[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4820 Introduced in House (IH)]

<DOC>






115th CONGRESS
  2d Session
                                H. R. 4820

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            January 18, 2018

 Mr. McEachin (for himself, Ms. Roybal-Allard, Mr. Clay, Mr. Serrano, 
 Mr. Espaillat, Mr. Deutch, Mrs. Napolitano, Mr. Pocan, Mr. Langevin, 
 Mr. Richmond, Mr. Huffman, Mr. Schrader, Ms. Adams, Mr. McNerney, Mr. 
Grijalva, Mr. Brendan F. Boyle of Pennsylvania, Mr. Carson of Indiana, 
 Mr. Sablan, Ms. Bonamici, Mr. Larson of Connecticut, Ms. Judy Chu of 
California, Ms. DelBene, Ms. Norton, Mr. Scott of Virginia, Mr. Cohen, 
  Mr. Sean Patrick Maloney of New York, Ms. Barragan, Ms. Matsui, Ms. 
  Schakowsky, Mr. Veasey, Mr. Soto, Ms. Jayapal, Mr. Keating, Mr. Al 
Green of Texas, Mr. Lowenthal, Ms. Wilson of Florida, Ms. Hanabusa, Ms. 
Castor of Florida, Ms. Sewell of Alabama, Mr. Gomez, Mr. Loebsack, Ms. 
Wasserman Schultz, Mrs. Watson Coleman, Mr. Thompson of California, Mr. 
    Courtney, Ms. Rosen, Mr. Takano, Ms. Pingree, Ms. Kuster of New 
  Hampshire, Mr. Khanna, Mr. Panetta, and Mr. Kihuen) introduced the 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL


 
  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 ``Advancing Seniors and Kids Act'' or 
the ``ASK Act''.

SEC. 2. TABLE OF CONTENTS.

    The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.
              TITLE I--CHILDREN'S HEALTH INSURANCE PROGRAM

Sec. 100. Short title.
Sec. 101. Permanent extension of the Children's Health Insurance 
                            Program.
Sec. 102. Extension of certain programs and demonstration projects.
Sec. 103. Extension of outreach and enrollment program.
Sec. 104. Extension and reduction of additional Federal financial 
                            participation for CHIP.
             TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

          Subtitle A--Medicare Extenders and Related Policies

Sec. 201. Extension of work GPCI floor.
Sec. 202. Permanent repeal of the therapy caps.
Sec. 203. Ground ambulance services cost reporting requirement.
Sec. 204. Ground ambulance services cost reporting study.
Sec. 205. Extension of ground ambulance services extenders.
Sec. 206. Extension of increased inpatient hospital payment adjustment 
                            for certain low-volume hospitals.
Sec. 207. Extension of the Medicare-Dependent Hospital (MDH) program.
Sec. 208. Specialized Medicare Advantage plans for special needs 
                            individuals.
Sec. 209. Expanding supplemental benefits to meet the needs of 
                            chronically ill Medicare Advantage 
                            enrollees.
Sec. 210. Extension of consensus-based entity funding.
Sec. 211. Extension of certain MIPPA funding provisions.
Sec. 212. Extension of home health rural add-on.
            Subtitle B--Medicaid and Public Health Extenders

Sec. 221. Extension for community health centers and the National 
                            Health Service Corps.
Sec. 222. Extension for special diabetes programs.
Sec. 223. Reauthorization of program of payments to teaching health 
                            centers that operate graduate medical 
                            education programs.
Sec. 224. Extension for family-to-family health information centers.
Sec. 225. Extension of abstinence education; extension of personal 
                            responsibility education program.
Sec. 226. Extension of health workforce demonstration projects for low-
                            income individuals.
Sec. 227. Delay of reduction to Medicaid DSH allotments.
Sec. 228. Delay of Bipartisan Budget Act of 2013 third-party liability 
                            provisions.
 Subtitle C--Continuing the Maternal, Infant, and Early Childhood Home 
                            Visiting Program

Sec. 231. Continuing evidence-based home visiting program.
Sec. 232. Continuing to demonstrate results to help families.
Sec. 233. Reviewing statewide needs to target resources.
Sec. 234. Improving the likelihood of success in high-risk communities.
Sec. 235. Option to fund evidence-based home visiting on a pay for 
                            outcome basis.
Sec. 236. Data exchange standards for improved interoperability.
Sec. 237. Allocation of funds.
TITLE III--STRENGTHENING PROTECTIONS FOR SOCIAL SECURITY BENEFICIARIES 
                              ACT OF 2018

Sec. 300. Short title.
     Subtitle A--Strengthening Oversight and Beneficiary Protection

Sec. 301. Stronger monitoring of representative payees.
Sec. 302. Reducing the burden on families.
Sec. 303. Protecting beneficiaries through information sharing.
Sec. 304. Clarifying overpayment liability for child in child welfare 
                            system.
Sec. 305. Reports.
           Subtitle B--Improving Payee Selection and Quality

Sec. 311. Advance designation of representative payees.
Sec. 312. Prohibition on individuals convicted of certain crimes 
                            serving as representative payees.
Sec. 313. Prohibition on individuals with representative payees serving 
                            as representative payees.
Sec. 314. Reassessment of payee selection and replacement policies.

              TITLE I--CHILDREN'S HEALTH INSURANCE PROGRAM

SEC. 100. SHORT TITLE.

    This title may be cited as the ``Keeping Kids' Insurance Delivery 
Stable Act'' or the ``KIDS Act''.

SEC. 101. PERMANENT EXTENSION OF THE CHILDREN'S HEALTH INSURANCE 
              PROGRAM.

    (a) Funding.--
            (1) In general.--Section 2104(a) of the Social Security Act 
        (42 U.S.C. 1397dd(a)), as amended by section 3201(a) of the 
        CHIP and Public Health Funding Extension Act (division C of 
        Public Law 115-96), is amended--
                    (A) in paragraph (20)(B), by striking ``; and'' and 
                inserting a semicolon; and
                    (B) by striking paragraph (21) and inserting 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;
            ``(25) for fiscal year 2022, $25,900,000,000;
            ``(26) for fiscal year 2023, $27,000,000,000;
            ``(27) for fiscal year 2024, $28,100,000,000;
            ``(28) for fiscal year 2025, $29,200,000,000;
            ``(29) for fiscal year 2026, $30,300,000,000;
            ``(30) for fiscal year 2027, $31,400,000,000; and
            ``(31) for fiscal year 2028 and each subsequent fiscal 
        year, the amount provided for the previous fiscal year, 
        increased by the product of--
                    ``(A) 1 plus the percentage increase in the 
                projected per capita amount of National Health 
                Expenditures from the calendar year in which the 
                previous fiscal year ends to the calendar year in which 
                the fiscal year involved ends, as most recently 
                published by the Secretary before the beginning of the 
                fiscal year; and
                    ``(B) 1 plus the percentage increase (if any) in 
                the national population of children from July 1 in the 
                previous fiscal year to July 1 in the fiscal year 
                involved, as determined by the Secretary based on the 
                most recent published estimates of the Bureau of the 
                Census before the beginning of the fiscal year 
                involved, plus 1 percentage point.''.
            (2) Prevention of duplicate appropriations for fiscal year 
        2018.--Notwithstanding any other provision of law, insofar as 
        funds have been appropriated under subsection (a)(21) of 
        section 2104 of the Social Security Act (42 U.S.C. 1397dd), as 
        such subsection is in effect on the day before the date of the 
        enactment of this Act, to provide allotments to States under 
        the State Children's Health Insurance Program established under 
        title XXI of the Social Security Act (42 U.S.C. 1397aa et seq.) 
        (whether implemented under title XIX, XXI, or both, of the 
        Social Security Act) for fiscal year 2018--
                    (A) any amounts that are so appropriated that are 
                not so allotted and obligated before the date of the 
                enactment of this Act, are rescinded; and
                    (B) any amount provided for CHIP allotments to a 
                State under this section (and the amendments made by 
                this section) for such fiscal year shall be reduced by 
                the amount of such appropriations so allotted and 
                obligated before such date.
    (b) Allotments.--Section 2104(m) of the Social Security Act (42 
U.S.C. 1397dd(m)), as amended by section 3201(b) of the CHIP and Public 
Health Funding Extension Act (division C of Public Law 115-96), is 
amended--
            (1) in paragraph (2)(B)--
                    (A) in the matter preceding clause (i), by striking 
                ``(19)'' and inserting ``(31)''; and
                    (B) in clause (ii)--
                            (i) in the matter preceding subclause (I), 
                        by striking ``and paragraph (10)''; and
                            (ii) in subclause (I), by inserting ``(or, 
                        in the case of fiscal year 2018, under 
                        paragraph (4))'' after ``clause (i)'';
            (2) in paragraph (5), by striking ``, 2017, or 2018'' and 
        inserting ``or 2017'';
            (3) in paragraph (7)--
                    (A) in subparagraph (A), by striking ``and ending 
                with fiscal year 2017'';
                    (B) 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 KIDS Act)'' 
                after ``before the August 31 preceding the beginning of 
                the fiscal year''; and
                    (C) in the matter following subparagraph (B), by 
                striking ``or fiscal year 2016'' and inserting ``fiscal 
                year 2016, or any succeeding even-numbered fiscal 
                year'';
            (4) in paragraph (9), by striking ``, 2017, or 2018'' and 
        inserting ``or 2017''; and
            (5) by striking paragraph (10).
    (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), by striking ``2010, 
                2011, 2012, 2013, 2014, and 2016'' and inserting ``2010 
                through 2014, 2016, 2018, and each subsequent fiscal 
                year''; and
                    (B) in subparagraph (B), by striking ``2010, 2011, 
                2012, 2013, 2014, and 2016'' and inserting ``2010 
                through 2014, 2016, 2018, and each subsequent fiscal 
                year''; 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 fiscal year 2018 or 
        any subsequent fiscal year (or a semi-annual allotment period 
        for fiscal year 2015, or 2017)''.
    (d) Extension of Qualifying States Option.--
            (1) In general.--Section 2105(g)(4) of the Social Security 
        Act (42 U.S.C. 1397ee(g)(4)) is amended--
                    (A) in the heading, by striking ``through 2017'' 
                and inserting ``and subsequent fiscal years''; and
                    (B) in subparagraph (A), by striking ``for any of 
                fiscal years 2009 through 2017'' and inserting ``for 
                fiscal year 2009 or any subsequent fiscal year''.
            (2) Technical amendments.--Section 2104(f)(2)(B)(ii) of the 
        Social Security Act (42 U.S.C. 1397dd(f)(2)(B)(ii)), as amended 
        by section 3201(c) of the CHIP and Public Health Funding 
        Extension Act (division C of Public Law 115-96), is amended--
                    (A) in subclause (I), by striking ``for the month 
                (as defined in subclause (II))'' and inserting ``(as 
                defined in subclause (II)) for the month'';
                    (B) in subclause (II), by inserting ``, as in 
                effect on the day before the date of the enactment of 
                the KIDS Act,'' after ``section 2105(g)(4)(A)''; and
                    (C) in subclause (VI)--
                            (i) by inserting ``, as in effect on the 
                        day before the date of the enactment of the 
                        KIDS Act'' after ``, section 2105(g)(4)''; and
                            (ii) by inserting ``, as so in effect'' 
                        after ``under section 2105(g)(4)''.
    (e) Extension of Express Lane Eligibility Option.--Section 
1902(e)(13) of the Social Security Act (42 U.S.C. 1396a(e)(13)) is 
amended by striking subparagraph (I).
    (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
                    (B) in subparagraph (A), in the matter preceding 
                clause (i)--
                            (i) by striking ``During the period that 
                        begins on'' and inserting ``Beginning on'';
                            (ii) by striking ``and ends on September 
                        30, 2019''; and
                            (iii) by striking ``The preceding sentence 
                        shall not be construed as preventing a State 
                        during such period'' and inserting ``Beginning 
                        on October 1, 2019, 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
                    (B) by striking ``through September 30, 2019,'' and 
                inserting ``(but beginning on October 1, 2019, 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.
    (h) Availability of Unused Fiscal Year 2018 Redistribution 
Amounts.--Any amounts that have been redistributed to States under 
subsection (f) of section 2104 of the Social Security Act (42 U.S.C. 
1397dd) for fiscal year 2018 that are not, or will not be, expended by 
the end of that fiscal year shall be--
            (1) adjusted by the Secretary before the end of fiscal year 
        2018 to reflect an updated estimate of shortfalls under 
        subsection (f)(2)(A) of such section; and
            (2) available for redistribution under subsection (f) of 
        such section for subsequent fiscal years.

SEC. 102. 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 
        $5,000,000 for fiscal year 2018 and each subsequent fiscal 
        year''.
    (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 fiscal year 2018 and each subsequent 
                fiscal year, $15,000,000 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. 103. 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 ``during the period 
        of fiscal years 2009 through 2017''; 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 $20,000,000 for fiscal year 2018 and each 
                subsequent fiscal year''.
    (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. 104. 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,''.

             TITLE II--MEDICARE AND OTHER HEALTH EXTENDERS

          Subtitle A--Medicare Extenders and Related Policies

SEC. 201. EXTENSION OF WORK GPCI FLOOR.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 1, 2018'' and inserting 
``January 1, 2020''.

SEC. 202. PERMANENT REPEAL OF THE THERAPY CAPS.

    Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is 
amended--
            (1) in paragraph (1)--
                    (A) by striking ``Subject to paragraphs (4) and 
                (5)'' and inserting ``(A) Subject to paragraphs (4) and 
                (5)'';
                    (B) in the subparagraph (A), as inserted and 
                designated by subparagraph (A) of this paragraph, by 
                adding at the end the following new sentence: ``The 
                preceding sentence shall not apply to expenses incurred 
                with respect to services furnished after December 31, 
                2017.''; and
                    (C) by adding at the end the following new 
                subparagraph:
    ``(B) With respect to services furnished during 2018 or a 
subsequent year, in the case of physical therapy services of the type 
described in section 1861(p), speech-language pathology services of the 
type described in such section through the application of section 
1861(ll)(2), and physical therapy services and speech-language 
pathology services of such type which are furnished by a physician or 
as incident to physicians' services, with respect to expenses incurred 
in any calendar year, any amount that is more than the amount specified 
in paragraph (2) for the year shall not be considered as incurred 
expenses for purposes of subsections (a) and (b) unless the applicable 
requirements of paragraph (7) are met.'';
            (2) in paragraph (3)--
                    (A) by striking ``Subject to paragraphs (4) and 
                (5)'' and inserting ``(A) Subject to paragraphs (4) and 
                (5)'';
                    (B) in the subparagraph (A), as inserted and 
                designated by subparagraph (A) of this paragraph, by 
                adding at the end the following new sentence: ``The 
                preceding sentence shall not apply to expenses incurred 
                with respect to services furnished after December 31, 
                2017.''; and
                    (C) by adding at the end the following new 
                subparagraph:
    ``(B) With respect to services furnished during 2018 or a 
subsequent year, in the case of occupational therapy services (of the 
type that are described in section 1861(p) through the operation of 
section 1861(g) and of such type which are furnished by a physician or 
as incident to physicians' services), with respect to expenses incurred 
in any calendar year, any amount that is more than the amount specified 
in paragraph (2) for the year shall not be considered as incurred 
expenses for purposes of subsections (a) and (b) unless the applicable 
requirements of paragraph (7) are met.'';
            (3) in paragraph (5)--
                    (A) by redesignating subparagraph (D) as paragraph 
                (8) and moving such paragraph to immediately follow 
                paragraph (7), as added by paragraph (4) of this 
                section; and
                    (B) in subparagraph (E)(iv), by inserting ``, 
                except as such process is applied under paragraph 
                (7)(B)'' before the period at the end; and
            (4) by adding at the end the following new paragraph:
    ``(7) For purposes of paragraphs (1)(B) and (3)(B), with respect to 
services described in such paragraphs, the requirements described in 
this paragraph are as follows:
            ``(A) Inclusion of appropriate modifier.--The claim for 
        such services contains an appropriate modifier (such as the KX 
        modifier described in paragraph (5)(B)) indicating that such 
        services are medically necessary as justified by appropriate 
        documentation in the medical record involved.
            ``(B) Targeted medical review for certain services above 
        threshold.--
                    ``(i) In general.--In the case where expenses that 
                would be incurred for such services would exceed the 
                threshold described in clause (ii) for the year, such 
                services shall be subject to the process for medical 
                review implemented under paragraph (5)(E).
                    ``(ii) Threshold.--The threshold under this clause 
                for--
                            ``(I) a year before 2028, is $3,000;
                            ``(II) 2028, is the amount specified in 
                        subclause (I) increased by the percentage 
                        increase in the MEI (as defined in section 
                        1842(i)(3)) for 2028; and
                            ``(III) a subsequent year, is the amount 
                        specified in this clause for the preceding year 
                        increased by the percentage increase in the MEI 
                        (as defined in section 1842(i)(3)) for such 
                        subsequent year,
                except that if an increase under subclause (II) or 
                (III) for a year is not a multiple of $10, it shall be 
                rounded to the nearest multiple of $10.
                    ``(iii) Application.--The threshold under clause 
                (ii) shall be applied separately--
                            ``(I) for physical therapy services and 
                        speech-language pathology services; and
                            ``(II) for occupational therapy services.
                    ``(iv) Funding.--For purposes of carrying out this 
                subparagraph, the Secretary shall provide for the 
                transfer, from the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 to the Centers 
                for Medicare & Medicaid Services Program Management 
                Account, of $5,000,000 for each fiscal year beginning 
                with fiscal year 2018, to remain available until 
                expended. Such funds may not be used by a contractor 
                under section 1893(h) for medical reviews under this 
                subparagraph.''.

SEC. 203. GROUND AMBULANCE SERVICES COST REPORTING REQUIREMENT.

    (a) In General.--Section 1121 of the Social Security Act (42 U.S.C. 
1320a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``For the purposes of'' and 
                inserting ``Subject to subsection (d), for the purposes 
                of'';
                    (B) by inserting ``suppliers of ground ambulance 
                services,'' after ``health maintenance 
                organizations,''; and
                    (C) in the matter following paragraph (5), by 
                adding the following new sentence: ``Not later than 
                December 31, 2019, the Secretary shall modify the 
                uniform reporting system for providers of services with 
                respect to ambulance services to ensure that such 
                system contains information similar (as determined by 
                the Secretary) to information required under the 
                uniform reporting system for suppliers of ground 
                ambulance services.''; and
            (2) by adding at the end the following new subsection:
    ``(d) In the case of a supplier of ground ambulance services that 
furnishes such services for fewer than 20 individuals entitled to 
benefits under part A of title XVIII and enrolled under part B of such 
title in a cost reporting period (as defined by the Secretary), the 
Secretary may modify the requirements for inclusion of any information 
specified in subsection (a) in reports made in accordance with the 
uniform reporting systems established under this section with respect 
to such services.''.
    (b) Suspension of Payment for Ground Ambulance Services; Deeming 
Certain Payments Overpayments.--Section 1834(l) of the Social Security 
Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following 
new paragraph:
            ``(17) Requirement to submit cost report and authority to 
        suspend payments and deem certain payments overpayments for 
        ground ambulance services.--
                    ``(A) In general.--With respect to ground ambulance 
                services furnished by a supplier of such services 
                during cost reporting periods (as defined in 
                subparagraph (I)) beginning on or after January 1, 
                2020, such supplier shall make reports to the Secretary 
                of information described in section 1121(a) in 
                accordance with the uniform reporting system 
                established under such section for such suppliers and, 
                as may be required by the Secretary, of any of the 
                information described in subparagraph (B).
                    ``(B) Additional information.--The Secretary may, 
                with respect to a supplier of ground ambulance 
                services, require the following information (to be 
                reported to the extent practicable under the uniform 
                reporting system established under section 1121(a) for 
                such suppliers):
                            ``(i) Whether the supplier is part of an 
                        emergency services department, a governmental 
                        organization, or another type of entity (as 
                        described by the Secretary).
                            ``(ii) The number of hours in a week during 
                        which the supplier is available for furnishing 
                        ground ambulance services.
                            ``(iii) The average number of volunteer 
                        hours a week used by the supplier.
                    ``(C) Suspension of payment.--Subject to 
                subparagraph (E), in the case that the Secretary 
                determines that a supplier of ground ambulance services 
                has not made to the Secretary a timely report described 
                in subparagraph (A) with respect to a cost reporting 
                period beginning on or after January 1, 2020, and 
                before January 1, 2022, the Secretary may suspend 
                payments made under this subsection, in whole or in 
                part, to such supplier until the Secretary finds that 
                such supplier has made such a report.
                    ``(D) Deeming certain payments overpayments.--
                Subject to subparagraphs (E) and (F), in the case that 
                the Secretary determines that a supplier of ground 
                ambulance services has not made to the Secretary a 
                complete, accurate, and timely report described in 
                subparagraph (A) with respect to a cost reporting 
                period beginning on or after January 1, 2022, the 
                Secretary may deem payments made under this subsection 
                to such supplier for such period to be overpayments and 
                recoup such overpayments.
                    ``(E) Hardship delay.--The Secretary shall 
                establish a process whereby a supplier of ground 
                ambulance services may request a delay in making a 
                report described in subparagraph (A) with respect to a 
                cost reporting period for reason of significant 
                hardship (as determined by the Secretary).
                    ``(F) Authority to modify cost reporting elements 
                and enforcement.--Not earlier than January 1, 2024, the 
                Secretary may provide that subparagraph (D) no longer 
                applies to ground ambulance services suppliers or a 
                category of such suppliers after--
                            ``(i) taking into account the 
                        recommendation of the Medicare Payment Advisory 
                        Commission in the most recent report available 
                        to the Secretary submitted under section 204 of 
                        the Advancing Seniors and Kids Act regarding 
                        whether cost reports made by suppliers or a 
                        category of suppliers (as specified for 
                        purposes of the report submitted under such 
                        section) should be required or modified; and
                            ``(ii) undertaking notice and comment 
                        rulemaking.
                    ``(G) Audit of cost reports.--The Secretary shall 
                audit reports described in subparagraph (A) made with 
                respect to cost reporting periods beginning on or after 
                January 1, 2021.
                    ``(H) Appeals.--The Secretary shall establish a 
                process whereby a supplier of ground ambulance services 
                may appeal a determination described in subparagraph 
                (C) or (D) made with respect to a cost report required 
                to be made by such supplier under subparagraph (A).
                    ``(I) Definition.--In this paragraph, the term 
                `cost reporting period' means, with respect to a year, 
                the 12-month period beginning on January 1 of such 
                year.''.
    (c) Stakeholder Feedback.--
            (1) In general.--The Secretary of Health and Human Services 
        shall implement the provisions of this section, including the 
        amendments made by this section, through notice and comment 
        rulemaking and seek input from stakeholders.
            (2) Nonapplication of paperwork reduction act.--Chapter 35 
        of title 44, United States Code, shall not apply with respect 
        to--
                    (A) the development and implementation of the 
                uniform reporting system required under section 1121(a) 
                of the Social Security Act (42 U.S.C. 1320a(a)) for 
                suppliers of ground ambulance services and reports 
                required to be made under section 1834(l)(17) of such 
                Act (42 U.S.C. 1395m(l)(17)), as added by subsection 
                (b) of this section; and
                    (B) the modification of the uniform reporting 
                systems under such section 1121(a) of such Act for 
                providers of such services and reports required to be 
                made under section 1861(v)(1)(F) of such Act (42 U.S.C. 
                1395x(v)(1)(F)).
    (d) Implementation Resources.--
            (1) In general.--There are hereby appropriated to the 
        Secretary from the Federal Hospital Insurance Trust Fund under 
        section 1817 of the Social Security Act (42 U.S.C. 1395i) 
        $8,000,000 and from the Federal Supplementary Medical Insurance 
        Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) 
        $92,000,000 (of which not less than $10,000,000 shall be used 
        to fulfill the auditing requirement under section 
        1834(l)(17)(G) of such Act, as added by subsection (b) of this 
        section) to carry out the provisions of this section, including 
        the amendments made by this section, to remain available 
        through December 31, 2022.
            (2) Funding for employees.--The Secretary of Health and 
        Human Services shall provide for the transfer to the Centers 
        for Medicare & Medicaid Services Program Management Account, 
        from the Federal Supplementary Medical Insurance Trust Fund 
        under section 1841 of the Social Security Act (42 U.S.C. 
        1395t), of such sums as may be necessary in order to directly 
        hire no more than 2 full-time employees to carry out the 
        provisions of this section, including the amendments made by 
        this section.
    (e) Sense of Congress.--It is the sense of Congress that--
            (1) a cost report made by a supplier of ground ambulance 
        services with respect to a cost reporting period beginning 
        before January 1, 2022, may not contain complete and accurate 
        information on ground ambulance services furnished during such 
        a period by the supplier; and
            (2) the Secretary should take into account only the 
        timeliness of such a report made with respect to such a period 
        when determining whether to suspend payments to a supplier 
        under section 1834(l) of the Social Security Act (42 U.S.C. 
        1395m(l)).

SEC. 204. GROUND AMBULANCE SERVICES COST REPORTING STUDY.

    (a) In General.--Not later than March 15, 2023, and as determined 
necessary by the Medicare Payment Advisory Commission thereafter, such 
Commission shall assess and submit to Congress a report on cost reports 
carried out in accordance with sections 1121(a) and 1834(l) of the 
Social Security Act (42 U.S.C. 1320a(a), 1395m(l)), the adequacy of 
payments for such services made under section 1834(l) of such Act, and 
geographic variations in the cost of providing such services.
    (b) Contents.--The report described in subsection (a) shall contain 
the following:
            (1) An analysis of cost report data submitted in accordance 
        with such sections.
            (2) An analysis of any burden on providers and suppliers of 
        such services associated with reporting such data.
            (3) A recommendation on whether or not cost reports of 
        ambulance services made by suppliers or a category of suppliers 
        (as specified by the Secretary) of such services, or the ground 
        ambulance portion of cost reports made by providers of such 
        services, should be required or modified, taking into account 
        the analyses described in paragraphs (1) and (2).

SEC. 205. EXTENSION OF GROUND AMBULANCE SERVICES EXTENDERS.

    Section 1834(l) of the Social Security Act (42 U.S.C. 1395m(l)) is 
amended--
            (1) in paragraph (12)(A), by striking ``2018'' and 
        inserting ``2023''; and
            (2) in paragraph (13)(A), by striking ``2018'' each place 
        it appears and inserting ``2023''.

SEC. 206. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT 
              FOR CERTAIN LOW-VOLUME HOSPITALS.

    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended--
            (1) in subparagraph (B), in the matter preceding clause 
        (i), by striking ``and for discharges occurring in fiscal year 
        2020 and subsequent fiscal years'';
            (2) in subparagraph (C)(i)--
                    (A) by striking ``fiscal years 2011 through 2017'' 
                each place it appears and inserting ``fiscal years 2011 
                through 2019''; and
                    (B) by striking ``or portion of fiscal year''; and
            (3) in subparagraph (D)--
                    (A) in the heading, by striking ``Temporary 
                applicable percentage increase'' and inserting 
                ``Applicable percentage increase beginning with fiscal 
                year 2011'';
                    (B) by striking ``fiscal years 2011 through 2017,'' 
                and inserting ``fiscal years 2011 through 2019''; and
                    (C) by striking ``or the portion of fiscal year'' 
                each place it appears.

SEC. 207. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.

    (a) In General.--Section 1886(d)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
            (1) in clause (i), by striking ``October 1, 2017'' and 
        inserting ``October 1, 2019''; and
            (2) in clause (ii)(II), by striking ``October 1, 2017'' and 
        inserting ``October 1, 2019''.
    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
        amended--
                    (A) in the matter preceding clause (i), by striking 
                ``October 1, 2017'' and inserting ``October 1, 2019''; 
                and
                    (B) in clause (iv), by striking ``through fiscal 
                year 2017'' and inserting ``through fiscal year 2019''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``through 
        fiscal year 2017'' and inserting ``through fiscal year 2019''.

SEC. 208. SPECIALIZED MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS 
              INDIVIDUALS.

    (a) Permanent Extension.--Section 1859(f)(1) of the Social Security 
Act (42 U.S.C. 1395w-28(f)(1)) is amended by striking ``and for periods 
before January 1, 2019''.
    (b) Increased Integration of Dual SNPs.--
            (1) In general.--Section 1859(f) of the Social Security Act 
        (42 U.S.C. 1395w-28(f)) is amended--
                    (A) in paragraph (3), by adding at the end the 
                following new subparagraph:
                    ``(F) The plan meets the requirements applicable 
                under paragraph (8).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Increased integration of dual snps.--
                    ``(A) Designated contact.--The Secretary, acting 
                through the Federal Coordinated Health Care Office 
                established under section 2602 of Public Law 111-148, 
                shall serve as a dedicated point of contact for States 
                to address misalignments that arise with the 
                integration of specialized MA plans for special needs 
                individuals described in subsection (b)(6)(B)(ii) under 
                this paragraph and, consistent with such role, shall--
                            ``(i) establish a uniform process for 
                        disseminating to State Medicaid agencies 
                        information under this title impacting 
                        contracts between such agencies and such plans 
                        under this subsection; and
                            ``(ii) establish basic resources for States 
                        interested in exploring such plans as a 
                        platform for integration, such as a model 
                        contract or other tools to achieve those goals.
                    ``(B) Unified grievances and appeals process.--
                            ``(i) In general.--Not later than April 1, 
                        2020, the Secretary shall establish procedures, 
                        to the extent feasible as determined by the 
                        Secretary, unifying grievances and appeals 
                        procedures under sections 1852(f), 1852(g), 
                        1902(a)(3), 1902(a)(5), and 1932(b)(4) for 
                        items and services provided by specialized MA 
                        plans for special needs individuals described 
                        in subsection (b)(6)(B)(ii) under this title 
                        and title XIX. The Secretary shall solicit 
                        comment in developing such procedures from 
                        States, plans, beneficiaries and their 
                        representatives, and other relevant 
                        stakeholders. With respect to items and 
                        services described in the previous sentence, 
                        appeals procedures established under this 
                        clause shall apply in place of otherwise 
                        applicable appeals procedures.
                            ``(ii) Procedures.--The procedures 
                        established under clause (i) shall be included 
                        in the plan contract under paragraph (3)(D) and 
                        shall--
                                    ``(I) adopt the provisions for the 
                                enrollee that are most protective for 
                                the enrollee and, to the extent 
                                feasible as determined by the 
                                Secretary, are compatible with unified 
                                timeframes and consolidated access to 
                                external review under an integrated 
                                process;
                                    ``(II) take into account 
                                differences in State plans under title 
                                XIX to the extent necessary;
                                    ``(III) be easily navigable by an 
                                enrollee; and
                                    ``(IV) include the elements 
                                described in clause (iii), as 
                                applicable.
                            ``(iii) Elements described.--Both unified 
                        appeals and unified grievance procedures shall 
                        include, as applicable, the following elements 
                        described in this clause:
                                    ``(I) Single written notification 
                                of all applicable grievances and appeal 
                                rights under this title and title XIX. 
                                For purposes of this subparagraph, the 
                                Secretary may waive the requirements 
                                under section 1852(g)(1)(B) when the 
                                specialized MA plan covers items or 
                                services under this part or under title 
                                XIX.
                                    ``(II) Single pathways for 
                                resolution of any grievance or appeal 
                                related to a particular item or service 
                                provided by specialized MA plans for 
                                special needs individuals described in 
                                subsection (b)(6)(B)(ii) under this 
                                title and title XIX.
                                    ``(III) Notices written in plain 
                                language and available in a language 
                                and format that is accessible to the 
                                enrollee, including in non-English 
                                languages that are prevalent in the 
                                service area of the specialized MA 
                                plan.
                                    ``(IV) Unified timeframes for 
                                grievances and appeals processes, such 
                                as an individual's filing of a 
                                grievance or appeal, a plan's 
                                acknowledgment and resolution of a 
                                grievance or appeal, and notification 
                                of decisions with respect to a 
                                grievance or appeal.
                                    ``(V) Requirements for how the plan 
                                must process, track, and resolve 
                                grievances and appeals, to ensure 
                                beneficiaries are notified on a timely 
                                basis of decisions that are made 
                                throughout the grievance or appeals 
                                process and are able to easily 
                                determine the status of a grievance or 
                                appeal.
                            ``(iv) Continuation of benefits pending 
                        appeal.--The unified procedures under clause 
                        (i) shall, with respect to all benefits under 
                        parts A and B and title XIX subject to appeal 
                        under such procedures, incorporate provisions 
                        under current law and implementing regulations 
                        that provide continuation of benefits pending 
                        appeal under this title and title XIX.
                    ``(C) Requirement for unified grievances and 
                appeals.--For 2022 and subsequent years, the contract 
                of a specialized MA plan for special needs individuals 
                described in subsection (b)(6)(B)(ii) with a State 
                Medicaid agency under paragraph (3)(D) shall require 
                the use of unified grievances and appeals procedures as 
                described in subparagraph (B).
                    ``(D) Requirements for full integration for certain 
                dual snps.--
                            ``(i) Requirement.--For 2021 and subsequent 
                        years, a specialized MA plan for special needs 
                        individuals described in subsection 
                        (b)(6)(B)(ii) shall meet one or more of the 
                        following requirements for integration of 
                        benefits under this title and title XIX:
                                    ``(I) Meet the requirements of a 
                                fully integrated plan described in 
                                section 1853(a)(1)(B)(iv)(II) (other 
                                than the requirement that the plan have 
                                similar average levels of frailty, as 
                                determined by the Secretary, as the 
                                PACE program).
                                    ``(II) Enter into a capitated 
                                contract with the State Medicaid agency 
                                to provide long-term services and 
                                supports or behavioral health services, 
                                or both.
                                    ``(III) To the extent the State 
                                does not allow for or require such a 
                                specialized MA plan to enter into a 
                                capitated contract described in 
                                subclause (II), enter into another type 
                                of integration arrangement, as 
                                determined appropriate by the Secretary 
                                after consultation with stakeholders, 
                                such as by--
                                            ``(aa) entering into a 
                                        contract with the State that 
                                        requires notifying the State in 
                                        a timely manner of 
                                        hospitalizations, emergency 
                                        room visits, and hospital or 
                                        nursing home discharges of 
                                        enrollees or otherwise requires 
                                        sharing data that would benefit 
                                        the coordination of items and 
                                        services under this title and 
                                        the State plan under title XIX; 
                                        or
                                            ``(bb) being offered by a 
                                        parent organization that also 
                                        offers a Medicaid managed care 
                                        plan that provides long-term 
                                        services and supports or 
                                        behavioral health services to 
                                        the same enrollees as under 
                                        such specialized MA plan.
                            ``(ii) Sanctions.--For 2021 and subsequent 
                        years, if the Secretary determines that a 
                        specialized MA plan fails to comply with clause 
                        (i), the Secretary may provide for the 
                        application against the Medicare Advantage 
                        organization offering the plan any of the 
                        remedies described in section 1857(g)(2).''.
            (2) Conforming amendment to responsibilities of federal 
        coordinated health care office.--Section 2602(d) of Public Law 
        111-148 (42 U.S.C. 1315b(d)) is amended by adding at the end 
        the following new paragraphs:
            ``(6) To act as a designated contact for States under 
        subsection (f)(8)(A) of section 1859 of the Social Security Act 
        (42 U.S.C. 1395w-28) with respect to the integration of 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section.
            ``(7) To be responsible for developing regulations and 
        guidance related to the implementation of a unified grievance 
        and appeals process as described in subparagraphs (B) and (C) 
        of section 1859(f)(8) of the Social Security Act (42 U.S.C. 
        1395w-28(f)(8)).
            ``(8) To be responsible for developing regulations and 
        guidance related to the integration or alignment of policy and 
        oversight under the Medicare program under title XVIII of such 
        Act and Medicaid program under title XIX of such Act regarding 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section 1859.''.
    (c) Improvements to Severe or Disabling Chronic Condition SNPs.--
            (1) Care management requirements.--Section 1859(f)(5) of 
        the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is amended--
                    (A) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively, and indenting 
                appropriately;
                    (B) in clause (ii), as redesignated by subparagraph 
                (B), by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                indenting appropriately;
                    (C) by striking ``all snps.--The requirements'' and 
                inserting ``all snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                requirements''; and
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(B) Improvements to care management requirements 
                for severe or disabling chronic condition snps.--For 
                2020 and subsequent years, in the case of a specialized 
                MA plan for special needs individuals described in 
                subsection (b)(6)(B)(iii), the requirements described 
                in this paragraph include the following:
                            ``(i) The interdisciplinary team under 
                        subparagraph (A)(ii)(III) includes a team of 
                        providers with demonstrated expertise, 
                        including training in an applicable specialty, 
                        in treating individuals similar to the targeted 
                        population of the plan.
                            ``(ii) Requirements developed by the 
                        Secretary to provide face-to-face encounters 
                        with individuals enrolled in the plan not less 
                        frequently than on an annual basis.
                            ``(iii) As part of the model of care under 
                        clause (i) of subparagraph (A), the results of 
                        the initial assessment and annual reassessment 
                        under clause (ii)(I) of such subparagraph of 
                        each individual enrolled in the plan are 
                        addressed in the individual's individualized 
                        care plan under clause (ii)(II) of such 
                        subparagraph.
                            ``(iv) As part of the annual evaluation and 
                        approval of such model of care, the Secretary 
                        shall take into account whether the plan 
                        fulfilled the previous year's goals (as 
                        required under the model of care).
                            ``(v) The Secretary shall establish a 
                        minimum benchmark for each element of the model 
                        of care of a plan. The Secretary shall only 
                        approve a plan's model of care under this 
                        paragraph if each element of the model of care 
                        meets the minimum benchmark applicable under 
                        the preceding sentence.''.
            (2) Revisions to the definition of a severe or disabling 
        chronic conditions specialized needs individual.--
                    (A) In general.--Section 1859(b)(6)(B)(iii) of the 
                Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) 
                is amended--
                            (i) by striking ``who have'' and inserting 
                        ``who--
                                    ``(I) before January 1, 2022, 
                                have'';
                            (ii) in subclause (I), as added by clause 
                        (i), by striking the period at the end and 
                        inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(II) on or after January 1, 2022, 
                                have one or more capitated and 
                                medically complex chronic conditions 
                                that is life threatening or 
                                significantly limits overall health or 
                                function, have a high risk of 
                                hospitalization or other adverse health 
                                outcomes, and require intensive care 
                                coordination and that is listed under 
                                subsection (f)(9)(A).''.
                    (B) Panel of clinical advisors.--Section 1859(f) of 
                the Social Security Act (42 U.S.C. 1395w-28(f)), as 
                amended by subsection (b), is amended by adding at the 
                end the following new paragraph:
            ``(9) List of conditions for clarification of the 
        definition of a severe or disabling chronic conditions 
        specialized needs individual.--
                    ``(A) In general.--Not later than December 31, 
                2020, and every 5 years thereafter, the Secretary shall 
                convene a panel of clinical advisors to establish and 
                update a list of conditions that meet each of the 
                following criteria:
                            ``(i) Conditions that meet the definition 
                        of a severe or disabling chronic condition 
                        under subsection (b)(6)(B)(iii) on or after 
                        January 1, 2022.
                            ``(ii) Conditions that require prescription 
                        drugs, providers, and models of care that are 
                        unique to the specific population of enrollees 
                        in a specialized MA plan for special needs 
                        individuals described in such subsection on or 
                        after such date and--
                                    ``(I) as a result of such special 
                                needs individuals with such a condition 
                                having access to and being enrolled in 
                                such a plan, as compared to access to 
                                and enrollment in other Medicare 
                                Advantage plans under this part, it is 
                                projected that such individuals would 
                                improve health outcomes with respect to 
                                such condition, that such individuals 
                                would have reduced overall costs under 
                                this title, and that there would not be 
                                any increase in expenditures under this 
                                title for such individuals; or
                                    ``(II) have a low prevalence in the 
                                general population of beneficiaries 
                                under this title or a disproportionally 
                                high per-beneficiary cost under this 
                                title.
                    ``(B) GAO study on health outcomes of individuals 
                enrolled in specialized ma plans.--Not later than the 
                date that is 3 years after the date of the enactment of 
                this paragraph, the Comptroller General of the United 
                States shall conduct a study and submit to Congress a 
                report on the extent to which health outcomes can be 
                compared across specialized MA plans for special needs 
                individuals (as defined in section 1859(b)(6)) and 
                other Medicare Advantage plans under this part across 
                similar populations, using existing measures and that 
                identifies any potential limitations where new measures 
                may need to be developed for such population.''.
    (d) Quality Measurement at the Plan Level for SNPs and 
Determination of Feasibility of Quality Measurement at the Plan Level 
for All MA Plans.--Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w-23(o)) is amended by adding at the end the following new 
paragraphs:
            ``(6) Quality measurement at the plan level for snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may require reporting of data under section 
                1852(e) for, and apply under this subsection, quality 
                measures at the plan level for specialized MA plans for 
                special needs individuals instead of at the contract 
                level.
                    ``(B) Considerations.--Prior to applying quality 
                measurement at the plan level under this paragraph, the 
                Secretary shall--
                            ``(i) take into consideration the minimum 
                        number of enrollees in a specialized MA plan 
                        for special needs individuals in order to 
                        determine if a statistically significant or 
                        valid measurement of quality at the plan level 
                        is possible under this paragraph;
                            ``(ii) if quality measures are reported at 
                        the plan level, ensure that MA plans are not 
                        required to provide duplicative information; 
                        and
                            ``(iii) ensure that such reporting does not 
                        interfere with the collection of encounter data 
                        submitted by MA organizations or the 
                        administration of any changes to the program 
                        under this part as a result of the collection 
                        of such data.
                    ``(C) Application.--If the Secretary applies 
                quality measurement at the plan level under this 
                paragraph--
                            ``(i) such quality measurement may include 
                        Medicare Health Outcomes Survey (HOS), 
                        Healthcare Effectiveness Data and Information 
                        Set (HEDIS), Consumer Assessment of Healthcare 
                        Providers and Systems (CAHPS) measures and 
                        quality measures under part D; and
                            ``(ii) the Secretary shall consider 
                        applying administrative actions, such as 
                        remedies described in section 1857(g)(2), to 
                        the plan level.
            ``(7) Determination of feasibility of quality measurement 
        at the plan level for all ma plans.--
                    ``(A) Determination of feasibility.--The Secretary 
                shall determine the feasibility of requiring reporting 
                of data under section 1852(e) for, and applying under 
                this subsection, quality measures at the plan level for 
                all MA plans under this part.
                    ``(B) Consideration of change.--After making a 
                determination under subparagraph (A), the Secretary 
                shall consider requiring such reporting and applying 
                such quality measures at the plan level as described in 
                such subparagraph.''.
    (e) GAO Study and Report on State-Level Integration Between Dual 
SNPs and Medicaid.--
            (1) Study.--The Comptroller General of the United States 
        (in this paragraph referred to as the ``Comptroller General'') 
        shall conduct a study on State-level integration between 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of section 1859 of the Social Security 
        Act (42 U.S.C. 1395w-28) and the Medicaid program under title 
        XIX of such Act (42 U.S.C. 1396 et seq.). Such study shall 
        include an analysis of the following:
                    (A) The characteristics of States in which the 
                State agency responsible for administering the State 
                plan under such title XIX has a contract with such a 
                specialized MA plan and that delivers long-term 
                services and supports under the State plan under such 
                title XIX through a managed care program, including the 
                requirements under such State plan with respect to 
                long-term services and supports.
                    (B) The types of such specialized MA plans, which 
                may include the following:
                            (i) A plan described in section 
                        1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
                        1395w-23(a)(1)(B)(iv)(II)).
                            (ii) A plan that meets the requirements 
                        described in subsection (f)(3)(D) of such 
                        section 1859.
                            (iii) A plan described in clause (ii) that 
                        also meets additional requirements established 
                        by the State.
                    (C) The characteristics of individuals enrolled in 
                such specialized MA plans.
                    (D) As practicable, the following with respect to 
                State programs for the delivery of long-term services 
                and supports under such title XIX through a managed 
                care program:
                            (i) Which populations of individuals are 
                        eligible to receive such services and supports.
                            (ii) Whether all such services and supports 
                        are provided on a capitated basis or if any of 
                        such services and supports are carved out and 
                        provided through fee-for-service.
                    (E) As, practicable, how the availability and 
                variation of integration arrangements of such 
                specialized MA plans offered in States affects 
                spending, service delivery options, access to 
                community-based care, and utilization of care.
                    (F) Barriers and opportunities for making further 
                progress on dual integration, as well as recommend 
                legislation to expedite or refine pathways toward fully 
                integrated care.
            (2) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 209. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF 
              CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.

    (a) In General.--Section 1852(a)(3) of the Social Security Act (42 
U.S.C. 1395w-22(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``Each'' and inserting 
        ``Subject to subparagraph (D), each''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Expanding supplemental benefits to meet the 
                needs of chronically ill enrollees.--
                            ``(i) In general.--For plan year 2020 and 
                        subsequent plan years, in addition to any 
                        supplemental health care benefits otherwise 
                        provided under this paragraph, an MA plan, 
                        including a specialized MA plan for special 
                        needs individuals described in subsection 
                        (b)(6) of section 1859, may provide 
                        supplemental benefits described in clause (ii) 
                        to a chronically ill enrollee (as defined in 
                        clause (iii)).
                            ``(ii) Supplemental benefits described.--
                                    ``(I) In general.--Supplemental 
                                benefits described in this clause are 
                                supplemental benefits that, with 
                                respect to a chronically ill enrollee, 
                                have a reasonable expectation of 
                                improving or maintaining the health or 
                                overall function of the chronically ill 
                                enrollee and may not be limited to 
                                being primarily health related 
                                benefits.
                                    ``(II) Authority to waive 
                                uniformity requirements.--The Secretary 
                                may, with respect to supplemental 
                                benefits provided to a chronically ill 
                                enrollee under this subparagraph, waive 
                                the uniformity requirement, as 
                                determined appropriate by the 
                                Secretary.
                            ``(iii) Chronically ill enrollee defined.--
                        In this subparagraph, the term `chronically ill 
                        enrollee' means an enrollee in an MA plan that 
                        the Secretary determines--
                                    ``(I) has one or more comorbid and 
                                medically complex chronic conditions 
                                that is life threatening or 
                                significantly limits the overall health 
                                or function of the enrollee;
                                    ``(II) has a high risk of 
                                hospitalization or other adverse health 
                                outcomes; or
                                    ``(III) requires intensive care 
                                coordination.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on supplemental benefits provided to 
        enrollees in Medicare Advantage plans under part C of title 
        XVIII of the Social Security Act, including specialized MA 
        plans for special needs individuals described in section 
        1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6)). Such study 
        shall be conducted in consultation with the Centers for 
        Medicare & Medicaid Services and Medicare Advantage plans as 
        necessary and, to the extent data is available, shall include 
        an analysis of the following:
                    (A) The type of supplemental benefits provided to 
                such enrollees, the total number of enrollees receiving 
                each supplemental benefit, and whether the supplemental 
                benefit is covered by the standard benchmark cost of 
                the benefit or with an additional premium.
                    (B) The frequency in which supplemental benefits 
                are utilized by such enrollees.
                    (C) The impact supplemental benefits have on--
                            (i) indicators of the quality of care 
                        received by such enrollees, including overall 
                        health and function of the enrollees;
                            (ii) the utilization of items and services 
                        for which benefits are available under the 
                        original Medicare fee-for-service program 
                        option under parts A and B of such title XVIII 
                        by such enrollees; and
                            (iii) the amount of the bids submitted by 
                        Medicare Advantage Organizations for Medicare 
                        Advantage plans under such part C.
            (2) Report.--Not later than 5 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 210. EXTENSION OF CONSENSUS-BASED ENTITY FUNDING.

    Section 1890(d)(2) of the Social Security Act (42 U.S.C. 
1395aaa(d)(2)) is amended by striking ``2017'' and inserting ``2019''.

SEC. 211. EXTENSION OF CERTAIN MIPPA FUNDING PROVISIONS.

    Section 119 of the Medicare Improvements for Patients and Providers 
Act of 2008 (42 U.S.C. 1395b-3 note) is amended--
            (1) in subsection (a)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 
                        through 2019, of $13,000,000.'';
            (2) in subsection (b)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 
                        through 2019, of $7,500,000.'';
            (3) in subsection (c)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 
                        through 2019, of $5,000,000.''; and
            (4) in subsection (d)(2)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 
                        through 2019, of $12,000,000.''.

SEC. 212. EXTENSION OF HOME HEALTH RURAL ADD-ON.

    Section 421(a) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283; 42 
U.S.C. 1395fff note), as amended by section 5201(b) of the Deficit 
Reduction Act of 2005 (Public Law 109-171; 120 Stat. 46), section 
3131(c) of the Patient Protection and Affordable Care Act (Public Law 
111-148; 124 Stat. 428), and section 210 of the Medicare Access and 
CHIP Reauthorization Act of 2015 (Public Law 114-10), is further 
amended by striking ``January 1, 2018'' and inserting ``January 1, 
2020'' each place it appears.

            Subtitle B--Medicaid and Public Health Extenders

SEC. 221. EXTENSION FOR COMMUNITY HEALTH CENTERS AND THE NATIONAL 
              HEALTH SERVICE CORPS.

    (a) Community Health Centers Funding.--Section 10503(b)(1) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)), as 
amended by section 3101 of Public Law 115-96, is amended by amending 
subparagraph (F) to read as follows:
                    ``(F) $3,600,000,000 for each of fiscal years 2018 
                and 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 (l)(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) by striking subsection (s);
            (8) by redesignating subsections (g) through (r) as 
        subsections (h) through (s), respectively;
            (9) by inserting after subsection (f), the following:
    ``(g) New Access Points and Expanded Services.--
            ``(1) Approval of new access points.--
                    ``(A) In general.--The Secretary may approve 
                applications for grants under subparagraph (A) or (B) 
                of subsection (e)(1) to establish new delivery sites.
                    ``(B) Special consideration.--In carrying out 
                subparagraph (A), 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.
                    ``(C) Consideration of applications.--In carrying 
                out subparagraph (A), the Secretary shall approve 
                applications for grants under subparagraphs (A) and (B) 
                of subsection (e)(1) 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.
                    ``(D) Service area overlap.--If in carrying out 
                subparagraph (A) 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.
            ``(2) Approval of expanded service applications.--
                    ``(A) In general.--The Secretary may approve 
                applications for grants under subparagraph (A) or (B) 
                of subsection (e)(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).
                    ``(B) Priority expansion projects.--In carrying out 
                subparagraph (A), 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.
                    ``(C) Consideration of applications.--In carrying 
                out subparagraph (A), the Secretary shall approve 
                applications for applicants 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.'';
            (10) in subsection (i) (as so redesignated)--
                    (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'';
            (11) in subsection (l) (as so redesignated)--
                    (A) in paragraph (2)--
                            (i) in the paragraph heading, by inserting 
                        ``unmet'' before ``need'';
                            (ii) in the matter preceding subparagraph 
                        (A), by inserting ``and an application for a 
                        grant under subsection (g)'' 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 (g)(1), 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 (g)'' 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);
            (12) in subsection (m) (as so redesignated), by adding at 
        the end the following: ``Funds expended to carry out activities 
        under this subsection and operational support activities under 
        subsection (n) shall not exceed 3 percent of the amount 
        appropriated for this section for the fiscal year involved.'';
            (13) in subsection (q) (as so redesignated), by striking 
        ``grants for new health centers under subsections (c) and (e)'' 
        and inserting ``operating grants under subsection (e), 
        applications for new access points and expanded service 
        pursuant to subsection (g)'';
            (14) in subsection (r)(4) (as so redesignated), 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.'';
            (15) in subsection (s)(3) (as so redesignated)--
                    (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 (r)(4).''; and
            (16) in subsection (s) (as so redesignated) 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 subsection (d) of this section, 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.''.
    (c) National Health Service Corps.--Section 10503(b)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)), as 
amended by section 3101 of Public Law 115-96, is amended by amending 
subparagraph (F) to read as follows:
                    ``(F) $310,000,000 for each of fiscal years 2018 
                and 2019.''.

SEC. 222. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

    (a) Special Diabetes Program for Type I Diabetes.--Subparagraph (D) 
of section 330B(b)(2) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)), as amended by section 3102 of Public Law 115-96, is amended 
to read as follows:
                    ``(D) $150,000,000 for each of fiscal years 2018 
                and 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)), as amended by section 3102 of Public Law 115-96, is amended 
to read as follows:
                    ``(D) $150,000,000 for each of fiscal years 2018 
                and 2019.''.

SEC. 223. REAUTHORIZATION OF PROGRAM OF PAYMENTS TO TEACHING HEALTH 
              CENTERS THAT OPERATE GRADUATE MEDICAL EDUCATION PROGRAMS.

    (a) 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 filled positions at 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) Per resident amount.--In making payments under 
        paragraph (1), the Secretary shall consider the cost of 
        training residents at teaching health centers and the 
        implications of the per resident amount on approved graduate 
        medical residency training programs at teaching health centers.
            ``(3) Priority.--In making payments under 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).''.
    (b) Funding.--Paragraph (1) of section 340H(g) of the Public Health 
Service Act (42 U.S.C. 256h(g)), as amended by section 3101 of Public 
Law 115-96, is amended by striking ``and $30,000,000 for the period of 
the first and second quarters of fiscal year 2018'' and inserting ``and 
$126,500,000 for each of fiscal years 2018 and 2019''.
    (c) Annual Reporting.--Subsection (h)(1) of section 340H of the 
Public Health Service Act (42 U.S.C. 256h) is amended--
            (1) by redesignating subparagraph (D) as subparagraph (H); 
        and
            (2) 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).''.
    (d) 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)).
    (e) Definition.--Subsection (j) of section 340H of the Public 
Health Service Act (42 U.S.C. 256h) is amended--
            (1) by redesignating paragraphs (2) and (3) as paragraphs 
        (3) and (4), respectively; and
            (2) 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)).''.
    (f) 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''.
    (g) 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 Public Law 115-96, shall 
continue to apply with respect to payments under such section for 
fiscal years before fiscal year 2018.

SEC. 224. 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. 225. EXTENSION OF ABSTINENCE EDUCATION; EXTENSION OF PERSONAL 
              RESPONSIBILITY EDUCATION PROGRAM.

    (a) Abstinence Education.--Section 510 of the Social Security Act 
(42 U.S.C. 710) is amended--
            (1) in subsection (a), in the matter preceding paragraph 
        (1), by striking ``2017'' and inserting ``2019''; and
            (2) in subsection (d)--
                    (A) by striking ``2015 and'' and inserting 
                ``2015,''; and
                    (B) by inserting after ``2017'' the following: ``, 
                and an additional $75,000,000 for each of fiscal years 
                2018 through 2019''.
    (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'';
                    (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.

SEC. 226. EXTENSION OF HEALTH WORKFORCE DEMONSTRATION PROJECTS FOR LOW-
              INCOME INDIVIDUALS.

    Section 2008(c)(1) of the Social Security Act (42 U.S.C. 
1397g(c)(1)) is amended by striking ``2017'' and inserting ``2019''.

SEC. 227. DELAY OF REDUCTION TO MEDICAID DSH ALLOTMENTS.

    Section 1923(f) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)) is amended--
            (1) in paragraph (7)(A)--
                    (A) in clause (i), in the matter preceding 
                subclause (I), by striking ``2018 through 2025'' and 
                inserting ``2020 through 2027''; and
                    (B) by amending clause (ii) to read as follows:
                                    ``(I) $2,000,000,000 for fiscal 
                                year 2020;
                                    ``(II) $3,000,000,000 for fiscal 
                                year 2021;
                                    ``(III) $4,000,000,000 for fiscal 
                                year 2022;
                                    ``(IV) $5,000,000,000 for fiscal 
                                year 2023;
                                    ``(V) $6,000,000,000 for fiscal 
                                year 2024;
                                    ``(VI) $7,000,000,000 for fiscal 
                                year 2025;
                                    ``(VII) $8,000,000,000 for fiscal 
                                year 2026; and
                                    ``(VIII) $8,000,000,000 for fiscal 
                                year 2027.''; and
            (2) in paragraph (8), by striking ``2025'' and inserting 
        ``2027''.

SEC. 228. 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 ``2022''.
    (b) Effective Date; Treatment.--The amendment made by subsection 
(a) shall take effect on September 30, 2017, and shall apply with 
respect to claims pending, generated, or filed after such date.

 Subtitle C--Continuing the Maternal, Infant, and Early Childhood Home 
                            Visiting Program

SEC. 231. CONTINUING EVIDENCE-BASED HOME VISITING PROGRAM.

    Section 511(j)(1)(H) of the Social Security Act (42 U.S.C. 
711(j)(1)(H)) is amended by striking ``fiscal year 2017'' and inserting 
``each of fiscal years 2017 through 2022''.

SEC. 232. CONTINUING TO DEMONSTRATE RESULTS TO HELP FAMILIES.

    (a) Require Service Delivery Models To Demonstrate Improvement in 
Applicable Benchmark Areas.--Section 511 of the Social Security Act (42 
U.S.C. 711) is amended in each of subsections (d)(1)(A) and (h)(4)(A) 
by striking ``each of''.
    (b) Demonstration of Improvements in Subsequent Years.--Section 
511(d)(1) of such Act (42 U.S.C. 711(d)(1)) is amended by adding at the 
end the following:
                    ``(D) Demonstration of improvements in subsequent 
                years.--
                            ``(i) Continued measurement of improvement 
                        in applicable benchmark areas.--The eligible 
                        entity, after demonstrating improvements for 
                        eligible families as specified in subparagraphs 
                        (A) and (B), shall continue to track and 
                        report, not later than 30 days after the end of 
                        fiscal year 2020 and every 3 years thereafter, 
                        information demonstrating that the program 
                        results in improvements for the eligible 
                        families participating in the program in at 
                        least 4 of the areas specified in subparagraph 
                        (A) that the service delivery model or models 
                        selected by the entity are intended to improve.
                            ``(ii) Corrective action plan.--If the 
                        eligible entity fails to demonstrate 
                        improvement in at least 4 of the areas 
                        specified in subparagraph (A), as compared to 
                        eligible families who do not receive services 
                        under an early childhood home visitation 
                        program, the entity shall develop and implement 
                        a plan to improve outcomes in each of the areas 
                        specified in subparagraph (A) that the service 
                        delivery model or models selected by the entity 
                        are intended to improve, subject to approval by 
                        the Secretary. The plan shall include 
                        provisions for the Secretary to monitor 
                        implementation of the plan and conduct 
                        continued oversight of the program, including 
                        through submission by the entity of regular 
                        reports to the Secretary.
                            ``(iii) Technical assistance.--The 
                        Secretary shall provide an eligible entity 
                        required to develop and implement an 
                        improvement plan under clause (ii) with 
                        technical assistance to develop and implement 
                        the plan. The Secretary may provide the 
                        technical assistance directly or through 
                        grants, contracts, or cooperative agreements.
                            ``(iv) No improvement or failure to submit 
                        report.--If the Secretary determines after a 
                        period of time specified by the Secretary that 
                        an eligible entity implementing an improvement 
                        plan under clause (ii) has failed to 
                        demonstrate any improvement in at least 4 of 
                        the areas specified in subparagraph (A), or if 
                        the Secretary determines that an eligible 
                        entity has failed to submit the report required 
                        by clause (i), the Secretary shall terminate 
                        the grant made to the entity under this section 
                        and may include any unexpended grant funds in 
                        grants made to nonprofit organizations under 
                        subsection (h)(2)(B).''.
    (c) Including Information on Applicable Benchmarks in 
Application.--Section 511(e)(5) of such Act (42 U.S.C. 711(e)(5)) is 
amended by inserting ``that the service delivery model or models 
selected by the entity are intended to improve'' before the period at 
the end.

SEC. 233. REVIEWING STATEWIDE NEEDS TO TARGET RESOURCES.

    Section 511(b)(1) of the Social Security Act (42 U.S.C. 711(b)(1)) 
is amended by striking ``Not later than'' and all that follows through 
``section 505(a))'' and inserting ``Each State shall, as a condition of 
receiving payments from an allotment for the State under section 502, 
conduct a statewide needs assessment (which may be separate from but in 
coordination with the statewide needs assessment required under section 
505(a) and which shall be reviewed and updated by the State not later 
than October 1, 2020)''.

SEC. 234. IMPROVING THE LIKELIHOOD OF SUCCESS IN HIGH-RISK COMMUNITIES.

    Section 511(d)(4)(A) of the Social Security Act (42 U.S.C. 
711(d)(4)(A)) is amended by inserting ``, taking into account the 
staffing, community resource, and other requirements to operate at 
least one approved model of home visiting and demonstrate improvements 
for eligible families'' before the period.

SEC. 235. OPTION TO FUND EVIDENCE-BASED HOME VISITING ON A PAY FOR 
              OUTCOME BASIS.

    (a) In General.--Section 511(c) of the Social Security Act (42 
U.S.C. 711(c)) is amended by redesignating paragraphs (3) and (4) as 
paragraphs (4) and (5), respectively, and by inserting after paragraph 
(2) the following:
            ``(3) Authority to use grant for a pay for outcomes 
        initiative.--An eligible entity to which a grant is made under 
        paragraph (1) may use up to 25 percent of the grant for 
        outcomes or success payments related to a pay for outcomes 
        initiative that will not result in a reduction of funding for 
        services delivered by the entity under a childhood home 
        visitation program under this section while the eligible entity 
        develops or operates such an initiative.''.
    (b) Definition of Pay for Outcomes Initiative.--Section 511(k) of 
such Act (42 U.S.C. 711(k)) is amended by adding at the end the 
following:
            ``(4) Pay for outcomes initiative.--The term `pay for 
        outcomes initiative' means a performance-based grant, contract, 
        cooperative agreement, or other agreement awarded by a public 
        entity in which a commitment is made to pay for improved 
        outcomes achieved as a result of the intervention that result 
        in social benefit and direct cost savings or cost avoidance to 
        the public sector. Such an initiative shall include--
                    ``(A) a feasibility study that describes how the 
                proposed intervention is based on evidence of 
                effectiveness;
                    ``(B) a rigorous, third-party evaluation that uses 
                experimental or quasi-experimental design or other 
                research methodologies that allow for the strongest 
                possible causal inferences to determine whether the 
                initiative has met its proposed outcomes as a result of 
                the intervention;
                    ``(C) an annual, publicly available report on the 
                progress of the initiative; and
                    ``(D) a requirement that payments are made to the 
                recipient of a grant, contract, or cooperative 
                agreement only when agreed upon outcomes are achieved, 
                except that this requirement shall not apply with 
                respect to payments to a third party conducting the 
                evaluation described in subparagraph (B).''.
    (c) Extended Availability of Funds.--Section 511(j)(3) of such Act 
(42 U.S.C. 711(j)(3)) is amended--
            (1) by striking ``(3) Availability.--Funds'' and inserting 
        the following:
            ``(3) Availability.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), funds''; and
            (2) by adding at the end the following:
                    ``(B) Funds for pay for outcomes initiatives.--
                Funds made available to an eligible entity under this 
                section for a fiscal year (or portion of a fiscal year) 
                for a pay for outcomes initiative shall remain 
                available for expenditure by the eligible entity for 
                not more than 10 years after the funds are so made 
                available.''.

SEC. 236. DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPERABILITY.

    (a) In General.--Section 511(h) of the Social Security Act (42 
U.S.C. 711(h)) is amended by adding at the end the following:
            ``(5) Data exchange standards for improved 
        interoperability.--
                    ``(A) Designation and use of data exchange 
                standards.--
                            ``(i) Designation.--The head of the 
                        department or agency responsible for 
                        administering a program funded under this 
                        section shall, in consultation with an 
                        interagency work group established by the 
                        Office of Management and Budget and considering 
                        State government perspectives, designate data 
                        exchange standards for necessary categories of 
                        information that a State agency operating the 
                        program is required to electronically exchange 
                        with another State agency under applicable 
                        Federal law.
                            ``(ii) Data exchange standards must be 
                        nonproprietary and interoperable.--The data 
                        exchange standards designated under clause (i) 
                        shall, to the extent practicable, be 
                        nonproprietary and interoperable.
                            ``(iii) Other requirements.--In designating 
                        data exchange standards under this paragraph, 
                        the Secretary shall, to the extent practicable, 
                        incorporate--
                                    ``(I) interoperable standards 
                                developed and maintained by an 
                                international voluntary consensus 
                                standards body, as defined by the 
                                Office of Management and Budget;
                                    ``(II) interoperable standards 
                                developed and maintained by 
                                intergovernmental partnerships, such as 
                                the National Information Exchange 
                                Model; and
                                    ``(III) interoperable standards 
                                developed and maintained by Federal 
                                entities with authority over 
                                contracting and financial assistance.
                    ``(B) Data exchange standards for federal 
                reporting.--
                            ``(i) Designation.--The head of the 
                        department or agency responsible for 
                        administering a program referred to in this 
                        section shall, in consultation with an 
                        interagency work group established by the 
                        Office of Management and Budget, and 
                        considering State government perspectives, 
                        designate data exchange standards to govern 
                        Federal reporting and exchange requirements 
                        under applicable Federal law.
                            ``(ii) Requirements.--The data exchange 
                        reporting standards required by clause (i) 
                        shall, to the extent practicable--
                                    ``(I) incorporate a widely 
                                accepted, nonproprietary, searchable, 
                                computer-readable format;
                                    ``(II) be consistent with and 
                                implement applicable accounting 
                                principles;
                                    ``(III) be implemented in a manner 
                                that is cost-effective and improves 
                                program efficiency and effectiveness; 
                                and
                                    ``(IV) be capable of being 
                                continually upgraded as necessary.
                            ``(iii) Incorporation of nonproprietary 
                        standards.--In designating data exchange 
                        standards under this paragraph, the Secretary 
                        shall, to the extent practicable, incorporate 
                        existing nonproprietary standards, such as the 
                        eXtensible Mark up Language.
                            ``(iv) Rule of construction.--Nothing in 
                        this paragraph shall be construed to require a 
                        change to existing data exchange standards for 
                        Federal reporting about a program referred to 
                        in this section, if the head of the department 
                        or agency responsible for administering the 
                        program finds the standards to be effective and 
                        efficient.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date that is 2 years after the date of enactment of 
this Act.

SEC. 237. ALLOCATION OF FUNDS.

    Section 511(j) of the Social Security Act (42 U.S.C. 711(j)) is 
amended by adding at the end the following:
            ``(4) Allocation of funds.--To the extent that the grant 
        amount awarded under this section to an eligible entity is 
        determined on the basis of relative population or poverty 
        considerations, the Secretary shall make the determination 
        using the most accurate Federal data available for the eligible 
        entity.''.

TITLE III--STRENGTHENING PROTECTIONS FOR SOCIAL SECURITY BENEFICIARIES 
                              ACT OF 2018

SEC. 300. SHORT TITLE.

    This title may be cited as the ``Strengthening Protections for 
Social Security Beneficiaries Act of 2018''.

     Subtitle A--Strengthening Oversight and Beneficiary Protection

SEC. 301. STRONGER MONITORING OF REPRESENTATIVE PAYEES.

    (a) Protection and Advocacy for Beneficiaries With Representative 
Payees.--Section 205(j)(6) of the Social Security Act (42 U.S.C. 
405(j)(6)) is amended by adding at the end the following:
    ``(C)(i) The Commissioner of Social Security shall make annual 
grants directly to the protection and advocacy system serving each of 
the States and the American Indian consortium for the purpose of 
conducting reviews of representative payees in accordance with this 
subparagraph. The total amount used by the Commissioner for such grants 
each year--
            ``(I) shall be an amount sufficient, as determined by the 
        Commissioner in consultation with each of the protection and 
        advocacy systems, to carry out all of the activities described 
        in clause (ii); and
            ``(II) shall not be less than $25,000,000.
    ``(ii) A protection and advocacy system awarded a grant under this 
subparagraph shall use the grant funds to--
            ``(I) conduct all periodic onsite reviews pursuant to this 
        paragraph and such other reviews of representative payees as 
        the Commissioner may request, including reviews conducted in 
        response to allegations or concerns about the performance or 
        suitability of the payee;
            ``(II) conduct additional reviews that the protection and 
        advocacy system has reason to believe are warranted;
            ``(III) develop corrective action plans to assist 
        representative payees in conforming to requirements specified 
        by the Commissioner;
            ``(IV) submit a report to the Commissioner on each 
        completed review containing such information as the 
        Commissioner shall require; and
            ``(V) conduct an initial onsite assessment of any 
        organization that begins collecting a fee for its services as a 
        representative payee to ensure that such organization is 
        established as such a representative payee in accordance with 
        requirements specified by the Commissioner.
A protection and advocacy system may refer beneficiaries to other 
programs or services as the protection and advocacy system considers 
appropriate.
    ``(iii) To be eligible to receive grants under this section, a 
protection and advocacy system shall submit an initial application to 
the Commissioner at such time, in such form and manner, and accompanied 
by such information and assurances as the Commissioner may require.
    ``(iv)(I) Subject to subclause (II), the Commissioner shall ensure 
that any funds used for grants under clause (i) shall be allocated to 
the protection and advocacy systems serving each of the States and the 
American Indian consortium in a manner such that the amount provided to 
each protection and advocacy system bears the same ratio to the total 
of such funds as the number of represented beneficiaries in the State 
or American Indian consortium in which such protection and advocacy 
system is located bears to the total number of represented 
beneficiaries.
    ``(II) The amount of an annual grant to a protection and advocacy 
system under clause (i) shall--
            ``(aa) in the case of a protection and advocacy system 
        serving American Samoa, Guam, the United States Virgin Islands, 
        or the Commonwealth of the Northern Mariana Islands, or the 
        American Indian consortium, not be less than $30,000; and
            ``(bb) in the case of a protection and advocacy system 
        serving any other State, not be less than $60,000.
    ``(III) Funds provided to a protection and advocacy system through 
a grant under clause (i) for a one-year period shall remain available 
through the end of the following one-year period.
    ``(IV) For purposes of this clause, the term `represented 
beneficiary' means an individual--
            ``(aa) who is entitled to benefits under this title, title 
        VIII, or title XVI; and
            ``(bb) whose benefits have been certified for payment to a 
        representative payee.
    ``(v)(I) The Commissioner shall make annual grants, in an amount 
equal to 4 percent of the total amount of grants awarded each year 
under clause (i), to an eligible national association for the provision 
of training and technical assistance, administrative support, and data 
collection services to protection and advocacy systems in connection 
with grants awarded under clause (i).
    ``(II) In this clause, the term `eligible national association' 
means a national disability association with extensive knowledge and 
demonstrated experience in providing training, technical assistance, 
and administrative oversight to protection and advocacy systems that 
monitor representative payees.
    ``(vi) In conducting reviews under this section, a protection and 
advocacy system shall have the same authorities, including access to 
records, facilities, and persons, as such system would have for 
purposes of providing services under subtitle C of title I of the 
Developmental Disabilities Assistance and Bill of Rights Act of 2000 
(42 U.S.C. 15041 et seq.).
    ``(vii) Whenever benefit amounts under this title are increased by 
any percentage effective with any month after November 2018 as a result 
of a determination made under section 215(i), each of the dollar 
amounts specified in clauses (i)(II) and (iv)(II) shall be increased by 
the same percentage.
    ``(viii) No additional funds are authorized to be appropriated to 
carry out the requirements of this subparagraph. Such requirements 
shall be carried out using amounts otherwise authorized.
    ``(ix) In this subparagraph:
            ``(I) The term `American Indian consortium' means a 
        consortium established under subtitle C of title I of the 
        Developmental Disabilities Assistance and Bill of Rights Act of 
        2000 (42 U.S.C. 15041 et seq.).
            ``(II) The term `protection and advocacy system' means a 
        protection and advocacy system established under subtitle C of 
        title I of the Developmental Disabilities Assistance and Bill 
        of Rights Act of 2000 (42 U.S.C. 15041 et seq.).
            ``(III) The term `State' means the several States of the 
        United States, the District of Columbia, the Commonwealth of 
        Puerto Rico, the United States Virgin Islands, Guam, American 
        Samoa, and the Commonwealth of the Northern Mariana Islands.''.
    (b) Expansion of Periodic Onsite Review Requirements.--Section 
205(j)(6)(A) of the Social Security Act (42 U.S.C. 405(j)(6)(A)) is 
amended--
            (1) in clause (ii), by striking ``or'';
            (2) in clause (iii), by striking the period and inserting 
        ``; or'';
            (3) by adding after clause (iii) the following:
            ``(iv) the representative payee collects a fee for its 
        services.''; and
            (4) by adding after clause (iv) (as added by paragraph (3)) 
        the following flush text:
``The Commissioner shall also conduct periodic onsite reviews of 
individual and organizational payees, including payees who are related 
to the beneficiary and primarily reside in the same household, selected 
on the basis of risk-factors for potential misuse or unsuitability 
associated with such payees or beneficiaries.''.
    (c) Availability of Grant Funds.--
            (1) Protection and advocacy system grants.--Grants 
        described under clause (i) of subparagraph (C) of section 
        205(j)(6) of the Social Security Act (as added by subsection 
        (a)) shall be awarded on August 1, 2018, and annually 
        thereafter, and funds provided by such grants to a protection 
        and advocacy system may be used to reimburse the protection and 
        advocacy system for amounts expended by the protection and 
        advocacy system during the period beginning on May 1, 2018, and 
        ending on such date for hiring and start-up costs in 
        preparation to carry out reviews of representative payees in 
        accordance with such subparagraph.
            (2) National association grants.--Grants described under 
        clause (v) of such subparagraph shall be awarded on May 1, 
        2018, and annually thereafter.

SEC. 302. REDUCING THE BURDEN ON FAMILIES.

    (a) Title II.--Section 205(j)(3) of the Social Security Act (42 
U.S.C. 405(j)(3)) is amended--
            (1) by redesignating subparagraphs (D) through (G) as 
        subparagraphs (E) through (H), respectively;
            (2) by inserting after subparagraph (C) the following:
                    ``(D)(i) Subparagraph (A) shall not apply in any 
                case where the other person to whom such payment is 
                made is--
                            ``(I) a parent, or other individual who is 
                        a legal guardian of, a minor child entitled to 
                        such payment who primarily resides in the same 
                        household;
                            ``(II) a parent of an individual entitled 
                        to such payment who is under a disability (as 
                        defined in section 223(d)) who primarily 
                        resides in the same household; or
                            ``(III) the spouse of the individual 
                        entitled to such payment.
                    ``(ii) The Commissioner of Social Security shall 
                establish and implement procedures as necessary for the 
                Commissioner to determine the eligibility of such 
                parties for the exemption provided in clause (i). The 
                Commissioner shall prescribe such regulations as may be 
                necessary to determine eligibility for such 
                exemption.'';
            (3) in subparagraph (E) (as so redesignated), by striking 
        ``and (C)'' and inserting ``(C), and (D)''; and
            (4) in subparagraph (F) (as so redesignated), by striking 
        ``(D)'' each place it appears and inserting ``(E)''.
    (b) Title VIII.--Section 807(h) of the Social Security Act (42 
U.S.C. 1007(h)) is amended--
            (1) by redesignating paragraphs (3) through (5) as 
        paragraphs (4) through (6), respectively; and
            (2) by inserting after paragraph (2) the following:
            ``(3)(A) Paragraph (1) shall not apply in any case where 
        the other person to whom such payment is made is the spouse of 
        the individual entitled to such payment.
            ``(B) The Commissioner of Social Security shall establish 
        and implement procedures as necessary for the Commissioner to 
        determine the eligibility of such parties for the exemption 
        provided in subparagraph (A). The Commissioner shall prescribe 
        such regulations as may be necessary to determine eligibility 
        for such exemption.''.
    (c) Title XVI.--Section 1631(a)(2)(C) of the Social Security Act 
(42 U.S.C. 1383(a)(2)(C)) is amended--
            (1) by redesignating clauses (iv) and (v) as clauses (v) 
        and (vi), respectively;
            (2) by inserting after clause (iii) the following:
            ``(iv)(I) Clause (i) shall not apply in any case where the 
        representative payee is--
                    ``(aa) a parent, or other individual who is a legal 
                guardian of, a minor child entitled to such payment who 
                primarily resides in the same household;
                    ``(bb) a parent of an individual entitled to such 
                payment who is under a disability who primarily resides 
                in the same household; or
                    ``(cc) the spouse of the individual entitled to 
                such payment.
            ``(II) The Commissioner of Social Security shall establish 
        and implement procedures as necessary for the Commissioner to 
        determine the eligibility of such parties for the exemption 
        provided in subclause (I). The Commissioner shall prescribe 
        such regulations as may be necessary to determine eligibility 
        for such exemption.'';
            (3) in clause (v) (as so redesignated), by striking ``and 
        (iii)'' and inserting ``(iii), and (iv)''; and
            (4) in clause (vi) (as so redesignated), by striking 
        ``(iv)'' each time it appears and inserting ``(v)''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on the date of the enactment of this Act.

SEC. 303. PROTECTING BENEFICIARIES THROUGH INFORMATION SHARING.

    (a) Information Sharing To Determine State Foster Care Status.--
            (1) In general.--Section 205(j) of the Social Security Act 
        (42 U.S.C. 405(j)) is amended by adding at the end the 
        following:
    ``(11)(A) The Commissioner of Social Security shall--
            ``(i) enter into agreements with each State with a plan 
        approved under part E of title IV for the purpose of sharing 
        and matching data, on an automated monthly basis, in the system 
        of records of the Social Security Administration with each 
        Statewide and Tribal Automated Child Welfare Information System 
        to identify represented minor beneficiaries who are in foster 
        care under the responsibility of the State for such month; and
            ``(ii) in any case in which a represented minor beneficiary 
        has entered or exited foster care or changed foster care 
        placement in such month, redetermine the appropriate 
        representative payee for such individual.
    ``(B) For purposes of this paragraph--
            ``(i) the term `State' has the meaning given such term for 
        purposes of part E of title IV;
            ``(ii) the term `Statewide and Tribal Automated Child 
        Welfare Information System' means a statewide mechanized data 
        collection and information retrieval system described in 
        section 474(a)(3)(C); and
            ``(iii) the term `represented minor beneficiary', with 
        respect to an individual for a month, means a child (as defined 
        for purposes of section 475(8)) entitled to benefits under this 
        title for such month whose benefits are certified for payment 
        to a representative payee.''.
            (2) Conforming change.--Section 471(a)(8)(A) of the Social 
        Security Act (42 U.S.C. 671(a)(8)(A)) is amended by inserting 
        ``the program established by title II,'' after ``XX,''.
            (3) GAO study and report.--
                    (A) Evaluation.--As soon as possible after the date 
                of the enactment of this Act, the Comptroller General 
                shall evaluate--
                            (i) the number of represented minor 
                        beneficiaries in foster care under the 
                        responsibility of a State for each month during 
                        the previous year;
                            (ii) whether the representative payee for 
                        each represented minor beneficiary is--
                                    (I) a governmental child welfare 
                                agency;
                                    (II) an organizational payee that 
                                is not a governmental child welfare 
                                agency;
                                    (III) a foster parent or child-care 
                                institution (within the meaning of part 
                                E of title IV); or
                                    (IV) another individual; and
                            (iii) whether funds were conserved, used 
                        for direct expenses of the minor beneficiary, 
                        or used to reimburse the State for foster care 
                        maintenance costs.
                    (B) Report to congress.--Not later than 36 months 
                after the date of enactment of this Act, the 
                Comptroller General shall submit to Congress a report 
                on the results of the evaluation required under 
                subparagraph (A).
                    (C) Definitions.--For purposes of this paragraph--
                            (i) the term ``State'' has the meaning 
                        given such term for purposes of part E of title 
                        IV of the Social Security Act; and
                            (ii) the term ``represented minor 
                        beneficiary'', with respect to an individual 
                        for a month, means a child (as defined for 
                        purposes of section 475(8) of the Social 
                        Security Act) entitled to benefits under title 
                        II of such Act for such month whose benefits 
                        are certified for payment to a representative 
                        payee.
            (4) Effective date.--
                    (A) In general.--The amendments made by this 
                subsection shall apply with respect to months beginning 
                on or after the date that is 1 year after the date of 
                the enactment of this Act.
                    (B) Exception if state legislation required.--In 
                the case of a State plan under part E of title IV of 
                the Social Security Act 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 
                subsection, 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.
    (b) Improving Coordination With Adult Protective Services.--
            (1) In general.--The Commissioner of Social Security shall 
        study and test the administrative feasibility of improving 
        information sharing, in partnership with State agencies that 
        provide adult protective services, with respect to--
                    (A) the assessment of an individual's need for a 
                representative payee in connection with benefits to 
                which the individual is entitled under title II or 
                title XVI of the Social Security Act; and
                    (B) oversight of individuals and organizations 
                serving as representative payees.
            (2) Report.--Not later than June 30, 2022, the Commissioner 
        of Social Security shall conclude the study described in 
        paragraph (1) and submit to the Committee on Ways and Means of 
        the House of Representatives and the Committee on Finance of 
        the Senate a report on the results of such study.
    (c) Study on Potential To Coordinate With State Courts.--
            (1) In general.--The Commissioner of Social Security shall 
        enter into an agreement with the Administrative Conference of 
        the United States to conduct a study that includes--
                    (A) an overview of potential opportunities for 
                information sharing between the Social Security 
                Administration and State courts and relevant State 
                agencies;
                    (B) a detailed analysis of the barriers to such 
                information sharing, including any Federal or State 
                statutory barriers;
                    (C) a description of how such information sharing 
                would be implemented, including any additional 
                infrastructure needed; and
                    (D) a description of any risks or other factors 
                that the Social Security Administration and the 
                Congress should consider before implementing such 
                information sharing.
            (2) Report.--Not later than June 30, 2020, the Commissioner 
        of Social Security shall submit to the Committee on Ways and 
        Means of the House of Representatives and the Committee on 
        Finance of the Senate and make publicly available a report on 
        the results of the study conducted under paragraph (1).

SEC. 304. CLARIFYING OVERPAYMENT LIABILITY FOR CHILD IN CHILD WELFARE 
              SYSTEM.

    (a) Amendment to Title II.--Section 204(a) of the Social Security 
Act (42 U.S.C. 404(a)) is amended by adding at the end the following:
    ``(3)(A) When any payment of more than the correct amount is made 
on behalf of an individual who is a represented minor beneficiary for a 
month in which such individual is in foster care under the 
responsibility of a State and the State is the representative payee of 
such individual, the State shall be liable for the repayment of the 
overpayment, and there shall be no adjustment of payments to, or 
recovery by the United States from, such individual.
    ``(B) For purposes of this paragraph, the term `represented minor 
beneficiary' has the meaning given such term in subsection 
(j)(11)(B)(iii).''.
    (b) Amendment to Title XVI.--Section 1631(b) of the Social Security 
Act (42 U.S.C. 1683(b)) is amended--
            (1) by redesignating paragraphs (3) through (7) as 
        paragraphs (4) through (8), respectively; and
            (2) by inserting after paragraph (2) the following:
    ``(3)(A) When any payment of more than the correct amount is made 
on behalf of an individual who is a represented minor beneficiary for a 
month in which such individual is in foster care under the 
responsibility of a State and the State is the representative payee of 
such individual, the State shall be liable for the repayment of the 
overpayment, and there shall be no adjustment of payments to, or 
recovery by the United States from, such individual.
    ``(B) For purposes of this paragraph, the term `represented minor 
beneficiary', with respect to an individual for a month, means a child 
(as defined for purposes of section 475(8)) entitled to benefits under 
this title for such month whose benefits are certified for payment to a 
representative payee.''.
    (c) Effective Date.--The amendment made by subsection (a) shall 
apply with respect to overpayment determinations made on or after the 
date of the enactment of this Act and to any other overpaid amounts 
that have not been recovered as of such date.

SEC. 305. REPORTS.

    (a) Report on Benefits Misused.--Section 205(j) of the Social 
Security Act (42 U.S.C. 405(j)), as amended by section 303(a), is 
further amended--
            (1) in paragraph (6)--
                    (A) by striking ``(A) In addition to'' and 
                inserting ``In addition to''; and
                    (B) by striking subparagraph (B); and
            (2) by adding at the end the following:
    ``(12)(A) Not later than January 31 of each fiscal year, the 
Commissioner shall submit to the Committee on Ways and Means of the 
House of Representatives and the Committee on Finance of the Senate a 
report on the total number of individuals entitled to benefits under 
titles II, VIII, and XVI, respectively (and the number of individuals 
concurrently entitled to benefits under more than one such title), who 
have a representative payee, the total number of such representative 
payees, and the results of all reviews of representative payees 
conducted during the previous fiscal year in connection with benefits 
under this title, title VIII, or title XVI. Such report shall summarize 
problems identified in such reviews and corrective actions taken or 
planned to be taken to correct such problems, and shall include--
            ``(i) the number of such reviews;
            ``(ii) the results of such reviews;
            ``(iii) the number of cases in which the representative 
        payee was changed and why;
            ``(iv) the number of reviews conducted in response to 
        allegations or concerns about the performance or suitability of 
        the payee;
            ``(v) the number of cases discovered in which there was a 
        misuse of funds, and the total dollar amount of benefits 
        determined by the Commissioner during such fiscal year to have 
        been misused by a representative payee (regardless of the 
        fiscal year in which such misuse occurred);
            ``(vi) the number of cases discovered in which such misuse 
        of funds resulted from the negligent failure of the 
        Commissioner to investigate or monitor a representative payee;
            ``(vii) the final disposition of such cases of misuse of 
        funds, including--
                    ``(I) any criminal, civil, and administrative 
                penalties imposed;
                    ``(II) the total dollar amount of misused benefits 
                repaid to beneficiaries and alternative representative 
                payees under each of--
                            ``(aa) paragraph (5) (on the basis of a 
                        negligent failure of the Commissioner described 
                        in such paragraph);
                            ``(bb) paragraph (5) (on any other basis); 
                        and
                            ``(cc) paragraph (7); and
                    ``(III) the total dollar amount of misused benefits 
                recovered under each of--
                            ``(aa) paragraph (5); and
                            ``(bb) paragraph (7);
            ``(viii) any updates to prior year reports necessary to 
        reflect subsequent recoveries and repayments pertaining to 
        misuse determinations made in prior years; and
            ``(ix) such other information as the Commissioner deems 
        appropriate.
    ``(B) Each report required under this paragraph for a fiscal year 
shall include the information described in clauses (i) through (ix) of 
subparagraph (A) with respect to--
            ``(i) all representative payees reviewed during such fiscal 
        year;
            ``(ii) all such representative payees that are 
        organizations, separated by whether such organization collects 
        a fee for its services as a representative payee;
            ``(iii) all such representative payees that are individuals 
        serving 15 or more individuals; and
            ``(iv) all such representative payees that are individuals 
        serving less than 15 individuals, separated by whether such 
        representative payee is a family member.''.
    (b) Report on Elimination of the Accounting Form.--The Commissioner 
shall--
            (1) conduct a study on the changes made by the amendments 
        made by section 102 of the Strengthening Protections for Social 
        Security Beneficiaries Act of 2018, which shall include the 
        impact of such changes on families, beneficiaries, and the 
        operations of the Social Security Administration; and
            (2) not later than January 1, 2021, submit a report on the 
        results of such study to the Committee on Ways and Means of the 
        House of Representatives and the Committee on Finance of the 
        Senate.
    (c) Report on the Advanced Designation Policy.--The Commissioner 
shall--
            (1) conduct a study on the changes made by the amendments 
        made by section 201 of the Strengthening Protections for Social 
        Security Beneficiaries Act of 2018, which shall include the 
        impact of such changes on beneficiaries and the operations of 
        the Social Security Administration; and
            (2) not later than January 1, 2025, submit a report on the 
        results of such study to the Committee on Ways and Means of the 
        House of Representatives and the Committee on Finance of the 
        Senate.

           Subtitle B--Improving Payee Selection and Quality

SEC. 311. ADVANCE DESIGNATION OF REPRESENTATIVE PAYEES.

    (a) In General.--Section 205(j)(1) of the Social Security Act (42 
U.S.C. 405(j)(1)) is amended by adding at the end the following:
    ``(C)(i) An individual who is entitled to or is an applicant for a 
benefit under this title, title VIII, or title XVI, who has attained 18 
years of age or is an emancipated minor, may, at any time, designate 
one or more other individuals to serve as a representative payee for 
such individual in the event that the Commissioner of Social Security 
determines under subparagraph (A) that the interest of such individual 
would be served by certification for payment of such benefits to which 
the individual is entitled to a representative payee. If the 
Commissioner of Social Security makes such a determination with respect 
to such individual at any time after such designation has been made, 
the Commissioner shall--
            ``(I) certify payment of such benefits to the designated 
        individual, subject to the requirements of paragraph (2); or
            ``(II) if the Commissioner determines that certification 
        for payment of such benefits to the designated individual would 
        not satisfy the requirements of paragraph (2), that the 
        designated individual is unwilling or unable to serve as 
        representative payee, or that other good cause exists, certify 
        payment of such benefits to another individual or organization, 
        in accordance with paragraph (1).
    ``(ii) An organization may not be designated to serve as a 
representative payee under this subparagraph.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date that is 2 years after the date of the enactment 
of this section.
    (c) Regulations.--Not later than 18 months after the date of the 
enactment of this section, the Commissioner of Social Security shall 
promulgate regulations specifying the information an individual is 
required to provide to the Commissioner in order to designate another 
individual to serve as the individual's representative payee under 
section 205(j)(1)(C) of the Social Security Act (as added by subsection 
(a)).
    (d) Notification to Beneficiaries.--Not later than January 1, 2020, 
and annually thereafter, the Commissioner of Social Security shall 
notify each individual entitled to a benefit under title II, VIII, or 
XVI of the Social Security Act of the name of any individual designated 
to serve as the individual's representative payee under section 
205(j)(1)(C) of such Act (as added by subsection (a)).

SEC. 312. PROHIBITION ON INDIVIDUALS CONVICTED OF CERTAIN CRIMES 
              SERVING AS REPRESENTATIVE PAYEES.

    (a) Amendments to Title II.--Section 205(j)(2) of the Social 
Security Act (42 U.S.C. 405(j)(2)) is amended--
            (1) in subparagraph (B)--
                    (A) in clause (i)--
                            (i) in subclause (V), by striking ``and'' 
                        at the end;
                            (ii) in subclause (VI), by striking the 
                        period and inserting ``, and''; and
                            (iii) by adding at the end the following:
            ``(VII) determine whether such person has been convicted 
        (and not subsequently exonerated), under Federal or State law, 
        of a felony provided under clause (iv), or of an attempt or a 
        conspiracy to commit such a felony.''; and
                    (B) by adding at the end the following:
    ``(iv) The felony crimes provided under this clause, whether an 
offense under State or Federal law, are the following:
            ``(I) Human trafficking, including as prohibited under 
        sections 1590 and 1591 of title 18, United States Code.
            ``(II) False imprisonment, including as prohibited under 
        section 1201 of title 18, United States Code.
            ``(III) Kidnapping, including as prohibited under section 
        1201 of title 18, United States Code.
            ``(IV) Rape and sexual assault, including as prohibited 
        under sections 2241, 2242, 2243, and 2244 of title 18, United 
        States Code.
            ``(V) First-degree homicide, including as prohibited under 
        section 1111 of title 18, United States Code.
            ``(VI) Robbery, including as prohibited under section 2111 
        of title 18, United States Code.
            ``(VII) Fraud to obtain access to government assistance, 
        including as prohibited under sections 287, 1001, and 1343 of 
        title 18, United States Code.
            ``(VIII) Fraud by scheme, including as prohibited under 
        section 1343 of title 18, United States Code.
            ``(IX) Theft of government funds or property, including as 
        prohibited under section 641 of title 18, United States Code.
            ``(X) Abuse or neglect, including as prohibited under 
        section 111, 113, 114, 115, 116, or 117 of title 18, United 
        States Code.
            ``(XI) Forgery, including as prohibited under section 642 
        and chapter 25 (except section 512) of title 18, United States 
        Code.
            ``(XII) Identity theft or identity fraud, including as 
        prohibited under sections 1028 and 1028A of title 18, United 
        States Code.
The Commissioner of Social Security may promulgate regulations to 
provide for additional felony crimes under this clause.
    ``(v)(I) For the purpose of carrying out the activities required 
under subparagraph (B)(i) as part of the investigation under 
subparagraph (A)(i), the Commissioner may conduct a background check of 
any individual seeking to serve as a representative payee under this 
subsection and may disqualify from service as a representative payee 
any such individual who fails to grant permission for the Commissioner 
to conduct such a background check.
    ``(II) The Commissioner may revoke certification of payment of 
benefits under this subsection to any individual serving as a 
representative payee on or after January 1, 2019, who fails to grant 
permission for the Commissioner to conduct such a background check.''; 
and
            (2) in subparagraph (C)--
                    (A) in clause (i)--
                            (i) in subclause (IV), by striking ``or'' 
                        at the end;
                            (ii) in subclause (V), by striking the 
                        period at the end and inserting ``, or''; and
                            (iii) by adding at the end the following:
            ``(VI) except as provided in clause (vi), such person has 
        previously been convicted (and not subsequently exonerated) as 
        described in subparagraph (B)(i)(VII).''; and
                    (B) by adding at the end the following:
    ``(vi)(I) With respect to any person described in subclause (II)--
            ``(aa) subparagraph (B)(i)(VII) shall not apply; and
            ``(bb) the Commissioner may grant an exemption from the 
        provisions of clause (i)(VI) if the Commissioner determines 
        that such exemption is in the best interest of the individual 
        entitled to benefits.
    ``(II) A person is described in this subclause if the person--
            ``(aa) is the custodial parent of a minor child for whom 
        the person applies to serve,
            ``(bb) is the custodial spouse of the beneficiary for whom 
        the person applies to serve,
            ``(cc) is the custodial parent of a beneficiary who is 
        under a disability (as defined in section 223(d)) which began 
        before the beneficiary attained the age of 22, for whom the 
        person applies to serve,
            ``(dd) is the custodial court appointed guardian of the 
        beneficiary for whom the person applies to serve,
            ``(ee) is the custodial grandparent of a minor grandchild 
        for whom the person applies to serve,
            ``(ff) is the parent who was previously representative 
        payee for his or her minor child who has since turned 18 and 
        continues to be eligible for such benefit, or
            ``(gg) received a presidential or gubernatorial pardon for 
        the relevant conviction.''.
    (b) Amendments to Title VIII.--Section 807 of the Social Security 
Act (42 U.S.C. 1007) is amended--
            (1) in subsection (b)--
                    (A) in paragraph (2)--
                            (i) in subparagraph (E), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (F), by striking the 
                        period and inserting ``, and''; and
                            (iii) by adding at the end the following:
                    ``(G) determine whether such person has been 
                convicted (and not subsequently exonerated), under 
                Federal or State law, of a felony provided under 
                paragraph (4), or of an attempt or a conspiracy to 
                commit such a felony.''; and
                    (B) by adding at the end the following:
            ``(4) The felony crimes provided under this paragraph, 
        whether an offense under State or Federal law, are the 
        following:
                    ``(A) Human trafficking, including as prohibited 
                under sections 1590 and 1591 of title 18, United States 
                Code.
                    ``(B) False imprisonment, including as prohibited 
                under section 1201 of title 18, United States Code.
                    ``(C) Kidnapping, including as prohibited under 
                section 1201 of title 18, United States Code.
                    ``(D) Rape and sexual assault, including as 
                prohibited under sections 2241, 2242, 2243, and 2244 of 
                title 18, United States Code.
                    ``(E) First-degree homicide, including as 
                prohibited under section 1111 of title 18, United 
                States Code.
                    ``(F) Robbery, including as prohibited under 
                section 2111 of title 18, United States Code.
                    ``(G) Fraud to obtain access to government 
                assistance, including as prohibited under sections 287, 
                1001, and 1343 of title 18, United States Code.
                    ``(H) Fraud by scheme, including as prohibited 
                under section 1343 of title 18, United States Code.
                    ``(I) Theft of government funds or property, 
                including as prohibited under section 641 of title 18, 
                United States Code.
                    ``(J) Abuse or neglect, including as prohibited 
                under section 111, 113, 114, 115, 116, or 117 of title 
                18, United States Code.
                    ``(K) Forgery, including as prohibited under 
                section 642 and chapter 25 (except section 512) of 
                title 18, United States Code.
                    ``(L) Identity theft or identity fraud, including 
                as prohibited under sections 1028 and 1028A of title 
                18, United States Code.
        The Commissioner of Social Security may promulgate regulations 
        to provide for additional felony crimes under this clause.
    ``(5)(A) For the purpose of carrying out the activities required 
under paragraph (2) as part of the investigation under paragraph 
(1)(A), the Commissioner may conduct a background check of any 
individual seeking to serve as a representative payee under this 
subsection and may disqualify from service as a representative payee 
any such individual who fails to grant permission for the Commissioner 
to conduct such a background check.
    ``(B) The Commissioner may revoke certification of payment of 
benefits under this subsection to any individual serving as a 
representative payee on or after January 1, 2019, who fails to grant 
permission for the Commissioner to conduct such a background check.''; 
and
            (2) in subsection (d)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (D), by striking ``or'' 
                        at the end;
                            (ii) in subparagraph (E), by striking the 
                        period at the end and inserting ``, or''; and
                            (iii) by adding at the end the following:
                    ``(F) except as provided in paragraph (2)(D), such 
                person has previously been convicted (and not 
                subsequently exonerated) as described in subsection 
                (b)(2)(G).''; and
                    (B) in paragraph (2), by adding at the end the 
                following:
    ``(D)(i) With respect to any person described in clause (II)--
            ``(I) subsection (b)(2)(G) shall not apply; and
            ``(II) the Commissioner may grant an exemption from the 
        provisions of paragraph (1)(F) if the Commissioner determines 
        that such exemption is in the best interest of the individual 
        entitled to benefits.
    ``(ii) A person is described in this clause if the person--
            ``(I) is the custodial spouse of the beneficiary for whom 
        the person applies to serve;
            ``(II) is the custodial court appointed guardian of the 
        beneficiary for whom the person applies to serve; or
            ``(III) received a presidential or gubernatorial pardon for 
        the relevant conviction.''.
    (c) Amendments to Title XVI.--Section 1631(a)(2)(B) of the Social 
Security Act (42 U.S.C. 1383(a)(2)(B)) is amended--
            (1) in clause (ii)--
                    (A) in subclause (V), by striking ``and'' at the 
                end;
                    (B) in subclause (VI), by striking the period and 
                inserting ``, and''; and
                    (C) by adding at the end the following:
            ``(VII) determine whether such person has been convicted 
        (and not subsequently exonerated), under Federal or State law, 
        of a felony provided under clause (xv), or of an attempt or a 
        conspiracy to commit such a felony.'';
            (2) in clause (iii)--
                    (A) in subclause (IV), by striking ``or'' at the 
                end;
                    (B) in subclause (V), by striking the period at the 
                end and inserting ``, or''; and
                    (C) by adding at the end the following:
            ``(VI) except as provided in clause (xvii), such person has 
        previously been convicted (and not subsequently exonerated) as 
        described in clause (ii)(VII).''; and
            (3) by adding at the end the following:
    ``(xv) The felony crimes provided under this clause, whether an 
offense under State or Federal law, are the following:
            ``(I) Human trafficking, including as prohibited under 
        sections 1590 and 1591 of title 18, United States Code.
            ``(II) False imprisonment, including as prohibited under 
        section 1201 of title 18, United States Code.
            ``(III) Kidnapping, including as prohibited under section 
        1201 of title 18, United States Code.
            ``(IV) Rape and sexual assault, including as prohibited 
        under sections 2241, 2242, 2243, and 2244 of title 18, United 
        States Code.
            ``(V) First-degree homicide, including as prohibited under 
        section 1111 of title 18, United States Code.
            ``(VI) Robbery, including as prohibited under section 2111 
        of title 18, United States Code.
            ``(VII) Fraud to obtain access to government assistance, 
        including as prohibited under sections 287, 1001, and 1343 of 
        title 18, United States Code.
            ``(VIII) Fraud by scheme, including as prohibited under 
        section 1343 of title 18, United States Code.
            ``(IX) Theft of government funds or property, including as 
        prohibited under section 641 of title 18, United States Code.
            ``(X) Abuse or neglect, including as prohibited under 
        section 111, 113, 114, 115, 116, or 117 of title 18, United 
        States Code.
            ``(XI) Forgery, including as prohibited under section 642 
        and chapter 25 (except section 512) of title 18, United States 
        Code.
            ``(XII) Identity theft or identity fraud, including as 
        prohibited under sections 1028 and 1028A of title 18, United 
        States Code.
The Commissioner of Social Security may promulgate regulations to 
provide for additional felony crimes under this clause.
    ``(xvi)(I) For the purpose of carrying out the activities required 
under clause (ii) as part of the investigation under clause (i)(I), the 
Commissioner may conduct a background check of any individual seeking 
to serve as a representative payee under this subsection and may 
disqualify from service as a representative payee any such individual 
who fails to grant permission for the Commissioner to conduct such a 
background check.
    ``(II) The Commissioner may revoke certification of payment of 
benefits under this subsection to any individual serving as a 
representative payee on or after January 1, 2019, who fails to grant 
permission for the Commissioner to conduct such a background check.
    ``(xvii)(I) With respect to any person described in subclause 
(II)--
            ``(aa) clause (ii)(VII) shall not apply; and
            ``(bb) the Commissioner may grant an exemption from the 
        provisions of clause (iii)(VI) if the Commissioner determines 
        that such exemption is in the best interest of the individual 
        entitled to benefits.
    ``(II) A person is described in this subclause if the person--
            ``(aa) is the custodial parent of a minor child for whom 
        the person applies to serve,
            ``(bb) is the custodial spouse of the beneficiary for whom 
        the person applies to serve,
            ``(cc) is the custodial parent of a beneficiary who is 
        under a disability which began before the beneficiary attained 
        the age of 22, for whom the person applies to serve,
            ``(dd) is the custodial court appointed guardian of the 
        beneficiary for whom the person applies to serve,
            ``(ee) is the custodial grandparent of a minor grandchild 
        for whom the person applies to serve,
            ``(ff) is the parent who was previously representative 
        payee for his or her minor child who has since turned 18 and 
        continues to be eligible for such benefit, or
            ``(gg) received a presidential or gubernatorial pardon for 
        the relevant conviction.''.
    (d) Application to New Appointments.--Subject to subsection (e), 
the amendments made by subsections (a), (b), and (c) shall apply with 
respect to any individual appointed to serve as a representative payee 
pursuant to section 205(j), 807, or 1631(a)(2) of the Social Security 
Act on or after January 1, 2019.
    (e) Application to Prior Appointments.--
            (1) In general.--Not later than January 1, 2024, the 
        Commissioner of Social Security shall conduct a review of each 
        individual serving as a representative payee pursuant to 
        section 205(j), 807, or 1631(a)(2) of the Social Security Act, 
        to determine whether such individual has been convicted of a 
        felony as described in section 205(j)(2)(B)(i)(VII), 
        807(b)(2)(G), or 1631(a)(2)(B)(ii)(VII), respectively (as such 
        provisions are added by this section). Except as provided in 
        section 205(j)(2)(C)(vi), 807(d)(2)(D), or 1631(a)(2)(B)(xvii) 
        (as so added), any individual determined by the Commissioner to 
        have been so convicted may not serve as a representative payee 
        on or after the date of such determination.
            (2) Priority.--In conducting reviews under paragraph (1), 
        the Commissioner shall prioritize reviews of the following 
        categories of individuals, in the following order:
                    (A) An individual serving as representative payee 
                for 15 or more individuals.
                    (B) An individual serving as representative payee 
                for an individual who is not related to the 
                representative payee.
                    (C) An individual serving as representative payee 
                for an individual who has attained the age of 18 and is 
                not the spouse of the representative payee.
    (f) Periodic Review.--Not later than 1 year after the date of 
enactment of this section, the Commissioner of Social Security shall 
issue regulations to establish a process for reviewing each individual 
serving as a representative payee pursuant to section 205(j), 807, or 
1631(a)(2) of the Social Security Act (other than individuals with 
respect to whom an exemption has been granted under section 
205(j)(2)(C)(vi), 807(d)(2)(D), or 1631(a)(2)(B)(xvii)) not less than 
once every 5 years to determine whether any such individual has been 
convicted of a felony as described in subsection (e)(1) of this 
section.

SEC. 313. PROHIBITION ON INDIVIDUALS WITH REPRESENTATIVE PAYEES SERVING 
              AS REPRESENTATIVE PAYEES.

    (a) Amendment to Title II.--Section 205(j)(2)(C)(i) of the Social 
Security Act (42 U.S.C. 405(j)(2)(C)(i)), as amended by section 
312(a)(2), is further amended--
            (1) in subclause (V), by striking ``or'' at the end;
            (2) in subclause (VI), by striking the period and inserting 
        ``, or''; and
            (3) by adding at the end the following:
            ``(VII) such person's benefits under this title, title 
        VIII, or title XVI are certified for payment to a 
        representative payee during the period for which the 
        individual's benefits would be certified for payment to another 
        person.''.
    (b) Amendment to Title VIII.--Section 807(d)(1) of the Social 
Security Act (42 U.S.C. 1007(d)(1)), as amended by section 312(b)(2), 
is further amended--
            (1) in subparagraph (E), by striking ``or'' at the end;
            (2) in subparagraph (F), by striking the period and 
        inserting ``, or''; and
            (3) by adding at the end the following:
                    ``(G) such person's benefits under this title, 
                title II, or title XVI are certified for payment to a 
                representative payee during the period for which the 
                individual's benefits would be certified for payment to 
                another person.''.
    (c) Amendment to Title XVI.--Section 1631(a)(2)(B)(iii) of the 
Social Security Act (42 U.S.C. 1383(a)(2)(B)(iii)), as amended by 
section 312(c)(2), is further amended--
            (1) in subclause (V), by striking ``or'' at the end;
            (2) in subclause (VI), by striking the period and inserting 
        ``, or''; and
            (3) by adding at the end the following:
            ``(VII) such person's benefits under this title, title II, 
        or title VIII are certified for payment to a representative 
        payee during the period for which the individual's benefits 
        would be certified for payment to another person.''.
    (d) Effective Date.--
            (1) New appointments.--Subject to paragraph (2), the 
        amendments made by this section shall apply with respect to any 
        individual appointed to serve as a representative payee under 
        title II, title VIII, or title XVI of the Social Security Act 
        on or after January 1, 2019.
            (2) Prior appointments.--With respect to individuals 
        serving as a representative payee whose benefits under this 
        title, title VIII, or title XVI are certified for payment to 
        another representative payee as of January 1, 2019, the 
        Commissioner shall take any steps necessary to terminate such 
        individual's service as a representative payee as soon as 
        possible, but no later than January 1, 2024.

SEC. 314. REASSESSMENT OF PAYEE SELECTION AND REPLACEMENT POLICIES.

    (a) In General.--The Commissioner of Social Security shall conduct, 
with opportunity for public comment, a review and reassessment of--
            (1) the appropriateness of its order of preference for 
        selecting representative payees, including payees who may be 
        creditors of the beneficiary or who are private, for-profit 
        institutions; and
            (2) the effectiveness of its policy and operational 
        procedures in properly determining when to change a 
        representative payee, including--
                    (A) from a payee that has a higher order of 
                preference (such as a family member) to a payee that 
                has a lower order of preference (such as a creditor); 
                or
                    (B) when a request to change payees arises from 
                someone other than the beneficiary.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Commissioner of Social Security shall submit 
to the Committee on Ways and Means of the House of Representatives and 
the Committee on Finance of the Senate and make publicly available a 
report on the results of the review and reassessment under subsection 
(a).
                                 <all>