A39EDC4EDBA6A6DB2A"><enum>(c)</enum><header>National Health Service Corps</header><text>Section 10503(b)(2)(E) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b-2">42 U.S.C. 254b–2(b)(2)(E)</external-xref>) is amended by striking <quote>2017</quote> and inserting <quote>2019</quote>.</text></subsection>
<subsection id="HDFC6261B6642409DB9FF39E9B6E19E00"><enum>(d)</enum><header>Teaching health centers that operate graduate medical education programs</header>
<paragraph id="HD6789C2B83A54B11819A0A5C876D9E9E"><enum>(1)</enum><header>Payments</header><text display-inline="yes-display-inline">Subsection (a) of section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>) is amended to read as follows:</text> <quoted-block display-inline="no-display-inline" id="H47D192CD5B58427496BB21BF5B0B823C" style="OLC"> <subsection id="HEBD0FA3CF46945ECA9AA7708D159C353"><enum>(a)</enum><header>Payments</header> <paragraph id="HE224A92426A84CF79E170F03266DFF4E"><enum>(1)</enum><header>In general</header><text>Subject to subsection (h)(2), the Secretary shall make payments under this section for direct expenses and indirect expenses to qualified teaching health centers that are listed as sponsoring institutions by the relevant accrediting body for, as appropriate—</text>
<subparagraph id="H9B72F11936DE4B259188BE3BDEDFC5D9"><enum>(A)</enum><text>maintenance of existing approved graduate medical residency training programs;</text></subparagraph> <subparagraph id="H68B29C126B624B53A07C129BB73294D6"><enum>(B)</enum><text display-inline="yes-display-inline">expansion of existing approved graduate medical residency training programs; and</text></subparagraph>
<subparagraph id="H9A4DE714C72243C4A767B000A1F2153D"><enum>(C)</enum><text>establishment of new approved graduate medical residency training programs.</text></subparagraph></paragraph> <paragraph id="HA770A97D2A724EDCB8F268CBB396B0C7"><enum>(2)</enum><header>Priority</header><text display-inline="yes-display-inline">In making payments pursuant to paragraph (1)(C), the Secretary shall give priority to qualified teaching health centers that—</text>
<subparagraph id="H488026D8DA3F4909BC8AA51FA8C28C69"><enum>(A)</enum><text>serve a health professional shortage area with a designation in effect under section 332 or a medically underserved community (as defined in section 799B); or</text></subparagraph> <subparagraph id="HFB7599CC10A247C19F7718F53B8AF671"><enum>(B)</enum><text>are located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act).</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="H0BE212165AD14B12B8A0E19766C5D03C"><enum>(2)</enum><header>Funding</header><text>Subsection (g) of section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>) is amended—</text> <subparagraph id="H6280C353D37B4CFBBB50B7B59C9D73CE"><enum>(A)</enum><text>by striking <quote>To carry out</quote> and inserting the following:</text>
<quoted-block style="OLC" id="H9C1D64062C3C4E33836B39DB21D0CE2F" display-inline="no-display-inline">
<paragraph id="H49F8118CC8484FB5A92D1983492425D2"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">To carry out</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph> <subparagraph id="H818459CCC0584F02A008EFD22261FA25"><enum>(B)</enum><text>by striking <quote>and $15,000,000 for the first quarter of fiscal year 2018</quote> and inserting <quote>and $126,500,000 for each of fiscal years 2018 and 2019, to remain available until expended</quote>; and</text></subparagraph>
<subparagraph id="HA5BBCC9C768C4A3FBC6AFAA94B8A3C1A"><enum>(C)</enum><text>by adding at the end the following:</text> <quoted-block style="OLC" id="H99F1AE6267F84D59949EC1E83D054B84" display-inline="no-display-inline"> <paragraph id="H241EB034C83147318F84DF879BDD6CFC"><enum>(2)</enum><header>Administrative expenses</header><text>Of the amount made available to carry out this section for any fiscal year, the Secretary may not use more than 5 percent of such amount for the expenses of administering this section.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="HC690143009EF488CA3710F2DD3161C45"><enum>(3)</enum><header>Annual reporting</header><text>Subsection (h)(1) of section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>) is amended—</text> <subparagraph id="H92669A5EC0D748F69C240317258E7C9C"><enum>(A)</enum><text>by redesignating subparagraph (D) as subparagraph (H); and</text></subparagraph>
<subparagraph id="HE15C4390383247CCAAD79D882BCF2B67"><enum>(B)</enum><text>by inserting after subparagraph (C) the following:</text> <quoted-block display-inline="no-display-inline" id="H47A3335037D14088ACB1EA173EB2C950" style="OLC"> <subparagraph id="H0603738B0D6D48ACA0870B058D285822"><enum>(D)</enum><text display-inline="yes-display-inline">The number of patients treated by residents described in paragraph (4).</text></subparagraph>
<subparagraph id="H261EA71090C84F208CCAF93F351B3AF6"><enum>(E)</enum><text>The number of visits by patients treated by residents described in paragraph (4).</text></subparagraph> <subparagraph id="H16BE5C1FD90F4F0BA410CA8DC2A55235"><enum>(F)</enum><text display-inline="yes-display-inline">Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents entering primary care practice (meaning any of the areas of practice listed in the definition of a primary care residency program in section 749A).</text></subparagraph>
<subparagraph id="H73087A73348D4F5C82AC0FB51B6488D4"><enum>(G)</enum><text display-inline="yes-display-inline">Of the number of residents described in paragraph (4) who completed their residency training at the end of such residency academic year, the number and percentage of such residents who entered practice at a health care facility—</text> <clause id="H8408DA3665E641A098612ED61CC75C23"><enum>(i)</enum><text display-inline="yes-display-inline">primarily serving a health professional shortage area with a designation in effect under section 332 or a medically underserved community (as defined in section 799B); or</text></clause>
<clause id="H7989D5E8D16F485EA44644043BC75481"><enum>(ii)</enum><text display-inline="yes-display-inline">located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act).</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="HA0373C896CCD4157B95F8CBCBAC253B8"><enum>(4)</enum><header>Report on training costs</header><text display-inline="yes-display-inline">Not later than March 31, 2019, the Secretary of Health and Human Services shall submit to the Congress a report on the direct graduate expenses of approved graduate medical residency training programs, and the indirect expenses associated with the additional costs of teaching residents, of qualified teaching health centers (as such terms are used or defined in section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>)).</text></paragraph>
<paragraph id="HA08196C0EBDD493D9A144C701FFE186D"><enum>(5)</enum><header>Definition</header><text display-inline="yes-display-inline">Subsection (j) of section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>) is amended—</text> <subparagraph id="H3FBEEAC6A0D34AB7A676F1508D63F289"><enum>(A)</enum><text>by redesignating paragraphs (2) and (3) as paragraphs (3) and (4), respectively; and</text></subparagraph>
<subparagraph id="H9D1182D4E0F048958D09F10A94FAF566"><enum>(B)</enum><text>by inserting after paragraph (1) the following:</text> <quoted-block display-inline="no-display-inline" id="H609100E710A149A587FCADD131AB213F" style="OLC"> <paragraph id="HF8EFF88CF22D4AEA842692C3C65BFB45"><enum>(2)</enum><header>New approved graduate medical residency training program</header><text display-inline="yes-display-inline">The term <term>new approved graduate medical residency training program</term> means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year (other than pursuant to subsection (a)(1)(C)).</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="HCFE8193E43F54562910D7E96E6706B3F"><enum>(6)</enum><header>Technical correction</header><text display-inline="yes-display-inline">Subsection (f) of section 340H (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>) is amended by striking <quote>hospital</quote> each place it appears and inserting <quote>teaching health center</quote>.</text></paragraph> <paragraph id="HFDCF13FCA9614CE2AC67A12B2B6B0F44"><enum>(7)</enum><header>Payments for previous fiscal years</header><text display-inline="yes-display-inline">The provisions of section 340H of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/256h">42 U.S.C. 256h</external-xref>), as in effect on the day before the date of enactment of this Act, shall continue to apply with respect to payments under such section for fiscal years before fiscal year 2018.</text></paragraph></subsection>
<subsection id="HC042DB46D00246FE968915D043156149"><enum>(e)</enum><header>Application</header><text display-inline="yes-display-inline">Amounts appropriated pursuant to this section for fiscal year 2018 or 2019 are subject to the requirements contained in <external-xref legal-doc="public-law" parsable-cite="pl/115/31">Public Law 115–31</external-xref> for funds for programs authorized under sections 330 through 340 of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254b">42 U.S.C. 254b–256</external-xref>).</text></subsection> <subsection id="H04AA44D8A649476CB955E47CD7DF79F2"><enum>(f)</enum><header>Conforming amendments</header><text>Section 3014(h) of title 18, United States Code, is amended—</text>
<paragraph id="HBA50C7B2ADAA40D481B7F2DE1C6BFE39"><enum>(1)</enum><text>in paragraph (1), by striking <quote>, as amended by section 221 of the Medicare Access and CHIP Reauthorization Act of 2015,</quote>; and</text></paragraph> <paragraph id="H8CAB1F3219E745CCA69C9BF3FBF4E444"><enum>(2)</enum><text>in paragraph (4), by inserting <quote>and section 101(e) of the <short-title>Community Health And Medical Professionals Improve Our Nation Act of 2017</short-title></quote> after <quote>section 221(c) of the Medicare Access and CHIP Reauthorization Act of 2015</quote>.</text></paragraph></subsection></section>
<section id="HAB3FD3CE447A459C89049F420013F116"><enum>102.</enum><header>Extension for special diabetes programs</header>
<subsection id="H0BCF12432D4A47B2BC9F868D9C13F8BE"><enum>(a)</enum><header>Special diabetes program for type I diabetes</header><text display-inline="yes-display-inline">Section 330B(b)(2)(C) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-2">42 U.S.C. 254c–2(b)(2)(C)</external-xref>) is amended by striking <quote>2017</quote> and inserting <quote>2019</quote>. </text></subsection> <subsection id="H70E2BE7FD637419FAC5E6079C92296B0"><enum>(b)</enum><header>Special diabetes program for Indians</header><text display-inline="yes-display-inline">Subparagraph (D) of section 330C(c)(2) of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/254c-3">42 U.S.C. 254c–3(c)(2)</external-xref>) is amended to read as follows:</text>
<quoted-block style="OLC" id="H614E560C84354D3C8BD5B503D2DF0845" display-inline="no-display-inline">
<subparagraph id="HBB3B2604CDC248F99C209B6924F6535D"><enum>(D)</enum><text display-inline="yes-display-inline">$150,000,000 for each of fiscal years 2018 and 2019.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subsection></section> <section id="HBA2CCDA5B04D4323ACA22A74CA51349B" section-type="subsequent-section"><enum>103.</enum><header>Extension for family-to-family health information centers</header><text display-inline="no-display-inline">Section 501(c) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/701">42 U.S.C. 701(c)</external-xref>) is amended—</text>
<paragraph id="H1F7EF0AA059E44B9B7F13CBB86CE76EC"><enum>(1)</enum><text>in paragraph (1)(A)—</text> <subparagraph id="H84C2966A2C064D9AA5980002C9140416"><enum>(A)</enum><text>in clause (v), by striking <quote>and</quote> at the end;</text></subparagraph>
<subparagraph id="H0AD5F46D3F5B4EE38845603CE5EAA96C"><enum>(B)</enum><text>in clause (vi), by striking the period at the end and inserting <quote>; and</quote>; and</text></subparagraph> <subparagraph id="H599DC2C9089143EAB86214CF91944FB7"><enum>(C)</enum><text>by adding at the end the following new clause:</text>
<quoted-block style="traditional" id="H15ECB931B3274768BD7029527F28DE1C" display-inline="no-display-inline">
<clause id="H9D50901246184405B451EEE7C2BB2A5F" indent="up2"><enum>(vii)</enum><text>$6,000,000 for each of fiscal years 2018 and 2019.</text></clause><after-quoted-block>;</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H637C1182854648D2831AF4534C26DCF6"><enum>(2)</enum><text>in paragraph (3)(C), by inserting before the period the following: <quote>, and with respect to fiscal years 2018 and 2019, such centers shall also be developed in all territories and at least one such center shall be developed for Indian tribes</quote>; and</text></paragraph>
<paragraph id="H074E6444500C4ED487AFA09AE4502DC0"><enum>(3)</enum><text>by amending paragraph (5) to read as follows:</text> <quoted-block style="traditional" id="H903E2DD5F5214F239CD87B2B1CA2A2ED" display-inline="no-display-inline"> <paragraph id="H85752FF25B1748DFBA35B92433BF702C" indent="up1"><enum>(5)</enum><text>For purposes of this subsection—</text>
<subparagraph id="H302416E2F4E8451787F6AAD33B1D0573"><enum>(A)</enum><text display-inline="yes-display-inline">the term <quote>Indian tribe</quote> has the meaning given such term in section 4 of the Indian Health Care Improvement Act (<external-xref legal-doc="usc" parsable-cite="usc/25/1603">25 U.S.C. 1603</external-xref>);</text></subparagraph> <subparagraph id="H8749C7399E334CD2BB0D0D0EF5406E6A"><enum>(B)</enum><text>the term <quote>State</quote> means each of the 50 States and the District of Columbia; and</text></subparagraph>
<subparagraph id="H159F1524102B4871866104C70BFD3063"><enum>(C)</enum><text>the term <quote>territory</quote> means Puerto Rico, Guam, American Samoa, the Virgin Islands, and the Northern Mariana Islands.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="H6EA414D9EB4E44E7B06EA56647164663"><enum>104.</enum><header>Youth empowerment program; personal responsibility education</header> <subsection id="H44D7A8B973FF400095F14EE9F66A4916"><enum>(a)</enum><header>Youth empowerment program</header> <paragraph id="H4E9129556B9C4A88AEFD557AECCA8C60"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 510 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/710">42 U.S.C. 710</external-xref>) is amended to read as follows:</text>
<quoted-block style="OLC" id="HD52362E057674BC7A1EF1CC98859EE4A" display-inline="no-display-inline">
<section id="H26859460EEFB4B948B037C8C2B31D1FA"><enum>510.</enum><header>Youth empowerment program</header>
<subsection id="H24168509AA3B44FC91E7B4280494844D"><enum>(a)</enum><header>In general</header>
<paragraph id="HAAB55A80352D48EEAE32854A535F5CC4"><enum>(1)</enum><header>Allotments to States</header><text display-inline="yes-display-inline">For the purpose described in subsection (b), the Secretary shall, for each of fiscal years 2018 and 2019, allot to each State which has transmitted an application for the fiscal year under section 505(a) an amount equal to the product of—</text> <subparagraph id="H790C48844D3348EF904C3EB8C7487B49"><enum>(A)</enum><text>the amount appropriated pursuant to subsection (e)(1) for the fiscal year, minus the amount reserved under subsection (e)(2) for the fiscal year; and</text></subparagraph>
<subparagraph id="HDD3A0C7914584D0E87300F167DF6BA27"><enum>(B)</enum><text display-inline="yes-display-inline">the proportion that the number of low-income children in the State bears to the total of such numbers of children for all the States.</text></subparagraph></paragraph> <paragraph id="HD67CDF43DBE04B129D3CB720E28E1FD3"><enum>(2)</enum><header>Other allotments</header> <subparagraph id="HFC6B9E93225F418592FAE4DA8ED6612D"><enum>(A)</enum><header>Other entities</header><text display-inline="yes-display-inline">For the purpose described in subsection (b), the Secretary shall, for each of fiscal years 2018 and 2019, for any State which has not transmitted an application for the fiscal year under section 505(a), allot to one or more entities in the State the amount that would have been allotted to the State under paragraph (1) if the State had submitted such an application.</text></subparagraph>
<subparagraph id="HF39E2CE893A34DD6B815F19F9DABC726"><enum>(B)</enum><header>Process</header><text>The Secretary shall select the recipients of allotments under subparagraph (A) by means of a competitive grant process under which—</text> <clause id="H3FD7014460ED4A1696F005CF0793F2CD"><enum>(i)</enum><text>not later than 30 days after the deadline for the State involved to submit an application for the fiscal year under section 505(a), the Secretary publishes a notice soliciting grant applications; and</text></clause>
<clause id="H4ADB0AFA4511479EA0262D9BE86A2743"><enum>(ii)</enum><text>not later than 120 days after such deadline, all such applications must be submitted.</text></clause></subparagraph></paragraph></subsection> <subsection id="HABD7DA3E76904EFC96156DAB335F9A11"><enum>(b)</enum><header>Purpose</header> <paragraph id="H893376E3DBFE4BA6AD9CD2FE7E6C40DD"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Except for research under paragraph (5) and information collection and reporting under paragraph (6), the purpose of an allotment under subsection (a) to a State (or to another entity in the State pursuant to subsection (a)(2)) is to enable the State or other entity to implement education exclusively on sexual risk avoidance (meaning voluntarily refraining from sexual activity).</text></paragraph>
<paragraph id="HD4A9EF65419C4133818602B8D0A2E05D"><enum>(2)</enum><header>Required components</header><text>Education on sexual risk avoidance pursuant to an allotment under this section shall—</text> <subparagraph id="H2201AFBA852244B5B31C7FC6AB95AE14"><enum>(A)</enum><text>ensure that the unambiguous and primary emphasis and context for each topic described in paragraph (3) is a message to youth that normalizes the optimal health behavior of avoiding nonmarital sexual activity;</text></subparagraph>
<subparagraph id="H8D6E5347A5A641F195508A682CD0B0AB"><enum>(B)</enum><text> be medically accurate and complete;</text></subparagraph> <subparagraph id="HEF31A970CDFC4BE682BBDF6A0178411D"><enum>(C)</enum><text>be age-appropriate; and</text></subparagraph>
<subparagraph id="H358AF79B36814CD4BA041CF6F7CB0CD9"><enum>(D)</enum><text display-inline="yes-display-inline">be based on adolescent learning and developmental theories for the age group receiving the education.</text></subparagraph></paragraph> <paragraph id="H3C47CDA64B0C4E17BDED527D64BAF6E1"><enum>(3)</enum><header>Topics</header><text display-inline="yes-display-inline">Education on sexual risk avoidance pursuant to an allotment under this section shall address each of the following topics:</text>
<subparagraph id="H4ECAD970D1284CA58667AD09276A6A81"><enum>(A)</enum><text>The holistic individual and societal benefits associated with personal responsibility, self-regulation, goal setting, healthy decisionmaking, and a focus on the future.</text></subparagraph> <subparagraph id="H27CCA8DD1E9E453993AA11C86CECEC70"><enum>(B)</enum><text>The advantage of refraining from nonmarital sexual activity in order to improve the future prospects and physical and emotional health of youth.</text></subparagraph>
<subparagraph id="H0B45E6A73FA24FA8B29BD238F9B4CE14"><enum>(C)</enum><text display-inline="yes-display-inline">The increased likelihood of avoiding poverty when youth attain self-sufficiency and emotional maturity before engaging in sexual activity.</text></subparagraph> <subparagraph id="HDB3E2DCDFB8944BA8AA53F4C1505952E"><enum>(D)</enum><text>The foundational components of healthy relationships and their impact on the formation of healthy marriages and safe and stable families.</text></subparagraph>
<subparagraph id="H3DB2F34CE4CF4E8F8C182002749AB3EF"><enum>(E)</enum><text>How other youth risk behaviors, such as drug and alcohol usage, increase the risk for teen sex.</text></subparagraph> <subparagraph id="H05DA7AF02F8943DBB01280A7F780CE08"><enum>(F)</enum><text display-inline="yes-display-inline">How to resist and avoid, and receive help regarding, sexual coercion and dating violence, recognizing that even with consent teen sex remains a youth risk behavior.</text></subparagraph></paragraph>
<paragraph id="H98A6A2CE86174348AE0E03EB25EB418B"><enum>(4)</enum><header>Contraception</header><text display-inline="yes-display-inline">Education on sexual risk avoidance pursuant to an allotment under this section shall ensure that—</text> <subparagraph id="HCAF565B52FF04D1793A57ABB2F6E2CA8"><enum>(A)</enum><text display-inline="yes-display-inline">any information provided on contraception is medically accurate and ensures that students understand that contraception offers physical risk reduction, but not risk elimination; and</text></subparagraph>
<subparagraph id="HDEB5AEB3478E49B98AF18CB541FB4EBF"><enum>(B)</enum><text>the education does not include demonstrations, simulations, or distribution of contraceptive devices.</text></subparagraph></paragraph> <paragraph id="HC76CA2F67E4D4E1DA0B5D42FB865A6E3"><enum>(5)</enum><header>Research</header> <subparagraph id="H15B94FF1F8AE4F1B801620046D1318CA"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">A State or other entity receiving an allotment pursuant to subsection (a) may use up to 20 percent of such allotment to build the evidence base for sexual risk avoidance education by conducting or supporting research.</text></subparagraph>
<subparagraph id="HEEAC5498CB024C9DB9FC1A76D1360092"><enum>(B)</enum><header>Requirements</header><text>Any research conducted or supported pursuant to subparagraph (A) shall be—</text> <clause id="HB14ED3734DEC49F5ADC7AD7D422DCB65"><enum>(i)</enum><text>rigorous;</text></clause>
<clause id="H589666AD04974D67A46EC6598D944AFC"><enum>(ii)</enum><text>evidence-based; and</text></clause> <clause id="HD3F09FC8A9C544F686A3A1AED05F1A0D"><enum>(iii)</enum><text>designed and conducted by independent researchers who have experience in conducting and publishing research in peer-reviewed outlets.</text></clause></subparagraph></paragraph>
<paragraph id="HD0E8D732487E403F9A30BD1360E3A52C"><enum>(6)</enum><header>Information collection and reporting</header><text display-inline="yes-display-inline">A State or other entity receiving an allotment pursuant to subsection (a) shall, as specified by the Secretary—</text> <subparagraph id="H7F6BC58BA8CD44F681159BAC9D96076E"><enum>(A)</enum><text>collect information on the programs and activities funded through the allotment; and</text></subparagraph>
<subparagraph id="H3F4402D6613E4B409D4D6A6AF0AAFC63"><enum>(B)</enum><text display-inline="yes-display-inline">submit reports to the Secretary on the data from such programs and activities.</text></subparagraph></paragraph></subsection> <subsection id="H704EFB28EF3946399B7CFA4CC3E2F0B3" commented="no"><enum>(c)</enum><header>National evaluation</header> <paragraph id="HAF09E34D8F6F4E7E94ADF532A0AB57B9" commented="no"><enum>(1)</enum><header>In general</header><text>The Secretary shall—</text>
<subparagraph id="HABF21590127E45FD9E7667EF5F08FF5A" commented="no"><enum>(A)</enum><text display-inline="yes-display-inline">in consultation with appropriate State and local agencies, conduct one or more rigorous evaluations of the education funded through this section and associated data; and</text></subparagraph> <subparagraph id="HD691D3B20F9F4A349EBC003037D8BDF1" commented="no"><enum>(B)</enum><text display-inline="yes-display-inline">submit a report to the Congress on the results of such evaluations, together with a summary of the information collected pursuant to subsection (b)(6).</text></subparagraph></paragraph>
<paragraph id="H299249537E684277BDF7F81E002E6B45" commented="no"><enum>(2)</enum><header>Consultation</header><text>In conducting the evaluations required by paragraph (1), including the establishment of evaluation methodologies, the Secretary shall consult with relevant stakeholders.</text></paragraph></subsection> <subsection id="H0D7523518BC04BB2A75C825D291E6C66"><enum>(d)</enum><header>Applicability of certain provisions</header><text></text>
<paragraph id="H6E9AB480AD254DCD87BB95C7CDD994F1"><enum>(1)</enum><text display-inline="yes-display-inline">Sections 503, 507, and 508 apply to allotments under subsection (a) to the same extent and in the same manner as such sections apply to allotments under section 502(c).</text></paragraph> <paragraph id="H63A1FA5C541E41CF9FB3043C9AA5ECD4"><enum>(2)</enum><text display-inline="yes-display-inline">Sections 505 and 506 apply to allotments under subsection (a) to the extent determined by the Secretary to be appropriate.</text></paragraph></subsection>
<subsection id="HCAEC5A8C639044818F7ECA86AB8E43AF"><enum>(e)</enum><header>Funding</header>
<paragraph id="H03EF586A4A774477B25683872F9FE417"><enum>(1)</enum><header>In general</header><text>To carry out this section, there is appropriated, out of any money in the Treasury not otherwise appropriated, $75,000,000 for each of fiscal years 2018 and 2019.</text></paragraph> <paragraph id="HDCEB94D2B5F347FD8ABFA118F2E798C8"><enum>(2)</enum><header>Reservation</header><text display-inline="yes-display-inline">The Secretary shall reserve, for each of fiscal years 2018 and 2019, not more than 20 percent of the amount appropriated pursuant to paragraph (1) for administering the program under this section, including the conducting of national evaluations and the provision of technical assistance to the recipients of allotments.</text></paragraph></subsection></section><after-quoted-block>.</after-quoted-block></quoted-block></paragraph>
<paragraph id="HBBACC407BD6E4899BB214EA04AA8C5B9"><enum>(2)</enum><header>Effective date</header><text>The amendment made by this subsection takes effect on October 1, 2017.</text></paragraph></subsection> <subsection id="HC32E07A9F6BA4DCC9E0F6D059DDE53D3" commented="no"><enum>(b)</enum><header>Personal responsibility education</header> <paragraph id="HC0BA9672670E432C9F93633BB256C4C4" commented="no"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 513 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/713">42 U.S.C. 713</external-xref>) is amended—</text>
<subparagraph id="H4AE678A815B34240B622848D6760C02E" commented="no"><enum>(A)</enum><text>in subsection (a)(1)(A), by striking <quote>2017</quote> and inserting <quote>2019</quote>; and</text></subparagraph> <subparagraph id="H6BF116B8E6474C6D84B51A10AD5EE133" commented="no"><enum>(B)</enum><text>in subsection (a)(4)—</text>
<clause id="H6C4067821CBB47B8B667C3C40C505A93" commented="no"><enum>(i)</enum><text>in subparagraph (A), by striking <quote>2017</quote> each place it appears and inserting <quote>2019</quote>; and</text></clause> <clause id="H19BC7795575545008B0153EAF8328867" commented="no"><enum>(ii)</enum><text>in subparagraph (B)—</text>
<subclause id="H06BB88B4C0014622A81191E3BD177D8A" commented="no"><enum>(I)</enum><text>in the subparagraph heading, by striking <quote><header-in-text level="subparagraph" style="OLC">3-year grants</header-in-text></quote> and inserting <quote><header-in-text level="subparagraph" style="OLC">Competitive PREP grants</header-in-text></quote>; and</text></subclause> <subclause id="H257D6FF166314D0997B2E67BB9E39C58" commented="no"><enum>(II)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>solicit applications to award 3-year grants in each of fiscal years 2012 through 2017</quote> and inserting <quote>continue through fiscal year 2019 grants awarded for any of fiscal years 2015 through 2017</quote>;</text></subclause></clause></subparagraph>
<subparagraph id="HC3ADEE078B9C446F99301528FB3F3A36" commented="no"><enum>(C)</enum><text>in subsection (c)(1), by inserting after <quote>youth with HIV/AIDS,</quote> the following: <quote>victims of human trafficking,</quote>; and </text></subparagraph> <subparagraph id="H3FD9C462B1514D02B56F913DE4473434" commented="no"><enum>(D)</enum><text display-inline="yes-display-inline">in subsection (f), by striking <quote>2017</quote> and inserting <quote>2019</quote>.</text></subparagraph></paragraph>
<paragraph id="H991C35E7886E4B139051E68503CCD931" commented="no"><enum>(2)</enum><header>Effective date</header><text display-inline="yes-display-inline">The amendments made by this subsection take effect on October 1, 2017.</text></paragraph></subsection></section> <enum>II</enum><header>Offsets</header> <section id="HE50E650A7FB441DDBF845AC89F291A72"><enum>201.</enum><header>Providing for qualified health plan grace period requirements for issuer receipt of advance payments of cost-sharing reductions and premium tax credits that are more consistent with State law grace period requirements</header> <subsection id="H3F68800F2CB44529A5A401599BDFE0C3"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1412(c) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/18082">42 U.S.C. 18082(c)</external-xref>) is amended—</text>
<paragraph id="H5F343E2316A841C28B4239E69ECEDF3B"><enum>(1)</enum><text>in paragraph (2)—</text> <subparagraph id="H11B3252E3DAF4AFD90EFA1EF1838B004"><enum>(A)</enum><text>in subparagraph (B)(iv)(II), by striking <quote>a 3-month grace period</quote> and inserting <quote>a grace period specified in subparagraph (C)</quote>; and</text></subparagraph>
<subparagraph id="H20BD968FF58744649F8B4D32795E8025"><enum>(B)</enum><text>by adding at the end the following new subparagraphs:</text> <quoted-block style="OLC" id="H755FC8990421443681010F1FC54E6CD1" display-inline="no-display-inline"> <subparagraph id="H2CC855110237453CA104B6D6AFD2DE82"><enum>(C)</enum><header>Grace period specified</header><text display-inline="yes-display-inline">For purposes of subparagraph (B)(iv)(II), the grace period specified in this subparagraph is—</text>
<clause id="H339BD500EF9D45B89C0B8F45E43AD1E6"><enum>(i)</enum><text>for plan years beginning before January 1, 2018, a 3-month grace period; and</text></clause> <clause id="HA410BED7F79543B2BC9E14B083B1B572"><enum>(ii)</enum><text>for plan years beginning on or after January 1, 2018—</text>
<subclause id="HE473154CD3134FDF90DC507965CF89C9"><enum>(I)</enum><text>in the case of an Exchange operating in a State that has a State law grace period in place, such State law grace period; and</text></subclause> <subclause id="H14D52449865C4880A90045ABDE0BEBC3"><enum>(II)</enum><text>in the case of an Exchange operating in a State that does not have a State law grace period in place, a 1-month grace period.</text></subclause></clause></subparagraph>
<subparagraph id="H59035EEFB07E4120B543B211F4D1C371"><enum>(D)</enum><header>State law grace period</header><text>For purposes of subparagraph (C), the term <quote>State law grace period</quote> means, with respect to a State, a grace period for nonpayment of premiums before discontinuing coverage that is applicable under the State law to health insurance coverage offered in the individual market of the State. </text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="H5B619DCFE29D4CC38F70AAD1A8131073"><enum>(2)</enum><text>in paragraph (3), by adding at the end the following new sentence: <quote>The requirements of paragraph (2)(B)(iv) apply to an issuer of a qualified health plan receiving an advanced payment under this paragraph in the same manner and to the same extent that such requirements apply to an issuer of a qualified health plan receiving an advanced payment under paragraph (2)(A).</quote>.</text></paragraph></subsection>
<subsection id="H40EC3742794E4E7E8350F01145026DE6"><enum>(b)</enum><header>Report on aligning grace periods for Medicaid, Medicare, and Exchange plans</header><text display-inline="yes-display-inline">Not later than 2 years after the date of full implementation of subsection (a), the Comptroller General of the United States shall submit to Congress a report on—</text> <paragraph id="H87408E156FF94F6C83B092FB1075FE88"><enum>(1)</enum><text>the effects on consumers of aligning grace periods applied under the Medicaid program under title XIX of the Social Security Act, under the Medicare program under parts C and D of title XVIII of such Act, and under qualified health plans offered on an Exchange established under title I of the Patient Protection and Affordable Care Act, including the extent to which such an alignment of grace periods may help to avoid enrollment status confusion for individuals under such Medicaid program, Medicare program, and qualified health plans; and</text></paragraph>
<paragraph id="HA4408990B3BF441D9CA9724743546CED"><enum>(2)</enum><text>the extent to which such an alignment of grace periods may reduce fraud, waste, and abuse under the Medicaid program.</text></paragraph></subsection></section> <section id="HC4B3BC27A27E47198C30F949DAB6BF24"><enum>202.</enum><header>Prevention and Public Health Fund</header><text display-inline="no-display-inline">Section 4002(b) of the Patient Protection and Affordable Care Act (<external-xref legal-doc="usc" parsable-cite="usc/42/300u-11">42 U.S.C. 300u–11(b)</external-xref>) is amended by striking paragraphs (3) through (8) and inserting the following new paragraphs:</text>
<quoted-block style="OLC" id="H4402D2909D574964A83E764F3393A236" display-inline="no-display-inline">
<paragraph id="H34799ECFDCE14850A1A99D1AB7AC002D"><enum>(3)</enum><text display-inline="yes-display-inline">for fiscal year 2018, $900,000,000;</text></paragraph> <paragraph id="H507D64AB4D204A5F81119DDBB6A4D88B" commented="no"><enum>(4)</enum><text>for fiscal year 2019, $500,000,000;</text></paragraph>
<paragraph id="H59CE31B4682441CAA5CAB03BB8B5160C" commented="no"><enum>(5)</enum><text>for fiscal year 2020, $500,000,000;</text></paragraph> <paragraph id="HAFC1C8BE00684B52A4052198FC0284AC" commented="no"><enum>(6)</enum><text>for fiscal year 2021, $500,000,000;</text></paragraph>
<paragraph id="H0E985616D46243CD8A513957AEBD6240" commented="no"><enum>(7)</enum><text>for fiscal year 2022, $500,000,000;</text></paragraph> <paragraph id="HB1C25F8F92F34BE3A7E17619041B3FD0" commented="no"><enum>(8)</enum><text>for fiscal year 2023, $500,000,000;</text></paragraph>
<paragraph id="HE94FB31888E04BECBD08F4E2F1433871" commented="no"><enum>(9)</enum><text>for fiscal year 2024, $500,000,000;</text></paragraph> <paragraph id="H5A5097DA957844B9ABD01E36629A41F5" commented="no"><enum>(10)</enum><text>for fiscal year 2025, $750,000,000;</text></paragraph>
<paragraph id="HFB18721349DC4B78BCE0E7D9E9EFAC25" commented="no"><enum>(11)</enum><text>for fiscal year 2026, $1,000,000,000; and</text></paragraph> <paragraph id="H71FEE24C0CB247E3B7950A6DED5ADFEB" commented="no"><enum>(12)</enum><text>for fiscal year 2027 and each fiscal year thereafter, $2,000,000,000.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
B
300.This division may be cited as the Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017
or the HEALTHY KIDS Act
. <enum>I</enum><header>CHIP Extension and Other Medicaid and CHIP Provisions</header> <section commented="no" id="HA3F555EE13BD4BB0B0C1D528E1AF67A6"><enum>301.</enum><header>Five-year funding extension of the Children’s Health Insurance Program</header> <subsection commented="no" id="HE444C9C1FEE647AF8FD887D24739EA09"><enum>(a)</enum><header>Appropriation; total allotment</header><text>Section 2104(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(a)</external-xref>) is amended—</text>
<paragraph commented="no" id="H04AE890C860841B587FA7A4469812CEE"><enum>(1)</enum><text>in paragraph (19), by striking <quote>and</quote>;</text></paragraph> <paragraph commented="no" id="HB598D99C4522446DBF1A0F6A5B48394C"><enum>(2)</enum><text>in paragraph (20), by striking the period at the end and inserting a semicolon; and</text></paragraph>
<paragraph commented="no" id="HD3D7257ABE334C548EA2281504268AA5"><enum>(3)</enum><text>by adding at the end the following new paragraphs:</text> <quoted-block id="H9D7248DF494C44F8BE61B7E7A43FA609" style="OLC"> <paragraph commented="no" id="H1AFDCEF6253D4D5192B08447DCE85669"><enum>(21)</enum><text>for fiscal year 2018, $21,500,000,000;</text></paragraph>
<paragraph commented="no" id="HFDF1CA782DA244FE96E054F16E1A8A21"><enum>(22)</enum><text display-inline="yes-display-inline">for fiscal year 2019, $22,600,000,000;</text></paragraph> <paragraph commented="no" id="HB1E9ABE7E33F4C6B9A012A8C2FABE4CA"><enum>(23)</enum><text display-inline="yes-display-inline">for fiscal year 2020, $23,700,000,000;</text></paragraph>
<paragraph commented="no" id="HD32FA84D1845400EA50ECA889F55B4E9"><enum>(24)</enum><text display-inline="yes-display-inline">for fiscal year 2021, $24,800,000,000; and</text></paragraph> <paragraph commented="no" id="H88547382B77D44E79A5FBC1D11893D32"><enum>(25)</enum><text display-inline="yes-display-inline">for fiscal year 2022, for purposes of making two semi-annual allotments—</text>
<subparagraph id="H7A2A417A2E894D8D84654D3BF689807A"><enum>(A)</enum><text display-inline="yes-display-inline">$2,850,000,000 for the period beginning on October 1, 2021, and ending on March 31, 2022; and</text></subparagraph> <subparagraph id="HAB6356F508BA40A2B5FD6B94BC5401C4"><enum>(B)</enum><text display-inline="yes-display-inline">$2,850,000,000 for the period beginning on April 1, 2022, and ending on September 30, 2022.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection commented="no" id="HDBAC1BAC8F894A23B0A6E52C9307E9D2"><enum>(b)</enum><header>Allotments</header>
<paragraph commented="no" id="H5156611AD19A4AF9ABA60DC3B7CA98C7"><enum>(1)</enum><header>In general</header><text>Section 2104(m) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(m)</external-xref>) is amended—</text> <subparagraph commented="no" id="HA5E6F0A0DD27445294EABB169F3BE7E5"><enum>(A)</enum><text>in paragraph (2)—</text>
<clause commented="no" id="H5D8F01828DF64DCB88D24F2227119EAC"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">through <enum-in-header>2016</enum-in-header></header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">through <enum-in-header>2022</enum-in-header></header-in-text></quote>; and</text></clause> <clause commented="no" id="H120463D3040B4145B8AB8C9F7702CA14"><enum>(ii)</enum><text>in subparagraph (B)—</text>
<subclause id="H056EC808A2CC4F98A1C7C3D1681DAA87"><enum>(I)</enum><text>in the matter preceding clause (i), by striking <quote>(19)</quote> and inserting <quote>(24)</quote>;</text></subclause> <subclause id="H118E455F66ED4FACAD034650B4466300"><enum>(II)</enum><text>in clause (ii), in the matter preceding subclause (I), by inserting <quote>(other than fiscal year 2022)</quote> after <quote>even-numbered fiscal year</quote>; and</text></subclause>
<subclause id="H69576D3F7A5C4C67BCF1E897CCFDEA71"><enum>(III)</enum><text>in clause (ii)(I), by inserting <quote>(or, in the case of fiscal year 2018, under paragraph (4))</quote> after <quote>clause (i)</quote>;</text></subclause></clause></subparagraph> <subparagraph commented="no" id="H913122EFE810467E84E8348A02108913"><enum>(B)</enum><text>in paragraph (5)—</text>
<clause commented="no" id="HA3C7444842A643209B71F9B7A2288963"><enum>(i)</enum><text>by striking <quote>or (4)</quote> and inserting <quote>(4), or (10)</quote>; and</text></clause> <clause commented="no" id="H6C43C961A96A46918F7292BB1BB93041"><enum>(ii)</enum><text>by striking <quote>or 2017</quote> and inserting <quote>, 2017, or 2022</quote>;</text></clause></subparagraph>
<subparagraph id="H7B2F37DE3783497E95D6BE47E323F43D"><enum>(C)</enum><text>in paragraph (7)—</text> <clause commented="no" id="H9D5D42D0501D4C27892277A979B85C01"><enum>(i)</enum><text>in subparagraph (A), by striking <quote>2017</quote> and inserting <quote>2022</quote>;</text></clause>
<clause commented="no" id="HF4D38A3DC6FF4D89A6CB29A7D063678B"><enum>(ii)</enum><text>in subparagraph (B), in the matter preceding clause (i), by inserting <quote>(or, in the case of fiscal year 2018, by not later than the date that is 60 days after the date of the enactment of the HEALTHY KIDS Act)</quote> after <quote>before the August 31 preceding the beginning of the fiscal year</quote>; and</text></clause> <clause id="H6E760DC5A7D645CB839BF8715A86AB21"><enum>(iii)</enum><text>in the matter following subparagraph (B), by striking <quote>or fiscal year 2016</quote> and inserting <quote>fiscal year 2016, fiscal year 2018, fiscal year 2020, or fiscal year 2022</quote>;</text></clause></subparagraph>
<subparagraph id="H0EBF12A9ABB2416A8E1B0576E68055B5"><enum>(D)</enum><text>in paragraph (9)—</text> <clause id="HF91BB819535A4D6B9A4A2A279ACBADF1"><enum>(i)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">fiscal years <enum-in-header>2015</enum-in-header> and <enum-in-header>2017</enum-in-header></header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">certain fiscal years</header-in-text></quote>;</text></clause>
<clause id="H80B0CD406BCF4AAD93557663097C4896"><enum>(ii)</enum><text>by striking <quote>or (4)</quote> and inserting <quote>, (4), or (10)</quote>; and</text></clause> <clause id="H6BE7412087C24327B843F26904E7EBB6"><enum>(iii)</enum><text>by striking <quote>or fiscal year 2017</quote> and inserting <quote>, 2017, or 2022</quote>; and</text></clause></subparagraph>
<subparagraph id="H177951EBE68347E1B844B6BA36CEFF8A"><enum>(E)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="HFC649F8061FB48C691D0D731BDD72BA8" style="OLC"> <paragraph commented="no" id="HC79ABAC4FD7546FA815ED6D2077CF290"><enum>(10)</enum><header>For fiscal year <enum-in-header>2022</enum-in-header></header> <subparagraph commented="no" id="H4B4D2BEAB8AE48DAB1BD1656BE5903A8"><enum>(A)</enum><header>First half</header><text display-inline="yes-display-inline">Subject to paragraphs (5) and (7), from the amount made available under subparagraph (A) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, increased by the amount of the appropriation for such period under section 301(b)(3) of the HEALTHY KIDS Act, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the first half ratio (described in subparagraph (D)) of the amount described in subparagraph (C).</text></subparagraph>
<subparagraph commented="no" id="H502FDC8D1298439A866A89AC178DC496"><enum>(B)</enum><header>Second half</header><text display-inline="yes-display-inline">Subject to paragraphs (5) and (7), from the amount made available under subparagraph (B) of paragraph (25) of subsection (a) for the semi-annual period described in such subparagraph, the Secretary shall compute a State allotment for each State (including the District of Columbia and each commonwealth and territory) for such semi-annual period in an amount equal to the amount made available under such subparagraph, multiplied by the ratio of—</text> <clause commented="no" id="H2E5134BB7B0946BCA3CA42FE4A74EC8F"><enum>(i)</enum><text display-inline="yes-display-inline">the amount of the allotment to such State under subparagraph (A); to</text></clause>
<clause commented="no" id="HBA78BE598C41489B8682CF9D3C685D87"><enum>(ii)</enum><text display-inline="yes-display-inline">the total of the amount of all of the allotments made available under such subparagraph.</text></clause></subparagraph> <subparagraph commented="no" id="H873A91DE96C6407A99A61E108A4B0980"><enum>(C)</enum><header>Full year amount based on growth factor updated amount</header><text display-inline="yes-display-inline">The amount described in this subparagraph for a State is equal to the sum of—</text>
<clause id="H37243A4D03A649E081F94A74FAD68123"><enum>(i)</enum><text>the amount of the State allotment for fiscal year 2021 determined under paragraph (2)(B)(i); and</text></clause> <clause id="H6A124001CD9D4CAF97D6E2D5B2763DDF"><enum>(ii)</enum><text>the amount of any payments made to the State under subsection (n) for fiscal year 2021,</text></clause><continuation-text continuation-text-level="subparagraph">multiplied by the allotment increase factor under paragraph (6) for fiscal year 2022.</continuation-text></subparagraph>
<subparagraph commented="no" id="H5B260F3A8C734033BBB7BA289F04AB97"><enum>(D)</enum><header>First half ratio</header><text display-inline="yes-display-inline">The first half ratio described in this subparagraph is the ratio of—</text> <clause commented="no" id="H5C0E5321FF9F473986F82C7A19F345B1"><enum>(i)</enum><text display-inline="yes-display-inline">the sum of—</text>
<subclause commented="no" id="H198D80E1F7394411B64A2B50B9DE008E"><enum>(I)</enum><text display-inline="yes-display-inline">the amount made available under subsection (a)(25)(A); and</text></subclause> <subclause commented="no" id="H2B3A4A37344545E9BE94E3C8B3DDCD9C"><enum>(II)</enum><text display-inline="yes-display-inline">the amount of the appropriation for such period under section 301(b)(3) of the HEALTHY KIDS Act; to</text></subclause></clause>
<clause commented="no" id="HD733056C187B455591038E837A451C38"><enum>(ii)</enum><text display-inline="yes-display-inline">the sum of—</text> <subclause commented="no" id="HC1DAA2A8B22E496499FAA14EC6EC571A"><enum>(I)</enum><text display-inline="yes-display-inline">the amount described in clause (i); and</text></subclause>
<subclause commented="no" id="HABE39A96E3EB4C6EAD594D6BCE18C4F1"><enum>(II)</enum><text display-inline="yes-display-inline">the amount made available under subsection (a)(25)(B).</text></subclause></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph commented="no" id="H377B70BB26F44A17AB8B87166EE11EC1"><enum>(2)</enum><header>Technical amendment</header><text display-inline="yes-display-inline">Section 2104(m)(2)(A) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(m)(2)(A)</external-xref>) is amended by striking <quote>the allotment increase factor under paragraph (5)</quote> each place it appears and inserting <quote>the allotment increase factor under paragraph (6)</quote>.</text></paragraph>
<paragraph commented="no" id="HBF9C1BD76C264F36942AD9A56094489E"><enum>(3)</enum><header>One-time appropriation for fiscal year <enum-in-header>2022</enum-in-header></header><text display-inline="yes-display-inline">There is appropriated to the Secretary of Health and Human Services, out of any money in the Treasury not otherwise appropriated, $20,200,000,000 to accompany the allotment made for the period beginning on October 1, 2021, and ending on March 31, 2022, under paragraph (25)(A) of section 2104(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(a)</external-xref>) (as added by subsection (a)(3)), to remain available until expended. Such amount shall be used to provide allotments to States under paragraph (10) of section 2104(m) of such Act (as added by subsection (b)(1)(E)) for the first 6 months of fiscal year 2022 in the same manner as allotments are provided under subsection (a)(25)(A) of such section 2104 and subject to the same terms and conditions as apply to the allotments provided from such subsection (a)(25)(A).</text></paragraph></subsection> <subsection commented="no" id="HF2546BC2B0A74880A97A8FA8C2FEDE38"><enum>(c)</enum><header>Extension of the Child Enrollment Contingency Fund</header><text display-inline="yes-display-inline">Section 2104(n) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397dd">42 U.S.C. 1397dd(n)</external-xref>) is amended—</text>
<paragraph commented="no" id="H34FFDE9CFFAB4669ABA731FF55E4DBAA"><enum>(1)</enum><text>in paragraph (2)—</text> <subparagraph commented="no" id="HFB250041434B43BFAD417644E7F2AAEE"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A)(ii)—</text>
<clause commented="no" id="H09F1BF09DC804A1EBD74E17ABAE24956"><enum>(i)</enum><text>by striking <quote>2010, 2011, 2012, 2013, 2014, and 2016</quote> and inserting <quote>2010 through 2014, 2016, and 2018 through 2021</quote>; and</text></clause> <clause commented="no" id="H2E6C5EE5682146A8ABAE17623E363374"><enum>(ii)</enum><text>by striking <quote>fiscal year 2015 and fiscal year 2017</quote> and inserting <quote>fiscal years 2015, 2017, and 2022</quote>; and</text></clause></subparagraph>
<subparagraph commented="no" id="HE20D494A37E74861AEAE5783487E52B3"><enum>(B)</enum><text display-inline="yes-display-inline">in subparagraph (B)—</text> <clause commented="no" id="H3EFD3D20EB1F40E1AD824E5B016B8184"><enum>(i)</enum><text>by striking <quote>2010, 2011, 2012, 2013, 2014, and 2016</quote> and inserting <quote>2010 through 2014, 2016, and 2018 through 2021</quote>; and</text></clause>
<clause commented="no" id="H7FDA7EDA2BC44109A9D939EA282EEE5C"><enum>(ii)</enum><text>by striking <quote>fiscal year 2015 and fiscal year 2017</quote> and inserting <quote>fiscal years 2015, 2017, and 2022</quote>; and</text></clause></subparagraph></paragraph> <paragraph commented="no" id="HBA7B3B818D5F467A82B60FFAE345B027"><enum>(2)</enum><text>in paragraph (3)(A), in the matter preceding clause (i), by striking <quote>or a semi-annual allotment period for fiscal year 2015 or 2017</quote> and inserting <quote>or in any of fiscal years 2018 through 2021 (or a semi-annual allotment period for fiscal year 2015, 2017, or 2022)</quote>.</text></paragraph></subsection>
<subsection commented="no" id="H2C313DE89A0E4069B8E3629D8036133C"><enum>(d)</enum><header>Extension of qualifying states option</header><text>Section 2105(g)(4) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(g)(4)</external-xref>) is amended—</text> <paragraph commented="no" id="H778E2D0B6D00423FBB3748062A114A9A"><enum>(1)</enum><text>in the heading, by striking <quote><header-in-text level="paragraph" style="OLC">through <enum-in-header>2017</enum-in-header></header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">through <enum-in-header>2022</enum-in-header></header-in-text></quote>; and</text></paragraph>
<paragraph commented="no" id="HFF4E73091D404063BA5E9199684D4F2B"><enum>(2)</enum><text>in subparagraph (A), by striking <quote>2017</quote> and inserting <quote>2022</quote>.</text></paragraph></subsection> <subsection commented="no" id="HAAB70F65BFF545E8B68DD74DECCFD932"><enum>(e)</enum><header>Extension of express lane eligibility option</header><text>Section 1902(e)(13)(I) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(e)(13)(I)</external-xref>) is amended by striking <quote>2017</quote> and inserting <quote>2022</quote>.</text></subsection>
<subsection commented="no" id="H8913BE6BB57741D78C82128B3B6759D9"><enum>(f)</enum><header>Assurance of affordability standard for children and families</header>
<paragraph commented="no" id="HB37F84E40CAE439395227CD45A023827"><enum>(1)</enum><header>In general</header><text>Section 2105(d)(3) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(d)(3)</external-xref>) is amended—</text> <subparagraph commented="no" id="H355E7EB9A3804F5F98F8C02C723DE634"><enum>(A)</enum><text>in the paragraph heading, by striking <quote><header-in-text level="paragraph" style="OLC">until October <enum-in-header>1</enum-in-header>, <enum-in-header>2019</enum-in-header></header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">through September <enum-in-header>30</enum-in-header>, <enum-in-header>2022</enum-in-header></header-in-text></quote>; and</text></subparagraph>
<subparagraph commented="no" id="HDEDAFE23FA794B269584C792356DC547"><enum>(B)</enum><text>in subparagraph (A), in the matter preceding clause (i)—</text> <clause commented="no" id="H5A43D941FAFC4C4F84FB17FD916D998E"><enum>(i)</enum><text>by striking <quote>2019</quote> and inserting <quote>2022</quote>; and</text></clause>
<clause commented="no" id="HC8192998F0AD4BBBB7789EE31D80586A"><enum>(ii)</enum><text>by striking <quote>The preceding sentence shall not be construed as preventing a State during such period</quote> and inserting <quote>During the period that begins on October 1, 2019, and ends on September 30, 2022, the preceding sentence shall only apply with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved. The preceding sentences shall not be construed as preventing a State during any such periods</quote>.</text></clause></subparagraph></paragraph> <paragraph commented="no" id="HCD9EF76FD4F3478488BA81511D63E9EC"><enum>(2)</enum><header>Conforming amendments</header><text>Section 1902(gg)(2) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(gg)(2)</external-xref>) is amended—</text>
<subparagraph commented="no" id="H7AB16D31421B4C3AAE837BE3CFFDC228"><enum>(A)</enum><text>in the paragraph heading, by striking <quote><header-in-text level="paragraph" style="OLC">until October <enum-in-header>1</enum-in-header>, <enum-in-header>2019</enum-in-header></header-in-text></quote> and inserting <quote><header-in-text level="paragraph" style="OLC">through September <enum-in-header>30</enum-in-header>, <enum-in-header>2022</enum-in-header></header-in-text></quote>; and</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="HE6614D9200E64E108A9C00743D1F5EC1"><enum>(B)</enum><text>by striking <quote>September 30, 2019,</quote> and inserting <quote>September 30, 2022 (but during the period that begins on October 1, 2019, and ends on September 30, 2022, only with respect to children in families whose income does not exceed 300 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved)</quote>.</text></subparagraph></paragraph></subsection>
<subsection id="H390C430AF5EE404A89EFAD69CBD5DE71"><enum>(g)</enum><header>CHIP look-Alike plans</header>
<paragraph id="HD637102757BA4AFB87441A9663CAE0E3"><enum>(1)</enum><header>Blending risk pools</header><text>Section 2107 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg</external-xref>) is amended by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="HBDD9BED014B6435B8C67989E2BF4C0DF" style="OLC"> <subsection id="HF53A9476F794427FB1EFB9C8B6216382"><enum>(g)</enum><header>Use of blended risk pools</header> <paragraph id="HB9EF00BF16BA47189050BE276321CE15"><enum>(1)</enum><header>In general</header><text>Nothing in this title (or any other provision of Federal law) shall be construed as preventing a State from considering children enrolled in a qualified CHIP look-alike program and children enrolled in a State child health plan under this title (or a waiver of such plan) as members of a single risk pool.</text></paragraph>
<paragraph commented="no" id="HAC10E0EA966E469489788F04AC4BFF38"><enum>(2)</enum><header>Qualified CHIP look-alike program</header><text display-inline="yes-display-inline">In this subsection, the term <term>qualified CHIP look-alike program</term> means a State program—</text> <subparagraph commented="no" id="H0C41A36C6C984DB887442885BFA3754A"><enum>(A)</enum><text display-inline="yes-display-inline">under which children who are under the age of 19 and are not eligible to receive medical assistance under title XIX or child health assistance under this title may purchase coverage through the State that provides benefits that are at least identical to the benefits provided under the State child health plan under this title (or a waiver of such plan); and</text></subparagraph>
<subparagraph commented="no" id="HA61EC113F4A84C868019D4781C116D91"><enum>(B)</enum><text display-inline="yes-display-inline">that is funded exclusively through non-Federal funds, including funds received by the State in the form of premiums for the purchase of such coverage.</text></subparagraph></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph> <paragraph commented="no" id="H5E6E11C06AE045B091E4AD27D80B2C74"><enum>(2)</enum><header>Coverage rule</header> <subparagraph commented="no" id="H48C65096DDD14B958CBA6286F87D7D35"><enum>(A)</enum><header>In general</header><text><external-xref legal-doc="usc" parsable-cite="usc/26/5000A">Section 5000A(f)(1)</external-xref> of the Internal Revenue Code of 1986 is amended in subparagraph (A)(iii), by inserting <quote>or under a qualified CHIP look-alike program (as defined in section 2107(g) of the Social Security Act)</quote> before the comma at the end.</text></subparagraph>
<subparagraph commented="no" id="H43C903BFA51B4203982B07B22C8B4CCA"><enum>(B)</enum><header>Effective date</header><text>The amendment made by subparagraph (A) shall apply with respect to taxable years beginning after December 31, 2017.</text></subparagraph></paragraph></subsection></section> <section commented="no" id="HDB8AD9773B8C4E25A8B2976C6C1E0CD4"><enum>302.</enum><header>Extension of certain programs and demonstration projects</header> <subsection commented="no" id="H56AC77B7B31B4F7293A7FD80DD8A0FF9"><enum>(a)</enum><header>Childhood obesity demonstration project</header><text>Section 1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b–9a(e)(8)) is amended—</text>
<paragraph commented="no" id="HBD9FA0419E7643E8B70B73845F2B0FE3"><enum>(1)</enum><text>by striking <quote>and $10,000,000</quote> and inserting <quote>, $10,000,000</quote>; and</text></paragraph> <paragraph commented="no" id="H0C02F6A00EA94A8FA9B9E15E7C8219C8"><enum>(2)</enum><text>by inserting after <quote>2017</quote> the following: <quote>, and $25,000,000 for the period of fiscal years 2018 through 2022</quote>.</text></paragraph></subsection>
<subsection commented="no" display-inline="no-display-inline" id="H0CD5B7F163E04255A53BDE975A82293B"><enum>(b)</enum><header display-inline="yes-display-inline">Pediatric quality measures program</header><text display-inline="yes-display-inline">Section 1139A(i) of the Social Security Act (42 U.S.C. 1320b–9a(i)) is amended—</text> <paragraph commented="no" display-inline="no-display-inline" id="H2D3213837CB34D76A62EF22ED3B12A96"><enum>(1)</enum><text display-inline="yes-display-inline">by striking <quote>Out of any</quote> and inserting the following:</text>
<quoted-block display-inline="no-display-inline" id="H36D7CFE3D1254D899DC8FABBF3A5DA1D" style="OLC">
<paragraph commented="no" display-inline="no-display-inline" id="HCF146AF229444ABD955F0792E1545D9F"><enum>(1)</enum><header>In general</header><text>Out of any</text></paragraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H2E202B2E70784D769F1B260EAB4A9D08"><enum>(2)</enum><text>by striking <quote>there is appropriated for each</quote> and inserting “there is appropriated—</text>
<quoted-block display-inline="no-display-inline" id="H6D4E635E1CE64623AB2557218EE20D8A" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H1D3B25436C574618B6C863CC9D8CDBC8"><enum>(A)</enum><text>for each</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H7ABDB558E866450C8EA7A2A6DB9FDE45"><enum>(3)</enum><text>by striking <quote>, and there is appropriated for the period</quote> and inserting “;</text>
<quoted-block display-inline="no-display-inline" id="H05FBA4FF08EA4E60805236A3F7094616" style="OLC">
<subparagraph commented="no" display-inline="no-display-inline" id="H47E688441A65477BAF29E28458D4355D"><enum>(B)</enum><text>for the period</text></subparagraph><after-quoted-block>;</after-quoted-block></quoted-block></paragraph> <paragraph commented="no" display-inline="no-display-inline" id="H402DCCA130734F5087039D19A1B297A4"><enum>(4)</enum><text>by striking <quote>. Funds appropriated under this subsection shall remain available until expended.</quote> and inserting <quote>; and</quote>; and</text></paragraph>
<paragraph commented="no" display-inline="no-display-inline" id="H24F7A54FAF7D40C580C866FDDB3D7DDF"><enum>(5)</enum><text>by adding at the end the following:</text> <quoted-block display-inline="no-display-inline" id="H2F142612FEF747EB93B4239042B0DA3E" style="OLC"> <subparagraph commented="no" display-inline="no-display-inline" id="H6F00E88046BA4DA3B6059CA1D72672B8"><enum>(C)</enum><text>for the period of fiscal years 2018 through 2022, $75,000,000 for the purpose of carrying out this section (other than subsections (e), (f), and (g)).</text></subparagraph>
<paragraph commented="no" display-inline="no-display-inline" id="H95CD46B7F2254A66B4F68F5044A894CE"><enum>(2)</enum><header>Availability</header><text>Funds appropriated under this subsection shall remain available until expended.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section> <section commented="no" display-inline="no-display-inline" id="H534818EE21A149F5A2254DFA71ED7F9E" section-type="subsequent-section"><enum>303.</enum><header display-inline="yes-display-inline">Extension of outreach and enrollment program</header> <subsection id="HF17C6538312B4CF480F4A8A51C21B59B"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 2113 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397mm">42 U.S.C. 1397mm</external-xref>) is amended—</text>
<paragraph commented="no" id="HEDC0A25929824EEB9844591210E41306"><enum>(1)</enum><text>in subsection (a)(1), by striking <quote>2017</quote> and inserting <quote>2022</quote>; and</text></paragraph> <paragraph commented="no" id="H7BAF1A67A27D4E909CB2E90CEDAF1EF8"><enum>(2)</enum><text>in subsection (g)—</text>
<subparagraph commented="no" id="HFCD1E012A7DA4E7F8AC7394DAF6FB033"><enum>(A)</enum><text>by striking <quote>and $40,000,000</quote> and inserting <quote>, $40,000,000</quote>; and</text></subparagraph> <subparagraph commented="no" display-inline="no-display-inline" id="H2C5DC461D7B9445CB9F370D31321DE3F"><enum>(B)</enum><text>by inserting after <quote>2017</quote> the following: <quote>, and $100,000,000 for the period of fiscal years 2018 through 2022</quote>.</text></subparagraph></paragraph></subsection>
<subsection id="H6C6BEBDFA2C3469E8AD6CEBD3C3C9DC0"><enum>(b)</enum><header>Making organizations that use parent mentors eligible To receive grants</header><text display-inline="yes-display-inline">Section 2113(f) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397mm">42 U.S.C. 1397mm(f)</external-xref>) is amended—</text> <paragraph id="H40C5FAD2774144A3B4E32E22CDF39C0E" commented="no"><enum>(1)</enum><text>in paragraph (1)(E), by striking <quote>or community-based doula programs</quote> and inserting <quote>, community-based doula programs, or parent mentors</quote>; and </text></paragraph>
<paragraph id="H62569A773C88473CAFFD4FAA7F7B74C5"><enum>(2)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block display-inline="no-display-inline" id="HD5172096A8B745C5BC1C043DEF5C04D1" style="OLC"> <paragraph id="H13412CF2EE974F22929827EAE9DCAE43"><enum>(5)</enum><header>Parent mentor</header><text display-inline="yes-display-inline">The term <quote>parent mentor</quote> means an individual who—</text>
<subparagraph id="H4F125BCF89084EB08AE1BB601984B7A7"><enum>(A)</enum><text>is a parent or guardian of at least one child who is an eligible child under this title or title XIX; and</text></subparagraph> <subparagraph id="HB2362C3CE1CC4509AEE465BBDE572ECE"><enum>(B)</enum><text>is trained to assist families with children who have no health insurance coverage with respect to improving the social determinants of the health of such children, including by providing—</text>
<clause id="HF55447361EE44A49ABD7D463BC9CABA1"><enum>(i)</enum><text>education about health insurance coverage, including, with respect to obtaining such coverage, eligibility criteria and application and renewal processes;</text></clause> <clause id="HBB6F23FAC9FE411495772D730089B8AD"><enum>(ii)</enum><text>assistance with completing and submitting applications for health insurance coverage;</text></clause>
<clause id="HF6555D9DD88B45988C0E110B45DB25EC"><enum>(iii)</enum><text>a liaison between families and representatives of State plans under title XIX or State child health plans under this title;</text></clause> <clause id="H463EB936662A45CA929C768DFCE66453"><enum>(iv)</enum><text>guidance on identifying medical and dental homes and community pharmacies for children; and</text></clause>
<clause id="HA29B23BDAA8B4F4A9A942056817ACBAD"><enum>(v)</enum><text>assistance and referrals to successfully address social determinants of children’s health, including poverty, food insufficiency, and housing.</text></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H6FF32E26B64F487DBFDBEAAAB9EDDC79" commented="no"><enum>(c)</enum><header>Exclusion from modified adjusted gross income</header><text display-inline="yes-display-inline">Section 1902(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(e)</external-xref>) is amended—</text>
<paragraph id="H6CFAD955C2A3411C8C7CBB257693AF3B"><enum>(1)</enum><text>in the first paragraph (14), relating to income determined using modified adjusted gross income, by adding at the end the following new subparagraph:</text> <quoted-block style="OLC" id="H88371A81923642568DF55B9DD93B89FB" display-inline="no-display-inline"> <subparagraph id="HF3FF7530E7DC40EA8E64AEA4DF6AED3C" commented="no"><enum>(J)</enum><header>Exclusion of parent mentor compensation from income determination</header><text display-inline="yes-display-inline">Any nominal amount received by an individual as compensation, including a stipend, for participation as a parent mentor (as defined in paragraph (5) of section 2113(f)) in an activity or program funded through a grant under such section shall be disregarded for purposes of determining the income eligibility of such individual for medical assistance under the State plan or any waiver of such plan.</text></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></paragraph>
<paragraph id="H05E5A76E908A4676BB9F6D9C391A5A44"><enum>(2)</enum><text>by striking <quote>(14) <header-in-text level="paragraph" style="OLC">Exclusion</header-in-text></quote> and inserting <quote>(15) <header-in-text level="paragraph" style="OLC">Exclusion</header-in-text></quote>.</text></paragraph></subsection></section> <section commented="no" display-inline="no-display-inline" id="HFA1DF7F55687428C9467FEC49E21041B"><enum>304.</enum><header>Extension and reduction of additional Federal financial participation for CHIP</header><text display-inline="no-display-inline">Section 2105(b) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397ee">42 U.S.C. 1397ee(b)</external-xref>) is amended in the second sentence by inserting <quote>and during the period that begins on October 1, 2019, and ends on September 30, 2020, the enhanced FMAP determined for a State for a fiscal year (or for any portion of a fiscal year occurring during such period) shall be increased by 11.5 percentage points</quote> after <quote>23 percentage points,</quote>.</text></section>
<section id="H78E5FF8906A54DB8AA78CADEA005DF2B" section-type="subsequent-section"><enum>305.</enum><header>Modifying reductions in Medicaid DSH allotments</header><text display-inline="no-display-inline">Section 1923(f)(7)(A) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396r-4">42 U.S.C. 1396r–4(f)(7)(A)</external-xref>) is amended—</text> <paragraph id="HA05D600464964957A607066D6B0F8BF1"><enum>(1)</enum><text>in clause (i), in the matter preceding subclause (I), by striking <quote>2018</quote> and inserting <quote>2020</quote>; and </text></paragraph>
<paragraph id="HCB27790E62F8403B8B63BA20C4D98250"><enum>(2)</enum><text>in clause (ii), by striking subclauses (I) through (VIII) and inserting the following:</text> <quoted-block style="OLC" id="HB00AF10595AE4FED8307FF2AD76A662D" display-inline="no-display-inline"> <subclause id="H8C8B2A96EF954667899303317AE8FC6A"><enum>(I)</enum><text display-inline="yes-display-inline">$4,000,000,000 for fiscal year 2020; and</text></subclause>
<subclause id="HC644B055E68D477DA8A17C16F8350459"><enum>(II)</enum><text>$8,000,000,000 for each of fiscal years 2021 through 2025.</text></subclause><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section> <section id="H5392A6DEDFF8494F8BEB718425F84365" section-type="subsequent-section"><enum>306.</enum><header>Puerto Rico and the Virgin Islands Medicaid payments</header> <subsection id="H1C66399E1B3046E4B92D867A535627C3"><enum>(a)</enum><header>Increased cap</header><text display-inline="yes-display-inline">Section 1108(g) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1308">42 U.S.C. 1308(g)</external-xref>) is amended—</text>
<paragraph id="HB350561E30C34F87A7D48AA6F202FA89"><enum>(1)</enum><text>in paragraph (2)—</text> <subparagraph id="HDF2990444B8D4D3FB7D8C1B8C3EC853D"><enum>(A)</enum><text>in subparagraph (A), by inserting <quote>(or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point)</quote> after <quote>beginning of the fiscal year</quote>; and</text></subparagraph>
<subparagraph id="H93D11E7A898F4318B91B23918D4E2378"><enum>(B)</enum><text>in subparagraph (B), by inserting <quote>(or, with respect to fiscal years 2018 and 2019, increased by such percentage increase plus one percentage point)</quote> after <quote>percentage increase referred to in subparagraph (A)</quote>; </text></subparagraph></paragraph> <paragraph id="H38E3B596CAA9408BA8589DD5190BD538"><enum>(2)</enum><text>in paragraph (5)—</text>
<subparagraph id="H45696AE512C84D748B82D1F4E2FB7600"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>subparagraph (B)</quote> and inserting <quote>subparagraphs (B), (C), (D), (E), and (F)</quote>; and </text></subparagraph> <subparagraph id="HC9E401B2BB254CFFBE24AB7B76EA57FE"><enum>(B)</enum><text>by adding at the end the following new subparagraphs:</text>
<quoted-block style="OLC" id="HA79289431C9348ECB85A7AB1F1E2133E" display-inline="no-display-inline">
<subparagraph id="HDF0A0696DD3A49D2BB0B888F9B41E693" indent="up1"><enum>(C)</enum><text display-inline="yes-display-inline">The amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $880,000,000.</text></subparagraph> <subparagraph id="H34282FC8B4454EDD8508031ECD227058" indent="up1"><enum>(D)</enum> <clause id="H840BFDC3488A48DE952B99FA080BC757" display-inline="yes-display-inline"><enum>(i)</enum><text display-inline="yes-display-inline">For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) for Puerto Rico shall be further increased by $120,000,000 if the Financial Oversight and Management Board for Puerto Rico established under section 101 of the Puerto Rico Oversight, Management, and Economic Stability Act (<external-xref legal-doc="usc" parsable-cite="usc/48/2121">48 U.S.C. 2121</external-xref>) certifies by a majority vote that Puerto Rico has taken reasonable and appropriate steps during such period to—</text>
<subclause id="H190542E934C9453F919781C3EA8C7AD8" indent="up1"><enum>(I)</enum><text>reduce fraud, waste, and abuse under the program under title XIX;</text></subclause> <subclause id="HCB91B99824C84C909A751E0AD0565753" indent="up1"><enum>(II)</enum><text>implement strategies to reduce unnecessary, inefficient, or excessive spending under title XIX;</text></subclause>
<subclause id="H9ABA19B6B77046AD9D3B2502196D1D22" indent="up1"><enum>(III)</enum><text>improve the use and availability of Medicaid data for program operation and oversight; and</text></subclause> <subclause id="H5AC85E580F55460F948C6836A781A6DB" indent="up1"><enum>(IV)</enum><text>improve the quality of care and patient experience for individuals enrolled under the program under title XIX.</text></subclause></clause>
<clause id="H9BF5D421F75A4379AD0BBB8A609A1D7A" indent="up1"><enum>(ii)</enum><text display-inline="yes-display-inline">As a condition of any additional increase pursuant to clause (i), not later than October 1, 2018, Puerto Rico shall submit to the Financial Oversight and Management Board for Puerto Rico a report regarding steps taken to achieve each of the goals described in subclauses (I) through (IV) of clause (i).</text></clause></subparagraph> <subparagraph id="H49D083C9589640C1B7BAA2D974D9AB3F" commented="no" indent="up1"><enum>(E)</enum><text>Payments under section 1903(a)(8) for a quarter of a fiscal year shall not be taken into account in applying subsection (f) (as increased in accordance with this paragraph and paragraphs (1), (2), (3), and (4)) to Puerto Rico or the Virgin Islands for such fiscal year.</text></subparagraph>
<subparagraph id="H3AFAA4D3F0904FB7BB6D27DE03E9057A" commented="no" indent="up1"><enum>(F)</enum>
<clause id="H507D6AED29ED47FA9DC62E2D08401523" display-inline="yes-display-inline" commented="no"><enum>(i)</enum><text display-inline="yes-display-inline">For the period beginning October 1, 2017, and ending December 31, 2019, the amount of the increase otherwise provided under subparagraph (A) for the Virgin Islands shall be further increased by an amount equal to the per capita equivalent of the total amount of the increase provided for Puerto Rico under subparagraphs (C) and (D) for such period.</text></clause> <clause id="H099FCB2EDD304685A9A1F0F017FAD491" indent="up1" commented="no"><enum>(ii)</enum><text display-inline="yes-display-inline">For purposes of clause (i), the term <quote>per capita equivalent</quote> means the ratio of—</text>
<subclause id="H71E44B08A122440F86A7E7B5235AB531" commented="no"><enum>(I)</enum><text>the population of the Virgin Islands, as determined by the most recent census estimate released by the Bureau of the Census before September 4, 2017; to</text></subclause> <subclause id="HA4C23446F6704A1091B4E81445287C2F" commented="no"><enum>(II)</enum><text>the population of Puerto Rico, as so determined.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph></subsection>
<subsection id="H3E751CFCE3B341559E7D6D83860F29B4"><enum>(b)</enum><header>Federal match for medical personnel and fraud reduction</header><text>Section 1903(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(a)</external-xref>) is amended—</text> <paragraph id="HBD56389EC54B447E8A8D9BD51A758655"><enum>(1)</enum><text>in paragraph (2)(A), by inserting <quote>subject to paragraph (8),</quote> before <quote>an amount</quote>; </text></paragraph>
<paragraph id="H748E29042145454BB06D22352D67ACED"><enum>(2)</enum><text>in paragraph (6)—</text> <subparagraph id="H373284CF7EE646EFA1A9761FC1620A0A"><enum>(A)</enum><text>in subparagraph (B), by inserting <quote>subject to paragraph (8),</quote> before <quote>75 per centum</quote>; and </text></subparagraph>
<subparagraph id="H7A165B664AD44E3B8D50E9965249D939"><enum>(B)</enum><text>by striking at the end <quote>plus</quote>;</text></subparagraph></paragraph> <paragraph id="H8F3239EA0E18417ABE035EDD431BF71F"><enum>(3)</enum><text>in paragraph (7), by striking at the end the period and inserting <quote>; plus</quote> ; and</text></paragraph>
<paragraph id="H74A12657982E4CA9898D39EC96F071DD"><enum>(4)</enum><text>by adding at the end the following new paragraph:</text> <quoted-block style="OLC" display-inline="no-display-inline" id="H748A711613134C7D9103210876E81428"> <paragraph id="HA8C9236D75994BBBA30AE33C0D47F8BA"><enum>(8)</enum><text display-inline="yes-display-inline">for quarters during the period beginning January 1, 2018, and ending December 31, 2019, paragraphs (2)(A) and (6) shall apply with respect to Puerto Rico and the Virgin Islands as if—</text>
<subparagraph id="H68B0571FEC774E85B8627C0CAD7B52B7"><enum>(A)</enum><text>the reference to <quote>75 per centum</quote> in paragraph (2)(A) were a reference to <quote>90 per centum</quote>; and</text></subparagraph> <subparagraph id="H83231A113A924EDF9D79AD692A820962"><enum>(B)</enum><text>the reference to <quote>75 per centum</quote> in paragraph (6)(B) were a reference to <quote>90 per centum</quote>.</text></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection></section>
<enum>II</enum><header>Offsets</header>
<section id="H74D91662E7A947CF9E0650F8293FAA66"><enum>401.</enum><header>Medicaid third party liability provisions</header>
<subsection id="H8927A192610A4151A13AF140300CDC32"><enum>(a)</enum><header>Medicaid third party liability</header>
<paragraph id="H6E3139C5AD214445A55C812BD1A17AD3"><enum>(1)</enum><header>Delay of Bipartisan Budget Act of 2013 third party liability provisions</header>
<subparagraph id="H632FE27E8C8F446288F94E03AD2E67B6"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Section 202(c) of the Bipartisan Budget Act of 2013 (<external-xref legal-doc="public-law" parsable-cite="pl/113/67">Public Law 113–67</external-xref>; 127 Stat. 1177; <external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref> note), as amended by section 211 of the Protecting Access to Medicare Act of 2014 (<external-xref legal-doc="public-law" parsable-cite="pl/113/93">Public Law 113–93</external-xref>; 128 Stat. 1047; <external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref> note) and section 220 of the Medicare Access and CHIP Reauthorization Act of 2015 (<external-xref legal-doc="public-law" parsable-cite="pl/114/10">Public Law 114–10</external-xref>), is amended by striking <quote>2017</quote> and inserting <quote>2019</quote>.</text></subparagraph> <subparagraph id="H5890171F082E4466BEDDBA52D3840534"><enum>(B)</enum><header>Effective date; treatment</header><text>The amendment made by subparagraph (A) shall take effect on September 30, 2017, and shall apply with respect to any open claims, including claims generated or filed, after such date.</text></subparagraph></paragraph>
<paragraph id="HCA840BAD568F43FA969449638ABDAF33"><enum>(2)</enum><header>Clarification of definitions applicable to third party liability</header>
<subparagraph id="HA12242C983F14AC6B094AD9E0FA746CA"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended by adding at the end the following new subsection:</text> <quoted-block display-inline="no-display-inline" id="H6D95325E866B4AF6AE83D4A2409504CF" style="OLC"> <subsection id="HBE3341569B354C6386E30A52A9617AB3"><enum>(nn)</enum><header>Responsible Third Party and Health Insurer Definitions</header><text display-inline="yes-display-inline">For purposes of subsection (a)(25) and section 1903(d)(2)(B):</text>
<paragraph id="H3E571D8B6D67464AB4D4A78A93E6DC3B"><enum>(1)</enum><header>Responsible third party</header><text display-inline="yes-display-inline">The term <quote>responsible third party</quote> means a health insurer, a pharmacy benefit manager to the extent the pharmacy benefit manager provides information under this title for the purpose of coordinating benefits, an accountable care organization under section 1899, or any other party that is, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service. Such term does not include a party if payment by such party has been made or can reasonably be expected to be made under a workmen’s compensation law or plan of the United States or a State, or under an automobile or liability insurance policy or plan (including a self-insured plan), or under no fault insurance.</text></paragraph> <paragraph id="H774B6BD8D4AB4CEC912502EE667CCE26"><enum>(2)</enum><header>Health insurer</header><text display-inline="yes-display-inline">The term <quote>health insurer</quote> means a group health plan, as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, a self-insured plan, a fully-insured plan<italic></italic>, a service benefit plan, a medicaid managed care plan under section 1903(m) or 1932, and any other health plan determined appropriate by the Secretary.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph>
<subparagraph commented="no" id="H7CF7838C08C6475FADDB00349A044747"><enum>(B)</enum><header>Conforming amendments</header><text display-inline="yes-display-inline">Section 1902(a)(25) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(25)</external-xref>) is amended—</text> <clause commented="no" id="HA4A9A8C9D4A54643857DBC453ACEA88C"><enum>(i)</enum><text>in subparagraph (A), in the matter preceding clause (i), by striking <quote>third parties</quote> and all that follows through <quote>item or service)</quote> and inserting <quote>responsible third parties</quote>;</text></clause>
<clause commented="no" id="H5B181325F44E47BA998B6D862D7AE5A6"><enum>(ii)</enum><text display-inline="yes-display-inline">in subparagraph (G), by striking <quote>health insurer</quote> and all that follows through <quote>item or service)</quote> and inserting <quote>responsible third party</quote>;</text></clause> <clause commented="no" id="H3D1154EBD18A444790942B531BB73EEE"><enum>(iii)</enum><text>in subparagraph (I), in the matter preceding clause (i), by striking <quote>health insurers</quote> and all that follows through <quote>item or service</quote> and inserting <quote>responsible third parties</quote>; and</text></clause>
<clause commented="no" id="H1EADA6F4DE204FC1B9A566B3860E7C37"><enum>(iv)</enum><text display-inline="yes-display-inline">by inserting <quote>responsible</quote> before <quote>third</quote> each place it appears in subparagraphs (A)(i), (A)(ii), (C), (D), and (H).</text></clause></subparagraph></paragraph> <paragraph id="H5A5A17810D9C431CA5F62F5BA5FF0BEE"><enum>(3)</enum><header>Removal of special treatment of certain types of care and payments under Medicaid third party liability rules</header><text display-inline="yes-display-inline">Section 1902(a)(25) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(25)</external-xref>), as amended by section 202(c) of the Bipartisan Budget Act of 2013 (after application of paragraph (1)), is amended—</text>
<subparagraph id="HD69CC0A5F7B747929541DD6E9DE13007"><enum>(A)</enum><text>in subparagraph (E)—</text> <clause id="H7DDD63770FBF4AEEB42B0FE030CEFD3D"><enum>(i)</enum><text>in the matter preceding clause (i), by striking <quote>prenatal or preventive</quote> and all that follows through <quote>State plan</quote> and inserting <quote>items and services provided under the program required under the State plan pursuant to paragraph (62)</quote>; and</text></clause>
<clause id="H694A529D808144688E97C0F41168C362"><enum>(ii)</enum><text>in clause (i)—</text> <subclause id="H65D92B982F0141CCAFBE64D24072A5A1"><enum>(I)</enum><text>by striking <quote>such service</quote> and inserting <quote>such items and services</quote>; and</text></subclause>
<subclause id="H771B174011694A1A84E92C1E0B60E9D0"><enum>(II)</enum><text>by striking each place it appears <quote>such services</quote> and inserting <quote>such items and services</quote> each such place; and</text></subclause></clause></subparagraph> <subparagraph id="H3063A957D2C14E6985D56A17AD485011"><enum>(B)</enum><text>by striking subparagraph (F).</text></subparagraph></paragraph>
<paragraph id="H285182161D2C4DE5994FD3BB2F546B01"><enum>(4)</enum><header>Clarification of role of health insurers with respect to third party liability</header>
<subparagraph id="HC8ED9FF4F6C041EB9859D0AAD96EA3AB"><enum>(A)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1902(a)(25) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(25)</external-xref>), as amended by paragraph (3), is further amended by inserting after subparagraph (E) the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="H36E7F199844F4938B7DBA59D9BC5040F" style="traditional"> <subparagraph id="HE79BD67065D94EA993C50966880709CA"><enum>(F)</enum><text display-inline="yes-display-inline">that—</text>
<clause id="H14D52E08196F4D86AEE273A7D6058705"><enum>(i)</enum><text>in the case of a State that provides medical assistance under this title through a contract with a health insurer, such contract shall specify any responsibility of such health insurer (or other entity) with respect to recovery of payment from responsible third parties pursuant to the delegation or transfer by the State to such insurer (or other entity) of a right described in subparagraph (I)(ii); and</text></clause> <clause id="HB321FBD3B4EE42D7A05CD9E722E5873F"><enum>(ii)</enum><text>in the case of a State that under a contract described in clause (i) delegates or transfers to a health insurer (or other entity) a right described in such clause, the State shall provide assurances to the Secretary that the State laws referred to in subparagraph (I), with respect to each responsibility of such health insurer (or other entity) specified under such clause, confer to such health insurer (or other entity) the authority of the State with respect to the requirements specified in clauses (i) through (iv) of such subparagraph (I);</text></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph>
<subparagraph id="HBCE54AC94A8E40D7A8F306EF853C7B6E"><enum>(B)</enum><header>Treatment of collected amounts</header><text display-inline="yes-display-inline">Section 1903(d)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(d)(2)(B)</external-xref>) is amended by adding at the end the following: <quote>For purposes of this subparagraph, reimbursements made by a responsible third party to health insurers (as defined in section 1902(nn)) pursuant to section 1902(a)(25)(F)(ii) shall be treated in the same manner as reimbursements made to a State under the previous sentence.</quote>.</text></subparagraph></paragraph> <paragraph id="H1AA3D1BF756846FBB8938D2B304F53E5"><enum>(5)</enum><header>Increasing State flexibility with respect to third party liability</header><text>Section 1902(a)(25)(I) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(25)(I)</external-xref>) is amended—</text>
<subparagraph id="HB0E783C30C4645268B42767BC1E16879"><enum>(A)</enum><text display-inline="yes-display-inline">in clause (i), by striking <quote>medical assistance under the State plan</quote> and inserting <quote>medical assistance under a State plan (or under a waiver of the plan)</quote>;</text></subparagraph> <subparagraph id="HD23DBAB21D434E828172D2658AF7A090"><enum>(B)</enum><text>by striking clause (ii) and inserting the following new clause:</text>
<quoted-block display-inline="no-display-inline" id="H2F40716679EE40F7BDFBED011113CB8B" style="traditional">
<clause id="H1CA7FA069C2E42ACBA94E6E44842B768"><enum>(ii)</enum><text>accept—</text> <subclause id="H836954CD9EAF46EEA5806B270EF62B5C"><enum>(I)</enum><text display-inline="yes-display-inline">any State’s right of recovery and the assignment to any State of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the respective State’s plan (or under a waiver of the plan); and</text></subclause>
<subclause id="H270FB20EC6D64F3490DCCE82CA952891"><enum>(II)</enum><text display-inline="yes-display-inline">as a valid authorization of the responsible third party for the furnishing of an item or service to an individual eligible to receive medical assistance under this title, an authorization made on behalf of such individual under the State plan (or under a waiver of such plan) for the furnishing of such item or service to such individual;</text></subclause></clause><after-quoted-block>; </after-quoted-block></quoted-block></subparagraph> <subparagraph id="HF6EE57C4DECE4D90BD47A0EA5B962F68"><enum>(C)</enum><text>in clause (iii)—</text>
<clause id="H699EE0AAFD6646138F0A6BE36D1EEA24"><enum>(i)</enum><text>by striking <quote>respond to</quote> and inserting <quote>not later than 60 days after receiving</quote>; and</text></clause> <clause id="H6991C41BDAFD44FAA4A4303064045947"><enum>(ii)</enum><text>by striking <quote>; and</quote> at the end and inserting <quote>, respond to such inquiry; and</quote>; and</text></clause></subparagraph>
<subparagraph id="HFCF7A42EDBA04EC88BDCD5FA3788FD9E"><enum>(D)</enum><text>in clause (iv), by inserting <quote>a failure to obtain a prior authorization,</quote> after <quote>claim form,</quote>.</text></subparagraph></paragraph> <paragraph id="H5602202B0C694CE183052D37BFDE8D16"><enum>(6)</enum><header>State incentive to pursue third party liability for newly eligibles</header><text>Section 1903(d)(2)(B) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(d)(2)(B)</external-xref>), as amended by paragraph (4)(B), is further amended by adding at the end the following: <quote>In the case of expenditures for medical assistance provided during 2017 and subsequent years for individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), in determining the amount, if any, of overpayment under this subparagraph with respect to such medical assistance, the Secretary shall apply the Federal medical assistance percentage for the State under section 1905(b), notwithstanding the application of section 1905(y).</quote>.</text></paragraph></subsection>
<subsection id="H7F38B8BD684E4CD297BF28CB9BCECA26"><enum>(b)</enum><header>Compliance with third party insurance reporting</header><text>Section 1905 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396d">42 U.S.C. 1396d</external-xref>) is amended by adding at the end the following new subsection:</text> <quoted-block display-inline="no-display-inline" id="H77A2713B11C2455B93798DD02FFB2619" style="traditional"> <subsection id="H3760F65ECC68499CA120DFEE7C9C6721"><enum>(ee)</enum><text display-inline="yes-display-inline">Notwithstanding subsection (b), for any year beginning after 2019, if a State fails to comply with the requirements of section 1902(a)(25) with respect to each calendar quarter in such year, the Secretary may reduce the Federal medical assistance percentage by 0.1 percentage point for calendar quarters in each subsequent year in which the State fails to so comply.</text></subsection><after-quoted-block>.</after-quoted-block></quoted-block></subsection>
<subsection id="H3DBDC24D84BF4873A8243D50EC31A431"><enum>(c)</enum><header>Application to CHIP</header>
<paragraph id="H9266391550B44DA290AEC48F96FE49F8"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Section 2107(e)(1) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397gg">42 U.S.C. 1397gg(e)(1)</external-xref>) is amended—</text> <subparagraph id="H92A1045CE38349E6A21FEAA5936DC09F"><enum>(A)</enum><text>by redesignating subparagraphs (B) through (R) as subparagraphs (C) through (S), respectively; and</text></subparagraph>
<subparagraph id="HAF2E7D52EF8F47D7943ABFB8937C8BDA"><enum>(B)</enum><text>by inserting after subparagraph (A) the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="H2FD6592D016F43A2873EA6B27140B386" style="OLC"> <subparagraph id="H64C2E1BF66874EAA9F17F5C618906F72"><enum>(B)</enum><text display-inline="yes-display-inline">Section 1902(a)(25) (relating to third party liability).</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></subparagraph></paragraph>
<paragraph id="H5A36E6F30794425EA3154A47326C9A35"><enum>(2)</enum><header>Mandatory reporting</header><text>Section 1902(a)(25)(I)(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(a)(25)(I)(i)</external-xref>), as amended by subsection (a)(5), is further amended—</text> <subparagraph id="H51397EAE92CC4CF392BA84F316F7DC4D"><enum>(A)</enum><text>by striking <quote>(and, at State option, child</quote> and inserting <quote>and child</quote>; and</text></subparagraph>
<subparagraph id="HC88B17CD6F75438C9BB200057868A818"><enum>(B)</enum><text>by striking <quote>title XXI)</quote> and inserting <quote>title XXI</quote>.</text></subparagraph></paragraph></subsection> <subsection id="HCFD19F9352174795AE7B18BF922A883A"><enum>(d)</enum><header>Training on third party liability</header><text>Section 1936 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396u-6">42 U.S.C. 1396u–6</external-xref>) is amended—</text>
<paragraph id="HD354B4FDAA694CD4BEE321A2E8ACC898"><enum>(1)</enum><text>in subsection (b)(4), by striking <quote>and quality of care</quote> and inserting <quote>, quality of care, and the liability of responsible third parties (as defined in section 1902(nn))</quote>; and</text></paragraph> <paragraph id="HC0D6DE9D847C4CA8A88FE64B7C81B4BE"><enum>(2)</enum><text>by adding at the end the following new subsection:</text>
<quoted-block display-inline="no-display-inline" id="H8D57A1CEE85F4215A21E444B4AEEAFC9" style="OLC">
<subsection id="H2443DAD3525F43BE84E4170D5B66E32C"><enum>(f)</enum><header>Third party liability training</header><text display-inline="yes-display-inline">With respect to education or training activities carried out pursuant to subsection (b)(4) with respect to the liability of responsible third parties (as defined in section 1902(nn) for payment for items and services furnished under State plans (or under waivers of such plans)) under this title, the Secretary shall—</text> <paragraph id="HECF47185CAFE496E9D7D55B61E5A78ED"><enum>(1)</enum><text>publish (and update on an annual basis) on the public Internet website of the Centers for Medicare & Medicaid Services a dedicated Internet page containing best practices to be used in assessing such liability;</text></paragraph>
<paragraph id="HF5A5E99B83A2428A8B6BCB3429B69DE1"><enum>(2)</enum><text>monitor efforts to assess such liability and analyze the challenges posed by that assessment;</text></paragraph> <paragraph id="H22B11AFB1DEB488E96AACA6DEEFADFA6"><enum>(3)</enum><text>distribute to State agencies administering the State plan under this title information related to such efforts and challenges; and</text></paragraph>
<paragraph id="H3F107BA7E91E47A5830B2417F218D0FA"><enum>(4)</enum><text>provide guidance to such State agencies with respect to State oversight of efforts under a medicaid managed care plan under section 1903(m) or 1932 to assess such liability.</text></paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection> <subsection id="H5EECA585BD444A4BBB41CA9D35E0C8B0"><enum>(e)</enum><header>Development of model uniform fields for States To report third party information</header><text>Not later than January 1, 2019, the Secretary of Health and Human Services shall, in consultation with the States, develop and make available to the States a model uniform reporting set of reporting fields and accompanying guidance documentation that States shall use for purposes of—</text>
<paragraph id="H2FFC33A09A104EA1ADFDCDD0F0350C9C"><enum>(1)</enum><text>reporting information to the Secretary within the Transformed Medicaid Statistical Information System (T–MSIS) (or a successor system); and</text></paragraph> <paragraph id="H731ED940C8CC4710AE38C472569C2817"><enum>(2)</enum><text display-inline="yes-display-inline">collecting information that identifies responsible third parties (as defined in subsection (nn) of section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>), as added by subsection (a)(2)(A)) and other relevant information for ascertaining the legal responsibility of such third parties to pay for care and services available under the State plan (or under a waiver of the plan) under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) or under the State child health plan under title XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397">42 U.S.C. 1397</external-xref> et seq.).</text></paragraph></subsection>
<subsection id="HCCC0DFA4D042492FB3E2C4E21D659150"><enum>(f)</enum><header>Effective date</header>
<paragraph id="H6CAE576FA74F44A6AEF5594E85865757"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">Except as provided in paragraph (2), this section and the amendments made by this section (other than as specified in the preceding provisions of this section) shall take effect on October 1, 2019, and shall apply to medical assistance or child health assistance provided on or after such date.</text></paragraph> <paragraph id="H53EEDF67F6F641CB88F3D50609D93D51"><enum>(2)</enum><header>Exception if State legislation required</header><text display-inline="yes-display-inline">In the case of a State plan for medical assistance under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.), or a State child health plan for child health assistance under title XXI of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1397aa">42 U.S.C. 1397aa</external-xref> et seq.), that the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirement imposed by the amendments made under this section, such plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet this additional requirement before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.</text></paragraph></subsection></section>
<section id="H20640A73A6A24A54A52D70A40673A159"><enum>402.</enum><header>Treatment of lottery winnings and other lump-sum income for purposes of income eligibility under Medicaid</header>
<subsection id="H230DCBE8B4494883906DAB51FB773675"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1902 of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a</external-xref>) is amended—</text> <paragraph id="HBB58F6A558244597B41080744A002521"><enum>(1)</enum><text>in subsection (a)(17), by striking <quote>(e)(14), (e)(14)</quote> and inserting <quote>(e)(14), (e)(15)</quote>; and</text></paragraph>
<paragraph id="H89B1DDADB6084843915D3465576825DB"><enum>(2)</enum><text>in subsection (e)(14), as amended by section 303(c), by adding at the end the following new subparagraph<italic></italic>:</text> <quoted-block display-inline="no-display-inline" id="H9EA8A16626894EBF83471C618887C7BE" style="OLC"> <subparagraph id="HAF9AA0E07D0F44C69E2E066A2E25C5D9"><enum>(K)</enum><header>Treatment of certain lottery winnings and income received as a lump sum</header> <clause id="H74468ACE0488422C95BBA6DD5688585E"><enum>(i)</enum><header>In general</header><text display-inline="yes-display-inline">In the case of an individual who is the recipient of qualified lottery winnings (pursuant to lotteries occurring on or after January 1, 2018) or qualified lump sum income (received on or after such date) and whose eligibility for medical assistance is determined based on the application of modified adjusted gross income under subparagraph (A), a State shall, in determining such eligibility, include such winnings or income (as applicable) as income received—</text>
<subclause id="H30195C2FEAB14FDEB10DBCEA7EAD7CAE"><enum>(I)</enum><text display-inline="yes-display-inline">in the month in which such winnings or income (as applicable) is received if the amount of such winnings or income is less than $80,000;</text></subclause> <subclause id="HFF2E35FAA6F840019199E7BD8736B24A"><enum>(II)</enum><text display-inline="yes-display-inline">over a period of 2 months if the amount of such winnings or income (as applicable) is greater than or equal to $80,000 but less than $90,000;</text></subclause>
<subclause id="H89C55CC4CE44429C874E81DEB090D709"><enum>(III)</enum><text display-inline="yes-display-inline">over a period of 3 months if the amount of such winnings or income (as applicable) is greater than or equal to $90,000 but less than $100,000; and</text></subclause> <subclause id="H11F3173F860D40939119ED9E0506200F"><enum>(IV)</enum><text display-inline="yes-display-inline">over a period of 3 months plus 1 additional month for each increment of $10,000 of such winnings or income (as applicable) received, not to exceed a period of 120 months (for winnings or income of $1,260,000 or more), if the amount of such winnings or income is greater than or equal to $100,000.</text></subclause></clause>
<clause id="H92C09BE8142848E7B8CD78D67FFD1B2C"><enum>(ii)</enum><header>Counting in equal installments</header><text>For purposes of subclauses (II), (III), and (IV) of clause (i), winnings or income to which such subclause applies shall be counted in equal monthly installments over the period of months specified under such subclause.</text></clause> <clause commented="no" id="H72C6401B47104F188DE6646BAFB46C85"><enum>(iii)</enum><header>Hardship exemption</header><text display-inline="yes-display-inline">An individual whose income, by application of clause (i), exceeds the applicable eligibility threshold established by the State, shall continue to be eligible for medical assistance to the extent that the State determines, under procedures established by the State (in accordance with standards specified by the Secretary), that the denial of eligibility of the individual would cause an undue medical or financial hardship as determined on the basis of criteria established by the Secretary.</text></clause>
<clause commented="no" id="H55B226A456C44A46BB602FA41BE0FA20"><enum>(iv)</enum><header>Notifications and assistance required in case of loss of eligibility</header><text>A State shall, with respect to an individual who loses eligibility for medical assistance under the State plan (or a waiver of such plan) by reason of clause (i)—</text> <subclause commented="no" id="H2F04EAE4ABB84EAA95C5EA8568E35AB4"><enum>(I)</enum><text>before the date on which the individual loses such eligibility, inform the individual—</text>
<item commented="no" id="HA1C4A6DDA8E04328A8BC4C5C284059E5"><enum>(aa)</enum><text>of the individual’s opportunity to enroll in a qualified health plan offered through an Exchange established under title I of the Patient Protection and Affordable Care Act during the special enrollment period specified in <external-xref legal-doc="usc" parsable-cite="usc/26/9801">section 9801(f)(3)</external-xref> of the Internal Revenue Code of 1986 (relating to loss of Medicaid or CHIP coverage); and</text></item> <item commented="no" id="H8D6021A0DA1447B284D1332DC282F40E"><enum>(bb)</enum><text display-inline="yes-display-inline">of the date on which the individual would no longer be considered ineligible by reason of clause (i) to receive medical assistance under the State plan or under any waiver of such plan and be eligible to reapply to receive such medical assistance; and</text></item></subclause>
<subclause commented="no" id="H49C793F93949413682882FDA9F8F5042"><enum>(II)</enum><text>provide technical assistance to the individual seeking to enroll in such a qualified health plan.</text></subclause></clause> <clause id="HC5886C8D798248C497CB8F838840C0F6"><enum>(v)</enum><header>Qualified lottery winnings defined</header><text>In this subparagraph, the term <term>qualified lottery winnings</term> means winnings from a sweepstakes, lottery, or pool described in paragraph (3) of <external-xref legal-doc="usc" parsable-cite="usc/26/4402">section 4402</external-xref> of the Internal Revenue Code of 1986 or a lottery operated by a multistate or multijurisdictional lottery association, including amounts awarded as a lump sum payment.</text></clause>
<clause id="HE1358268A1644762BC783025F6CF058D"><enum>(vi)</enum><header>Qualified lump sum income defined</header><text display-inline="yes-display-inline">In this subparagraph, the term <term>qualified lump sum income</term> means income that is received as a lump sum<italic></italic> from one of the following sources:</text> <subclause id="HF7986E2117614D16ACA9D7CB3A206431"><enum>(I)</enum><text display-inline="yes-display-inline">Monetary winnings from gambling (as defined by the Secretary and including gambling activities described in section 1955(b)(4) of title 18, United States Code).</text></subclause>
<subclause id="H71571E197C174A93BA5803487413686B"><enum>(II)</enum><text display-inline="yes-display-inline">Damages received, whether by suit or agreement and whether as lump sums or as periodic payments (other than monthly payments), on account of causes of action other than causes of action arising from personal physical injuries or physical sickness.</text></subclause> <subclause id="H81A74181778746AFB12FA5463B542562"><enum>(III)</enum><text>Income received as liquid assets from the estate (as defined in section 1917(b)(4)) of a deceased individual.</text></subclause></clause></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></subsection>
<subsection id="H28F84CAB5461404B8C924B6361499CA0"><enum>(b)</enum><header>Rules of construction</header>
<paragraph id="H350F48C1F7724EF8ABD9069853B752A9"><enum>(1)</enum><header>Interception of lottery winnings allowed</header><text>Nothing in the amendment made by subsection (a)(2) shall be construed as preventing a State from intercepting the State lottery winnings awarded to an individual in the State to recover amounts paid by the State under the State Medicaid plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) for medical assistance furnished to the individual.</text></paragraph> <paragraph commented="no" id="H1EDA0FB722E449E58815D070A63AC105"><enum>(2)</enum><header>Applicability limited to eligibility of recipient of lottery winnings or lump sum income</header><text display-inline="yes-display-inline">Nothing in the amendment made by subsection (a)(2) shall be construed, with respect to a determination of household income for purposes of a determination of eligibility for medical assistance under the State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396</external-xref> et seq.) (or a waiver of such plan) made by applying modified adjusted gross income under subparagraph (A) of section 1902(e)(14) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396a">42 U.S.C. 1396a(e)(14)</external-xref>), as limiting the eligibility for such medical assistance of any individual that is a member of the household other than the individual who received qualified lottery winnings or qualified lump-sum income (as defined in subparagraph (K) of such section 1902(e)(14), as added by subsection (a)(2) of this section).</text></paragraph></subsection></section>
<section id="HC5D52A2FDF9E4916B997EA8718AB0FAF" section-type="subsequent-section"><enum>403.</enum><header>Adjustments to Medicare part B and part D premium subsidies for higher income individuals</header>
<subsection id="HFE04F4FFBF0945FD9C9E8BCBCF1EDE4E"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">Section 1839(i)(3)(C)(i)(II) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(i)(3)(C)(i)(II)</external-xref>) is amended, in the table, by striking the last row and inserting the following new rows:</text> <quoted-block display-inline="no-display-inline" id="H6062EB50AA5C43C288764498E9B442CE" style="OLC"> <table align-to-level="section" blank-lines-before="1" colsep="0" frame="none" line-rules="no-gen" rowsep="0" rule-weights="0.0.0.0.0.0" table-template-name="Generic: 2 text, 1st longer" table-type=""> <tgroup cols="2" grid-typeface="1.1" no-carding="1" rowsep="0" thead-tbody-ldg-size="10.10.12"><colspec coldef="txt" colname="column1" colwidth="225pts" min-data-value="200"/><colspec coldef="fig" colname="column2" colwidth="100pts" min-data-value="18"/> <tbody> <row><entry colname="column1" leader-modify="force-ldr-bottom" stub-definition="txt-ldr" stub-hierarchy="1">More than $160,000 but less than $500,000</entry><entry align="left" colname="column2" leader-modify="clr-ldr">80 percent</entry></row> <row><entry align="left" colname="column1" leader-modify="force-ldr" stub-definition="txt-ldr" stub-hierarchy="1">At least $500,000</entry><entry align="left" colname="column2" leader-modify="clr-ldr">100 percent.</entry></row></tbody></tgroup></table><after-quoted-block>.</after-quoted-block></quoted-block></subsection> <subsection id="HDC6E11044E8D4D04BB9CD2088739223A"><enum>(b)</enum><header>Joint returns</header><text display-inline="yes-display-inline">Section 1839(i)(3)(C)(ii) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(i)(3)(C)(ii)</external-xref>) is amended by inserting before the period the following: <quote>except, with respect to the dollar amounts applied in the last row of the table under subclause (II) of such clause (and the second dollar amount specified in the second to last row of such table), clause (i) shall be applied by substituting dollar amounts which are 175 percent of such dollar amounts for the calendar year</quote>.</text></subsection>
<subsection id="H08F37AAFBF1E47C4AB6B2FA90447D0C6"><enum>(c)</enum><header>Inflation adjustment</header><text>Section 1839(i) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395r">42 U.S.C. 1395r(i)</external-xref>) is amended—</text> <paragraph id="H311FA57D5FDC4F48B661D1A05D8327D0"><enum>(1)</enum><text>in paragraph (5)—</text>
<subparagraph id="H8C5C34117F504C13970C2322D931CBF9"><enum>(A)</enum><text>in subparagraph (A), by striking <quote>In the case</quote> and inserting <quote>Subject to subparagraph (C), in the case</quote>;</text></subparagraph> <subparagraph id="HF97B1400A7374342A9A145AF6B27E953"><enum>(B)</enum><text>in subparagraph (B), by striking <quote>subparagraph (A)</quote> and inserting <quote>subparagraph (A) or (C)</quote>; and</text></subparagraph>
<subparagraph id="H4BBDB0FD7E9240E689E6A92D871207D6"><enum>(C)</enum><text>by adding at the end the following new subparagraph:</text> <quoted-block display-inline="no-display-inline" id="HA6C2B22406D94760B2F1E2ADAC4DAFBD" style="OLC"> <subparagraph id="HCD059FDBC18B4BD59EB1F68AAD19C96F"><enum>(C)</enum><header>Treatment of adjustments for certain higher income individuals</header> <clause id="HC7371930364D44D98AB3033A81B749B7"><enum>(i)</enum><header>In general</header><text>Subparagraph (A) shall not apply with respect to each dollar amount in paragraph (3) of $500,000.</text></clause>
<clause id="H54D3435BE9BF4FDBA65C5791FEE54A5E"><enum>(ii)</enum><header>Adjustment beginning 2027</header><text display-inline="yes-display-inline">In the case of any calendar year beginning after 2026, each dollar amount in paragraph (3) of $500,000 shall be increased by an amount equal to—</text> <subclause id="HF87E38105645482FB6F92E9076C67065"><enum>(I)</enum><text>such dollar amount, multiplied by</text></subclause>
<subclause id="H88CBD38310E44B148F13BAF01085647C"><enum>(II)</enum><text>the percentage (if any) by which the average of the Consumer Price Index for all urban consumers (United States city average) for the 12-month period ending with August of the preceding calendar year exceeds such average for the 12-month period ending with August 2025.</text></subclause></clause></subparagraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph></paragraph> <paragraph id="HD49B8B6FAECE43EFAD5A6BAF78E812D1"><enum>(2)</enum><text>in paragraph (6)(B), by inserting <quote>(other than $500,000)</quote> after <quote>the dollar amounts</quote>.</text></paragraph></subsection></section>
Passed the House of Representatives November 3, 2017.Karen L. Haas,Clerk.