[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3922 Referred in Senate (RFS)]
<DOC>
115th CONGRESS
1st Session
H. R. 3922
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 6, 2017
Received; read twice and referred to the Committee on Finance
_______________________________________________________________________
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:
KAREN L. HAAS,
Clerk.