[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3922 Engrossed in House (EH)]

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115th CONGRESS
  1st Session
                                H. R. 3922

_______________________________________________________________________

                                 AN ACT


 
  To extend funding for certain public health programs, and for other 
                               purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    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''.

SEC. 2. TABLE OF CONTENTS.

    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.

                        DIVISION A--CHAMPION ACT

SEC. 100. SHORT TITLE.

    This division may be cited as the ``Community Health And Medical 
Professionals Improve Our Nation Act of 2017'' or the ``CHAMPION Act''.

              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.

    (a) Community Health Centers Funding.--Section 10503(b)(1)(E) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(1)(E)) is amended by striking ``2017'' and inserting ``2019''.
    (b) Other Community Health Centers Provisions.--Section 330 of the 
Public Health Service Act (42 U.S.C. 254b) is amended--
            (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
        inserting ``use disorder'';
            (2) in subsection (b)(2)(A), by striking ``abuse'' and 
        inserting ``use disorder'';
            (3) in subsection (c)--
                    (A) in paragraph (1), by striking subparagraphs (B) 
                through (D);
                    (B) by striking ``(1) In general'' and all that 
                follows through ``The Secretary'' and inserting the 
                following:
            ``(1) Centers.--The Secretary''; and
                    (C) 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;
            (4) by striking subsection (d) and inserting the following:
    ``(d) Improving Quality of Care.--
            ``(1) Supplemental awards.--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--
                    ``(A) improving the delivery of care for 
                individuals with multiple chronic conditions;
                    ``(B) workforce configuration;
                    ``(C) reducing the cost of care;
                    ``(D) enhancing care coordination;
                    ``(E) expanding the use of telehealth and 
                technology-enabled collaborative learning and capacity 
                building models;
                    ``(F) care integration, including integration of 
                behavioral health, mental health, or substance use 
                disorder services; and
                    ``(G) addressing emerging public health or 
                substance use disorder issues to meet the health needs 
                of the population served by the health center.
            ``(2) Sustainability.--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.
            ``(3) Special consideration.--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.'';
            (5) in subsection (e)(1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``2 years'' and inserting 
                        ``1 year''; and
                            (ii) by adding at the end the following: 
                        ``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.''; and
                    (B) in subparagraph (C)--
                            (i) in the subparagraph heading, by 
                        striking ``and plans'';
                            (ii) by striking ``or plan (as described in 
                        subparagraphs (B) and (C) of subsection 
                        (c)(1))'';
                            (iii) by striking ``or plan, including the 
                        purchase'' and inserting the following: 
                        ``including--
                            ``(i) the purchase'';
                            (iv) by inserting ``, which may include 
                        data and information systems'' after ``of 
                        equipment'';
                            (v) by striking the period at the end and 
                        inserting a semicolon; and
                            (vi) by adding at the end the following:
                            ``(ii) the provision of training and 
                        technical assistance; and
                            ``(iii) other activities that--
                                    ``(I) reduce costs associated with 
                                the provision of health services;
                                    ``(II) improve access to, and 
                                availability of, health services 
                                provided to individuals served by the 
                                centers;
                                    ``(III) enhance the quality and 
                                coordination of health services; or
                                    ``(IV) improve the health status of 
                                communities.'';
            (6) in subsection (e)(5)(B)--
                    (A) in the heading of subparagraph (B), by striking 
                ``and plans''; and
                    (B) by striking ``and subparagraphs (B) and (C) of 
                subsection (c)(1) to a health center or to a network or 
                plan'' and inserting ``to a health center or to a 
                network'';
            (7) in subsection (e), by adding at the end the following:
            ``(6) New access points and expanded services.--
                    ``(A) Approval of new access points.--
                            ``(i) In general.--The Secretary may 
                        approve applications for grants under 
                        subparagraph (A) or (B) of paragraph (1) to 
                        establish new delivery sites.
                            ``(ii) Special consideration.--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.
                            ``(iii) Consideration of applications.--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.
                            ``(iv) Service area overlap.--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.
                    ``(B) Approval of expanded service applications.--
                            ``(i) In general.--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).
                            ``(ii) Priority expansion projects.--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.
                            ``(iii) Consideration of applications.--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.'';
            (8) in subsection (h)--
                    (A) in paragraph (1), by striking ``and children 
                and youth at risk of homelessness'' and inserting ``, 
                children and youth at risk of homelessness, homeless 
                veterans, and veterans at risk of homelessness''; and
                    (B) in paragraph (5)--
                            (i) by striking subparagraph (B);
                            (ii) by redesignating subparagraph (C) as 
                        subparagraph (B); and
                            (iii) in subparagraph (B) (as so 
                        redesignated)--
                                    (I) in the subparagraph heading, by 
                                striking ``abuse'' and inserting ``use 
                                disorder''; and
                                    (II) by striking ``abuse'' and 
                                inserting ``use disorder'';
            (9) in subsection (k)--
                    (A) in paragraph (2)--
                            (i) in the paragraph heading, by inserting 
                        ``unmet'' before ``need'';
                            (ii) in the matter preceding subparagraph 
                        (A), by inserting ``or subsection (e)(6)'' 
                        after ``subsection (e)(1)'';
                            (iii) in subparagraph (A), by inserting 
                        ``unmet'' before ``need for health services'';
                            (iv) in subparagraph (B), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (C), by striking the 
                        period at the end and inserting ``; and''; and
                            (vi) by adding after subparagraph (C) the 
                        following:
                    ``(D) 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.'';
                    (B) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by inserting ``or subsection (e)(6)'' 
                        after ``subsection (e)(1)(B)'';
                            (ii) in subparagraph (B), by striking ``in 
                        the catchment area of the center'' and 
                        inserting ``, 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'';
                            (iii) in subparagraph (H)(ii), by inserting 
                        ``who shall be directly employed by the 
                        center'' after ``approves the selection of a 
                        director for the center'';
                            (iv) in subparagraph (L), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (M), by striking the 
                        period and inserting ``; and''; and
                            (vi) by inserting after subparagraph (M), 
                        the following:
                    ``(N) 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.''; and
                    (C) by striking paragraph (4);
            (10) in subsection (l), by adding at the end the following: 
        ``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.'';
            (11) in subsection (q)(4), by adding at the end the 
        following: ``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.'';
            (12) in subsection (r)(3)--
                    (A) by striking ``appropriate committees of 
                Congress a report concerning the distribution of funds 
                under this section'' 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--
                    ``(A) the distribution of funds for carrying out 
                this section'';
                    (B) by striking ``populations. Such report shall 
                include an assessment'' and inserting the following: 
                ``populations;
                    ``(B) an assessment'';
                    (C) by striking ``and the rationale for any 
                substantial changes in the distribution of funds.'' and 
                inserting a semicolon; and
                    (D) by adding at the end the following:
                    ``(C) the distribution of awards and funding for 
                new or expanded services in each of rural areas and 
                urban areas;
                    ``(D) the distribution of awards and funding for 
                establishing new access points, and the number of new 
                access points created;
                    ``(E) the amount of unexpended funding for loan 
                guarantees and loan guarantee authority under title 
                XVI;
                    ``(F) the rationale for any substantial changes in 
                the distribution of funds;
                    ``(G) the rate of closures for health centers and 
                access points;
                    ``(H) the number and reason for any grants awarded 
                pursuant to subsection (e)(1)(B); and
                    ``(I) the number and reason for any waivers 
                provided pursuant to subsection (q)(4).'';
            (13) in subsection (r), by adding at the end the following 
        new paragraph:
            ``(5) Funding for participation of health centers in all of 
        us research program.--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.''; and
            (14) by striking subsection (s).
    (c) National Health Service Corps.--Section 10503(b)(2)(E) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)(E)) 
is amended by striking ``2017'' and inserting ``2019''.
    (d) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--
            (1) Payments.--Subsection (a) of section 340H of the Public 
        Health Service Act (42 U.S.C. 256h) is amended to read as 
        follows:
    ``(a) Payments.--
            ``(1) In general.--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--
                    ``(A) maintenance of existing approved graduate 
                medical residency training programs;
                    ``(B) expansion of existing approved graduate 
                medical residency training programs; and
                    ``(C) establishment of new approved graduate 
                medical residency training programs.
            ``(2) Priority.--In making payments pursuant to paragraph 
        (1)(C), the Secretary shall give priority to qualified teaching 
        health centers that--
                    ``(A) 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
                    ``(B) are located in a rural area (as defined in 
                section 1886(d)(2)(D) of the Social Security Act).''.
            (2) Funding.--Subsection (g) of section 340H of the Public 
        Health Service Act (42 U.S.C. 256h) is amended--
                    (A) by striking ``To carry out'' and inserting the 
                following:
            ``(1) In general.--To carry out'';
                    (B) by striking ``and $15,000,000 for the first 
                quarter of fiscal year 2018'' and inserting ``and 
                $126,500,000 for each of fiscal years 2018 and 2019, to 
                remain available until expended''; and
                    (C) by adding at the end the following:
            ``(2) Administrative expenses.--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.''.
            (3) Annual reporting.--Subsection (h)(1) of section 340H of 
        the Public Health Service Act (42 U.S.C. 256h) is amended--
                    (A) by redesignating subparagraph (D) as 
                subparagraph (H); and
                    (B) by inserting after subparagraph (C) the 
                following:
                    ``(D) The number of patients treated by residents 
                described in paragraph (4).
                    ``(E) The number of visits by patients treated by 
                residents described in paragraph (4).
                    ``(F) 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).
                    ``(G) 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--
                            ``(i) 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
                            ``(ii) located in a rural area (as defined 
                        in section 1886(d)(2)(D) of the Social Security 
                        Act).''.
            (4) Report on training costs.--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 (42 U.S.C. 256h)).
            (5) Definition.--Subsection (j) of section 340H of the 
        Public Health Service Act (42 U.S.C. 256h) is amended--
                    (A) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively; and
                    (B) by inserting after paragraph (1) the following:
            ``(2) New approved graduate medical residency training 
        program.--The term `new approved graduate medical residency 
        training program' 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)).''.
            (6) Technical correction.--Subsection (f) of section 340H 
        (42 U.S.C. 256h) is amended by striking ``hospital'' each place 
        it appears and inserting ``teaching health center''.
            (7) Payments for previous fiscal years.--The provisions of 
        section 340H of the Public Health Service Act (42 U.S.C. 256h), 
        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.
    (e) Application.--Amounts appropriated pursuant to this section for 
fiscal year 2018 or 2019 are subject to the requirements contained in 
Public Law 115-31 for funds for programs authorized under sections 330 
through 340 of the Public Health Service Act (42 U.S.C. 254b-256).
    (f) Conforming Amendments.--Section 3014(h) of title 18, United 
States Code, is amended--
            (1) in paragraph (1), by striking ``, as amended by section 
        221 of the Medicare Access and CHIP Reauthorization Act of 
        2015,''; and
            (2) in paragraph (4), by inserting ``and section 101(e) of 
        the Community Health And Medical Professionals Improve Our 
        Nation Act of 2017'' after ``section 221(c) of the Medicare 
        Access and CHIP Reauthorization Act of 2015''.

SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

    (a) Special Diabetes Program for Type I Diabetes.--Section 
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2017'' and inserting ``2019''.
    (b) Special Diabetes Program for Indians.--Subparagraph (D) of 
section 330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
3(c)(2)) is amended to read as follows:
                    ``(D) $150,000,000 for each of fiscal years 2018 
                and 2019.''.

SEC. 103. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.

    Section 501(c) of the Social Security Act (42 U.S.C. 701(c)) is 
amended--
            (1) in paragraph (1)(A)--
                    (A) in clause (v), by striking ``and'' at the end;
                    (B) in clause (vi), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
            ``(vii) $6,000,000 for each of fiscal years 2018 and 
        2019.'';
            (2) in paragraph (3)(C), by inserting before the period the 
        following: ``, 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''; 
        and
            (3) by amending paragraph (5) to read as follows:
    ``(5) For purposes of this subsection--
            ``(A) the term `Indian tribe' has the meaning given such 
        term in section 4 of the Indian Health Care Improvement Act (25 
        U.S.C. 1603);
            ``(B) the term `State' means each of the 50 States and the 
        District of Columbia; and
            ``(C) the term `territory' means Puerto Rico, Guam, 
        American Samoa, the Virgin Islands, and the Northern Mariana 
        Islands.''.

SEC. 104. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY EDUCATION.

    (a) Youth Empowerment Program.--
            (1) In general.--Section 510 of the Social Security Act (42 
        U.S.C. 710) is amended to read as follows:

``SEC. 510. YOUTH EMPOWERMENT PROGRAM.

    ``(a) In General.--
            ``(1) Allotments to states.--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--
                    ``(A) 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
                    ``(B) 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.
            ``(2) Other allotments.--
                    ``(A) Other entities.--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.
                    ``(B) Process.--The Secretary shall select the 
                recipients of allotments under subparagraph (A) by 
                means of a competitive grant process under which--
                            ``(i) 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
                            ``(ii) not later than 120 days after such 
                        deadline, all such applications must be 
                        submitted.
    ``(b) Purpose.--
            ``(1) In general.--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).
            ``(2) Required components.--Education on sexual risk 
        avoidance pursuant to an allotment under this section shall--
                    ``(A) 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;
                    ``(B) be medically accurate and complete;
                    ``(C) be age-appropriate; and
                    ``(D) be based on adolescent learning and 
                developmental theories for the age group receiving the 
                education.
            ``(3) Topics.--Education on sexual risk avoidance pursuant 
        to an allotment under this section shall address each of the 
        following topics:
                    ``(A) The holistic individual and societal benefits 
                associated with personal responsibility, self-
                regulation, goal setting, healthy decisionmaking, and a 
                focus on the future.
                    ``(B) The advantage of refraining from nonmarital 
                sexual activity in order to improve the future 
                prospects and physical and emotional health of youth.
                    ``(C) The increased likelihood of avoiding poverty 
                when youth attain self-sufficiency and emotional 
                maturity before engaging in sexual activity.
                    ``(D) The foundational components of healthy 
                relationships and their impact on the formation of 
                healthy marriages and safe and stable families.
                    ``(E) How other youth risk behaviors, such as drug 
                and alcohol usage, increase the risk for teen sex.
                    ``(F) 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.
            ``(4) Contraception.--Education on sexual risk avoidance 
        pursuant to an allotment under this section shall ensure that--
                    ``(A) any information provided on contraception is 
                medically accurate and ensures that students understand 
                that contraception offers physical risk reduction, but 
                not risk elimination; and
                    ``(B) the education does not include 
                demonstrations, simulations, or distribution of 
                contraceptive devices.
            ``(5) Research.--
                    ``(A) In general.--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.
                    ``(B) Requirements.--Any research conducted or 
                supported pursuant to subparagraph (A) shall be--
                            ``(i) rigorous;
                            ``(ii) evidence-based; and
                            ``(iii) designed and conducted by 
                        independent researchers who have experience in 
                        conducting and publishing research in peer-
                        reviewed outlets.
            ``(6) Information collection and reporting.--A State or 
        other entity receiving an allotment pursuant to subsection (a) 
        shall, as specified by the Secretary--
                    ``(A) collect information on the programs and 
                activities funded through the allotment; and
                    ``(B) submit reports to the Secretary on the data 
                from such programs and activities.
    ``(c) National Evaluation.--
            ``(1) In general.--The Secretary shall--
                    ``(A) 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
                    ``(B) 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).
            ``(2) Consultation.--In conducting the evaluations required 
        by paragraph (1), including the establishment of evaluation 
        methodologies, the Secretary shall consult with relevant 
        stakeholders.
    ``(d) Applicability of Certain Provisions.--
            ``(1) 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).
            ``(2) Sections 505 and 506 apply to allotments under 
        subsection (a) to the extent determined by the Secretary to be 
        appropriate.
    ``(e) Funding.--
            ``(1) In general.--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.
            ``(2) Reservation.--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.''.
            (2) Effective date.--The amendment made by this subsection 
        takes effect on October 1, 2017.
    (b) Personal Responsibility Education.--
            (1) In general.--Section 513 of the Social Security Act (42 
        U.S.C. 713) is amended--
                    (A) in subsection (a)(1)(A), by striking ``2017'' 
                and inserting ``2019''; and
                    (B) in subsection (a)(4)--
                            (i) in subparagraph (A), by striking 
                        ``2017'' each place it appears and inserting 
                        ``2019''; and
                            (ii) in subparagraph (B)--
                                    (I) in the subparagraph heading, by 
                                striking ``3-year grants'' and 
                                inserting ``Competitive prep grants''; 
                                and
                                    (II) in clause (i), by striking 
                                ``solicit applications to award 3-year 
                                grants in each of fiscal years 2012 
                                through 2017'' and inserting ``continue 
                                through fiscal year 2019 grants awarded 
                                for any of fiscal years 2015 through 
                                2017'';
                    (C) in subsection (c)(1), by inserting after 
                ``youth with HIV/AIDS,'' the following: ``victims of 
                human trafficking,''; and
                    (D) in subsection (f), by striking ``2017'' and 
                inserting ``2019''.
            (2) Effective date.--The amendments made by this subsection 
        take effect on October 1, 2017.

                           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.

    (a) In General.--Section 1412(c) of the Patient Protection and 
Affordable Care Act (42 U.S.C. 18082(c)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (B)(iv)(II), by striking ``a 3-
                month grace period'' and inserting ``a grace period 
                specified in subparagraph (C)''; and
                    (B) by adding at the end the following new 
                subparagraphs:
                    ``(C) Grace period specified.--For purposes of 
                subparagraph (B)(iv)(II), the grace period specified in 
                this subparagraph is--
                            ``(i) for plan years beginning before 
                        January 1, 2018, a 3-month grace period; and
                            ``(ii) for plan years beginning on or after 
                        January 1, 2018--
                                    ``(I) 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
                                    ``(II) 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.
                    ``(D) State law grace period.--For purposes of 
                subparagraph (C), the term `State law grace period' 
                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.''; and
            (2) in paragraph (3), by adding at the end the following 
        new sentence: ``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).''.
    (b) Report on Aligning Grace Periods for Medicaid, Medicare, and 
Exchange Plans.--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--
            (1) 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
            (2) the extent to which such an alignment of grace periods 
        may reduce fraud, waste, and abuse under the Medicaid program.

SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.

    Section 4002(b) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 300u-11(b)) is amended by striking paragraphs (3) through 
(8) and inserting the following new paragraphs:
            ``(3) for fiscal year 2018, $900,000,000;
            ``(4) for fiscal year 2019, $500,000,000;
            ``(5) for fiscal year 2020, $500,000,000;
            ``(6) for fiscal year 2021, $500,000,000;
            ``(7) for fiscal year 2022, $500,000,000;
            ``(8) for fiscal year 2023, $500,000,000;
            ``(9) for fiscal year 2024, $500,000,000;
            ``(10) for fiscal year 2025, $750,000,000;
            ``(11) for fiscal year 2026, $1,000,000,000; and
            ``(12) for fiscal year 2027 and each fiscal year 
        thereafter, $2,000,000,000.''.

                      DIVISION B--HEALTHY KIDS ACT

SEC. 300. SHORT TITLE.

    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''.

     TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS

SEC. 301. FIVE-YEAR FUNDING EXTENSION OF THE CHILDREN'S HEALTH 
              INSURANCE PROGRAM.

    (a) Appropriation; Total Allotment.--Section 2104(a) of the Social 
Security Act (42 U.S.C. 1397dd(a)) is amended--
            (1) in paragraph (19), by striking ``and'';
            (2) in paragraph (20), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following new paragraphs:
            ``(21) for fiscal year 2018, $21,500,000,000;
            ``(22) for fiscal year 2019, $22,600,000,000;
            ``(23) for fiscal year 2020, $23,700,000,000;
            ``(24) for fiscal year 2021, $24,800,000,000; and
            ``(25) for fiscal year 2022, for purposes of making two 
        semi-annual allotments--
                    ``(A) $2,850,000,000 for the period beginning on 
                October 1, 2021, and ending on March 31, 2022; and
                    ``(B) $2,850,000,000 for the period beginning on 
                April 1, 2022, and ending on September 30, 2022.''.
    (b) Allotments.--
            (1) In general.--Section 2104(m) of the Social Security Act 
        (42 U.S.C. 1397dd(m)) is amended--
                    (A) in paragraph (2)--
                            (i) in the heading, by striking ``through 
                        2016'' and inserting ``through 2022''; and
                            (ii) in subparagraph (B)--
                                    (I) in the matter preceding clause 
                                (i), by striking ``(19)'' and inserting 
                                ``(24)'';
                                    (II) in clause (ii), in the matter 
                                preceding subclause (I), by inserting 
                                ``(other than fiscal year 2022)'' after 
                                ``even-numbered fiscal year''; and
                                    (III) in clause (ii)(I), by 
                                inserting ``(or, in the case of fiscal 
                                year 2018, under paragraph (4))'' after 
                                ``clause (i)'';
                    (B) in paragraph (5)--
                            (i) by striking ``or (4)'' and inserting 
                        ``(4), or (10)''; and
                            (ii) by striking ``or 2017'' and inserting 
                        ``, 2017, or 2022'';
                    (C) in paragraph (7)--
                            (i) in subparagraph (A), by striking 
                        ``2017'' and inserting ``2022'';
                            (ii) in subparagraph (B), in the matter 
                        preceding clause (i), by inserting ``(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)'' after 
                        ``before the August 31 preceding the beginning 
                        of the fiscal year''; and
                            (iii) in the matter following subparagraph 
                        (B), by striking ``or fiscal year 2016'' and 
                        inserting ``fiscal year 2016, fiscal year 2018, 
                        fiscal year 2020, or fiscal year 2022'';
                    (D) in paragraph (9)--
                            (i) in the heading, by striking ``fiscal 
                        years 2015 and 2017'' and inserting ``certain 
                        fiscal years'';
                            (ii) by striking ``or (4)'' and inserting 
                        ``, (4), or (10)''; and
                            (iii) by striking ``or fiscal year 2017'' 
                        and inserting ``, 2017, or 2022''; and
                    (E) by adding at the end the following new 
                paragraph:
            ``(10) For fiscal year 2022.--
                    ``(A) First half.--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).
                    ``(B) Second half.--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--
                            ``(i) the amount of the allotment to such 
                        State under subparagraph (A); to
                            ``(ii) the total of the amount of all of 
                        the allotments made available under such 
                        subparagraph.
                    ``(C) Full year amount based on growth factor 
                updated amount.--The amount described in this 
                subparagraph for a State is equal to the sum of--
                            ``(i) the amount of the State allotment for 
                        fiscal year 2021 determined under paragraph 
                        (2)(B)(i); and
                            ``(ii) the amount of any payments made to 
                        the State under subsection (n) for fiscal year 
                        2021,
                multiplied by the allotment increase factor under 
                paragraph (6) for fiscal year 2022.
                    ``(D) First half ratio.--The first half ratio 
                described in this subparagraph is the ratio of--
                            ``(i) the sum of--
                                    ``(I) the amount made available 
                                under subsection (a)(25)(A); and
                                    ``(II) the amount of the 
                                appropriation for such period under 
                                section 301(b)(3) of the HEALTHY KIDS 
                                Act; to
                            ``(ii) the sum of--
                                    ``(I) the amount described in 
                                clause (i); and
                                    ``(II) the amount made available 
                                under subsection (a)(25)(B).''.
            (2) Technical amendment.--Section 2104(m)(2)(A) of such Act 
        (42 U.S.C. 1397dd(m)(2)(A)) is amended by striking ``the 
        allotment increase factor under paragraph (5)'' each place it 
        appears and inserting ``the allotment increase factor under 
        paragraph (6)''.
            (3) One-time appropriation for fiscal year 2022.--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 (42 U.S.C. 1397dd(a)) (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).
    (c) Extension of the Child Enrollment Contingency Fund.--Section 
2104(n) of the Social Security Act (42 U.S.C. 1397dd(n)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A)(ii)--
                            (i) by striking ``2010, 2011, 2012, 2013, 
                        2014, and 2016'' and inserting ``2010 through 
                        2014, 2016, and 2018 through 2021''; and
                            (ii) by striking ``fiscal year 2015 and 
                        fiscal year 2017'' and inserting ``fiscal years 
                        2015, 2017, and 2022''; and
                    (B) in subparagraph (B)--
                            (i) by striking ``2010, 2011, 2012, 2013, 
                        2014, and 2016'' and inserting ``2010 through 
                        2014, 2016, and 2018 through 2021''; and
                            (ii) by striking ``fiscal year 2015 and 
                        fiscal year 2017'' and inserting ``fiscal years 
                        2015, 2017, and 2022''; and
            (2) in paragraph (3)(A), in the matter preceding clause 
        (i), by striking ``or a semi-annual allotment period for fiscal 
        year 2015 or 2017'' and inserting ``or in any of fiscal years 
        2018 through 2021 (or a semi-annual allotment period for fiscal 
        year 2015, 2017, or 2022)''.
    (d) Extension of Qualifying States Option.--Section 2105(g)(4) of 
the Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
            (1) in the heading, by striking ``through 2017'' and 
        inserting ``through 2022''; and
            (2) in subparagraph (A), by striking ``2017'' and inserting 
        ``2022''.
    (e) Extension of Express Lane Eligibility Option.--Section 
1902(e)(13)(I) of the Social Security Act (42 U.S.C. 1396a(e)(13)(I)) 
is amended by striking ``2017'' and inserting ``2022''.
    (f) Assurance of Affordability Standard for Children and 
Families.--
            (1) In general.--Section 2105(d)(3) of the Social Security 
        Act (42 U.S.C. 1397ee(d)(3)) is amended--
                    (A) in the paragraph heading, by striking ``until 
                october 1, 2019'' and inserting ``through september 30, 
                2022''; and
                    (B) in subparagraph (A), in the matter preceding 
                clause (i)--
                            (i) by striking ``2019'' and inserting 
                        ``2022''; and
                            (ii) by striking ``The preceding sentence 
                        shall not be construed as preventing a State 
                        during such period'' and inserting ``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''.
            (2) Conforming amendments.--Section 1902(gg)(2) of the 
        Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
                    (A) in the paragraph heading, by striking ``until 
                october 1, 2019'' and inserting ``through september 30, 
                2022''; and
                    (B) by striking ``September 30, 2019,'' and 
                inserting ``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)''.
    (g) CHIP Look-Alike Plans.--
            (1) Blending risk pools.--Section 2107 of the Social 
        Security Act (42 U.S.C. 1397gg) is amended by adding at the end 
        the following:
    ``(g) Use of Blended Risk Pools.--
            ``(1) In general.--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.
            ``(2) Qualified chip look-alike program.--In this 
        subsection, the term `qualified CHIP look-alike program' means 
        a State program--
                    ``(A) 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
                    ``(B) 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.''.
            (2) Coverage rule.--
                    (A) In general.--Section 5000A(f)(1) of the 
                Internal Revenue Code of 1986 is amended in 
                subparagraph (A)(iii), by inserting ``or under a 
                qualified CHIP look-alike program (as defined in 
                section 2107(g) of the Social Security Act)'' before 
                the comma at the end.
                    (B) Effective date.--The amendment made by 
                subparagraph (A) shall apply with respect to taxable 
                years beginning after December 31, 2017.

SEC. 302. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION PROJECTS.

    (a) Childhood Obesity Demonstration Project.--Section 1139A(e)(8) 
of the Social Security Act (42 U.S.C. 1320b-9a(e)(8)) is amended--
            (1) by striking ``and $10,000,000'' and inserting ``, 
        $10,000,000''; and
            (2) by inserting after ``2017'' the following: ``, and 
        $25,000,000 for the period of fiscal years 2018 through 2022''.
    (b) Pediatric Quality Measures Program.--Section 1139A(i) of the 
Social Security Act (42 U.S.C. 1320b-9a(i)) is amended--
            (1) by striking ``Out of any'' and inserting the following:
            ``(1) In general.--Out of any'';
            (2) by striking ``there is appropriated for each'' and 
        inserting ``there is appropriated--
                    ``(A) for each'';
            (3) by striking ``, and there is appropriated for the 
        period'' and inserting ``;
                    ``(B) for the period'';
            (4) by striking ``. Funds appropriated under this 
        subsection shall remain available until expended.'' and 
        inserting ``; and''; and
            (5) by adding at the end the following:
                    ``(C) 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)).
            ``(2) Availability.--Funds appropriated under this 
        subsection shall remain available until expended.''.

SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.

    (a) In General.--Section 2113 of the Social Security Act (42 U.S.C. 
1397mm) is amended--
            (1) in subsection (a)(1), by striking ``2017'' and 
        inserting ``2022''; and
            (2) in subsection (g)--
                    (A) by striking ``and $40,000,000'' and inserting 
                ``, $40,000,000''; and
                    (B) by inserting after ``2017'' the following: ``, 
                and $100,000,000 for the period of fiscal years 2018 
                through 2022''.
    (b) Making Organizations That Use Parent Mentors Eligible To 
Receive Grants.--Section 2113(f) of the Social Security Act (42 U.S.C. 
1397mm(f)) is amended--
            (1) in paragraph (1)(E), by striking ``or community-based 
        doula programs'' and inserting ``, community-based doula 
        programs, or parent mentors''; and
            (2) by adding at the end the following new paragraph:
            ``(5) Parent mentor.--The term `parent mentor' means an 
        individual who--
                    ``(A) is a parent or guardian of at least one child 
                who is an eligible child under this title or title XIX; 
                and
                    ``(B) 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--
                            ``(i) education about health insurance 
                        coverage, including, with respect to obtaining 
                        such coverage, eligibility criteria and 
                        application and renewal processes;
                            ``(ii) assistance with completing and 
                        submitting applications for health insurance 
                        coverage;
                            ``(iii) a liaison between families and 
                        representatives of State plans under title XIX 
                        or State child health plans under this title;
                            ``(iv) guidance on identifying medical and 
                        dental homes and community pharmacies for 
                        children; and
                            ``(v) assistance and referrals to 
                        successfully address social determinants of 
                        children's health, including poverty, food 
                        insufficiency, and housing.''.
    (c) Exclusion From Modified Adjusted Gross Income.--Section 1902(e) 
of the Social Security Act (42 U.S.C. 1396a(e)) is amended--
            (1) in the first paragraph (14), relating to income 
        determined using modified adjusted gross income, by adding at 
        the end the following new subparagraph:
                    ``(J) Exclusion of parent mentor compensation from 
                income determination.--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.''; and
            (2) by striking ``(14) Exclusion'' and inserting ``(15) 
        Exclusion''.

SEC. 304. EXTENSION AND REDUCTION OF ADDITIONAL FEDERAL FINANCIAL 
              PARTICIPATION FOR CHIP.

    Section 2105(b) of the Social Security Act (42 U.S.C. 1397ee(b)) is 
amended in the second sentence by inserting ``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'' after ``23 percentage points,''.

SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``2018'' and inserting ``2020''; and
            (2) in clause (ii), by striking subclauses (I) through 
        (VIII) and inserting the following:
                                    ``(I) $4,000,000,000 for fiscal 
                                year 2020; and
                                    ``(II) $8,000,000,000 for each of 
                                fiscal years 2021 through 2025.''.

SEC. 306. PUERTO RICO AND THE VIRGIN ISLANDS MEDICAID PAYMENTS.

    (a) Increased Cap.--Section 1108(g) of the Social Security Act (42 
U.S.C. 1308(g)) is amended--
            (1) in paragraph (2)--
                    (A) in subparagraph (A), by inserting ``(or, with 
                respect to fiscal years 2018 and 2019, increased by 
                such percentage increase plus one percentage point)'' 
                after ``beginning of the fiscal year''; and
                    (B) in subparagraph (B), by inserting ``(or, with 
                respect to fiscal years 2018 and 2019, increased by 
                such percentage increase plus one percentage point)'' 
                after ``percentage increase referred to in subparagraph 
                (A)'';
            (2) in paragraph (5)--
                    (A) in subparagraph (A), by striking ``subparagraph 
                (B)'' and inserting ``subparagraphs (B), (C), (D), (E), 
                and (F)''; and
                    (B) by adding at the end the following new 
                subparagraphs:
            ``(C) The amount of the increase otherwise provided under 
        subparagraph (A) for Puerto Rico shall be further increased by 
        $880,000,000.
            ``(D)(i) 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 (48 U.S.C. 2121) certifies by a majority vote 
        that Puerto Rico has taken reasonable and appropriate steps 
        during such period to--
                    ``(I) reduce fraud, waste, and abuse under the 
                program under title XIX;
                    ``(II) implement strategies to reduce unnecessary, 
                inefficient, or excessive spending under title XIX;
                    ``(III) improve the use and availability of 
                Medicaid data for program operation and oversight; and
                    ``(IV) improve the quality of care and patient 
                experience for individuals enrolled under the program 
                under title XIX.
            ``(ii) 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).
            ``(E) 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.
            ``(F)(i) 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.
            ``(ii) For purposes of clause (i), the term `per capita 
        equivalent' means the ratio of--
                    ``(I) 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
                    ``(II) the population of Puerto Rico, as so 
                determined.''.
    (b) Federal Match for Medical Personnel and Fraud Reduction.--
Section 1903(a) of the Social Security Act (42 U.S.C. 1396b(a)) is 
amended--
            (1) in paragraph (2)(A), by inserting ``subject to 
        paragraph (8),'' before ``an amount'';
            (2) in paragraph (6)--
                    (A) in subparagraph (B), by inserting ``subject to 
                paragraph (8),'' before ``75 per centum''; and
                    (B) by striking at the end ``plus'';
            (3) in paragraph (7), by striking at the end the period and 
        inserting ``; plus'' ; and
            (4) by adding at the end the following new paragraph:
            ``(8) 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--
                    ``(A) the reference to `75 per centum' in paragraph 
                (2)(A) were a reference to `90 per centum'; and
                    ``(B) the reference to `75 per centum' in paragraph 
                (6)(B) were a reference to `90 per centum'.''.

                           TITLE II--OFFSETS

SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS.

    (a) Medicaid Third Party Liability.--
            (1) Delay of bipartisan budget act of 2013 third party 
        liability provisions.--
                    (A) In general.--Section 202(c) of the Bipartisan 
                Budget Act of 2013 (Public Law 113-67; 127 Stat. 1177; 
                42 U.S.C. 1396a note), as amended by section 211 of the 
                Protecting Access to Medicare Act of 2014 (Public Law 
                113-93; 128 Stat. 1047; 42 U.S.C. 1396a note) and 
                section 220 of the Medicare Access and CHIP 
                Reauthorization Act of 2015 (Public Law 114-10), is 
                amended by striking ``2017'' and inserting ``2019''.
                    (B) Effective date; treatment.--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.
            (2) Clarification of definitions applicable to third party 
        liability.--
                    (A) In general.--Section 1902 of the Social 
                Security Act (42 U.S.C. 1396a) is amended by adding at 
                the end the following new subsection:
    ``(nn) Responsible Third Party and Health Insurer Definitions.--For 
purposes of subsection (a)(25) and section 1903(d)(2)(B):
            ``(1) Responsible third party.--The term `responsible third 
        party' 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.
            ``(2) Health insurer.--The term `health insurer' 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, 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.''.
                    (B) Conforming amendments.--Section 1902(a)(25) of 
                the Social Security Act (42 U.S.C. 1396a(a)(25)) is 
                amended--
                            (i) in subparagraph (A), in the matter 
                        preceding clause (i), by striking ``third 
                        parties'' and all that follows through ``item 
                        or service)'' and inserting ``responsible third 
                        parties'';
                            (ii) in subparagraph (G), by striking 
                        ``health insurer'' and all that follows through 
                        ``item or service)'' and inserting 
                        ``responsible third party'';
                            (iii) in subparagraph (I), in the matter 
                        preceding clause (i), by striking ``health 
                        insurers'' and all that follows through ``item 
                        or service'' and inserting ``responsible third 
                        parties''; and
                            (iv) by inserting ``responsible'' before 
                        ``third'' each place it appears in 
                        subparagraphs (A)(i), (A)(ii), (C), (D), and 
                        (H).
            (3) Removal of special treatment of certain types of care 
        and payments under medicaid third party liability rules.--
        Section 1902(a)(25) of the Social Security Act (42 U.S.C. 
        1396a(a)(25)), as amended by section 202(c) of the Bipartisan 
        Budget Act of 2013 (after application of paragraph (1)), is 
        amended--
                    (A) in subparagraph (E)--
                            (i) in the matter preceding clause (i), by 
                        striking ``prenatal or preventive'' and all 
                        that follows through ``State plan'' and 
                        inserting ``items and services provided under 
                        the program required under the State plan 
                        pursuant to paragraph (62)''; and
                            (ii) in clause (i)--
                                    (I) by striking ``such service'' 
                                and inserting ``such items and 
                                services''; and
                                    (II) by striking each place it 
                                appears ``such services'' and inserting 
                                ``such items and services'' each such 
                                place; and
                    (B) by striking subparagraph (F).
            (4) Clarification of role of health insurers with respect 
        to third party liability.--
                    (A) In general.--Section 1902(a)(25) of the Social 
                Security Act (42 U.S.C. 1396a(a)(25)), as amended by 
                paragraph (3), is further amended by inserting after 
                subparagraph (E) the following new subparagraph:
                    ``(F) that--
                            ``(i) 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
                            ``(ii) 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);''.
                    (B) Treatment of collected amounts.--Section 
                1903(d)(2)(B) of the Social Security Act (42 U.S.C. 
                1396b(d)(2)(B)) is amended by adding at the end the 
                following: ``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.''.
            (5) Increasing state flexibility with respect to third 
        party liability.--Section 1902(a)(25)(I) of the Social Security 
        Act (42 U.S.C. 1396a(a)(25)(I)) is amended--
                    (A) in clause (i), by striking ``medical assistance 
                under the State plan'' and inserting ``medical 
                assistance under a State plan (or under a waiver of the 
                plan)'';
                    (B) by striking clause (ii) and inserting the 
                following new clause:
                            ``(ii) accept--
                                    ``(I) 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
                                    ``(II) 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;'';
                    (C) in clause (iii)--
                            (i) by striking ``respond to'' and 
                        inserting ``not later than 60 days after 
                        receiving''; and
                            (ii) by striking ``; and'' at the end and 
                        inserting ``, respond to such inquiry; and''; 
                        and
                    (D) in clause (iv), by inserting ``a failure to 
                obtain a prior authorization,'' after ``claim form,''.
            (6) State incentive to pursue third party liability for 
        newly eligibles.--Section 1903(d)(2)(B) of the Social Security 
        Act (42 U.S.C. 1396b(d)(2)(B)), as amended by paragraph (4)(B), 
        is further amended by adding at the end the following: ``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).''.
    (b) Compliance With Third Party Insurance Reporting.--Section 1905 
of the Social Security Act (42 U.S.C. 1396d) is amended by adding at 
the end the following new subsection:
    ``(ee) 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.''.
    (c) Application to CHIP.--
            (1) In general.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (B) through (R) 
                as subparagraphs (C) through (S), respectively; and
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Section 1902(a)(25) (relating to third party 
                liability).''.
            (2) Mandatory reporting.--Section 1902(a)(25)(I)(i) of the 
        Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)), as amended 
        by subsection (a)(5), is further amended--
                    (A) by striking ``(and, at State option, child'' 
                and inserting ``and child''; and
                    (B) by striking ``title XXI)'' and inserting 
                ``title XXI''.
    (d) Training on Third Party Liability.--Section 1936 of the Social 
Security Act (42 U.S.C. 1396u-6) is amended--
            (1) in subsection (b)(4), by striking ``and quality of 
        care'' and inserting ``, quality of care, and the liability of 
        responsible third parties (as defined in section 1902(nn))''; 
        and
            (2) by adding at the end the following new subsection:
    ``(f) Third Party Liability Training.--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--
            ``(1) 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;
            ``(2) monitor efforts to assess such liability and analyze 
        the challenges posed by that assessment;
            ``(3) distribute to State agencies administering the State 
        plan under this title information related to such efforts and 
        challenges; and
            ``(4) 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.''.
    (e) Development of Model Uniform Fields for States To Report Third 
Party Information.--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--
            (1) reporting information to the Secretary within the 
        Transformed Medicaid Statistical Information System (T-MSIS) 
        (or a successor system); and
            (2) collecting information that identifies responsible 
        third parties (as defined in subsection (nn) of section 1902 of 
        the Social Security Act (42 U.S.C. 1396a), 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 (42 U.S.C. 1396 et seq.) or under the State child 
        health plan under title XXI of such Act (42 U.S.C. 1397 et 
        seq.).
    (f) Effective Date.--
            (1) In general.--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.
            (2) Exception if state legislation required.--In the case 
        of a State plan for medical assistance under title XIX of the 
        Social Security Act (42 U.S.C. 1396 et seq.), or a State child 
        health plan for child health assistance under title XXI of such 
        Act (42 U.S.C. 1397aa 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.

SEC. 402. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM INCOME FOR 
              PURPOSES OF INCOME ELIGIBILITY UNDER MEDICAID.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(17), by striking ``(e)(14), (e)(14)'' 
        and inserting ``(e)(14), (e)(15)''; and
            (2) in subsection (e)(14), as amended by section 303(c), by 
        adding at the end the following new subparagraph:
                    ``(K) Treatment of certain lottery winnings and 
                income received as a lump sum.--
                            ``(i) In general.--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--
                                    ``(I) 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;
                                    ``(II) 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;
                                    ``(III) 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
                                    ``(IV) 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.
                            ``(ii) Counting in equal installments.--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.
                            ``(iii) Hardship exemption.--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.
                            ``(iv) Notifications and assistance 
                        required in case of loss of eligibility.--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)--
                                    ``(I) before the date on which the 
                                individual loses such eligibility, 
                                inform the individual--
                                            ``(aa) 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 
                                        section 9801(f)(3) of the 
                                        Internal Revenue Code of 1986 
                                        (relating to loss of Medicaid 
                                        or CHIP coverage); and
                                            ``(bb) 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
                                    ``(II) provide technical assistance 
                                to the individual seeking to enroll in 
                                such a qualified health plan.
                            ``(v) Qualified lottery winnings defined.--
                        In this subparagraph, the term `qualified 
                        lottery winnings' means winnings from a 
                        sweepstakes, lottery, or pool described in 
                        paragraph (3) of section 4402 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.
                            ``(vi) Qualified lump sum income defined.--
                        In this subparagraph, the term `qualified lump 
                        sum income' means income that is received as a 
                        lump sum from one of the following sources:
                                    ``(I) 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).
                                    ``(II) 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.
                                    ``(III) Income received as liquid 
                                assets from the estate (as defined in 
                                section 1917(b)(4)) of a deceased 
                                individual.''.
    (b) Rules of Construction.--
            (1) Interception of lottery winnings allowed.--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 (42 U.S.C. 1396 et seq.) for medical 
        assistance furnished to the individual.
            (2) Applicability limited to eligibility of recipient of 
        lottery winnings or lump sum income.--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 (42 
        U.S.C. 1396 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 (42 U.S.C. 1396a(e)(14)), 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).

SEC. 403. ADJUSTMENTS TO MEDICARE PART B AND PART D PREMIUM SUBSIDIES 
              FOR HIGHER INCOME INDIVIDUALS.

    (a) In General.--Section 1839(i)(3)(C)(i)(II) of the Social 
Security Act (42 U.S.C. 1395r(i)(3)(C)(i)(II)) is amended, in the 
table, by striking the last row and inserting the following new rows:


``More than $160,000 but less than $500,000.......            80 percent
At least $500,000.................................       100 percent.''.
 

    (b) Joint Returns.--Section 1839(i)(3)(C)(ii) of the Social 
Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by inserting 
before the period the following: ``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''.
    (c) Inflation Adjustment.--Section 1839(i) of the Social Security 
Act (42 U.S.C. 1395r(i)) is amended--
            (1) in paragraph (5)--
                    (A) in subparagraph (A), by striking ``In the 
                case'' and inserting ``Subject to subparagraph (C), in 
                the case'';
                    (B) in subparagraph (B), by striking ``subparagraph 
                (A)'' and inserting ``subparagraph (A) or (C)''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(C) Treatment of adjustments for certain higher 
                income individuals.--
                            ``(i) In general.--Subparagraph (A) shall 
                        not apply with respect to each dollar amount in 
                        paragraph (3) of $500,000.
                            ``(ii) Adjustment beginning 2027.--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--
                                    ``(I) such dollar amount, 
                                multiplied by
                                    ``(II) 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.''; and
            (2) in paragraph (6)(B), by inserting ``(other than 
        $500,000)'' after ``the dollar amounts''.

            Passed the House of Representatives November 3, 2017.

            Attest:

                                                                 Clerk.
115th CONGRESS

  1st Session

                               H. R. 3922

_______________________________________________________________________

                                 AN ACT

  To extend funding for certain public health programs, and for other 
                               purposes.