[Congressional Record Volume 163, Number 126 (Wednesday, July 26, 2017)]
[Senate]
[Pages S4312-S4347]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 281. Mr. PAUL submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on

[[Page S4313]]

the budget for fiscal year 2017; which was ordered to lie on the table; 
as follows:

       At the end of title I, insert the following:

     SEC. 122. SMALL BUSINESS HEALTH PLANS.

       (a) Tax Treatment of Small Business Health Plans.--A small 
     business health plan (as defined in section 801(a) of the 
     Employee Retirement Income Security Act of 1974) shall be 
     treated--
       (1) as a group health plan (as defined in section 2791 of 
     the Public Health Service Act (42 U.S.C. 300gg-91)) for 
     purposes of applying title XXVII of the Public Health Service 
     Act (42 U.S.C. 300gg et seq.) and title XXII of such Act (42 
     U.S.C. 300bb-1);
       (2) as a group health plan (as defined in section 
     5000(b)(1) of the Internal Revenue Code of 1986), for 
     purposes of applying sections 4980B and 5000 and chapter 100 
     of the Internal Revenue Code of 1986; and
       (3) as a group health plan (as defined in section 733(a)(1) 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1191b(a)(1))) for purposes of applying parts 6 and 7 
     of title I of the Employee Retirement Income Security Act of 
     1974 (29 U.S.C. 1161 et seq.)
       (b) Rules.--Subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1021 et 
     seq.) is amended by adding at the end the following new part:

      ``PART 8--RULES GOVERNING SMALL BUSINESS RISK SHARING POOLS

     ``SEC. 801. SMALL BUSINESS HEALTH PLANS.

       ``(a) In General.--For purposes of this part, the term 
     `small business health plan' means--
       ``(1) a fully insured group health plan, offered by a 
     health insurance issuer in the large group market; or
       ``(2) a self-insured group health plan,

     whose sponsor is described in subsection (b).
       ``(b) Sponsor.--The sponsor of a group health plan is 
     described in this subsection if such sponsor--
       ``(1) is a qualified sponsor and receives certification by 
     the Secretary;
       ``(2) is organized and maintained in good faith, with a 
     constitution or bylaws specifically stating its purpose and 
     providing for periodic meetings on at least an annual basis;
       ``(3) is established as a permanent entity; and
       ``(4) does not condition membership on the basis of a 
     minimum group size.

     ``SEC. 802. FILING FEE AND CERTIFICATION OF SMALL BUSINESS 
                   HEALTH PLANS.

       ``(a) Filing Fee.--A small business health plan shall pay 
     to the Secretary at the time of filing an application for 
     certification under subsection (b) a filing fee in the amount 
     of $5,000, which shall be available to the Secretary for the 
     sole purpose of administering the certification procedures 
     applicable with respect to small business health plans.
       ``(b) Certification.--
       ``(1) In general.--Not later than 6 months after the date 
     of enactment of this part, the Secretary shall prescribe by 
     interim final rule a procedure under which the Secretary--
       ``(A) will certify a qualified sponsor of a small business 
     health plan, upon receipt of an application that includes the 
     information described in paragraph (2);
       ``(B) may provide for continued certification of small 
     business health plans under this part;
       ``(C) shall provide for the revocation of a certification 
     if the applicable authority finds that the small business 
     health plan involved fails to comply with the requirements of 
     this part;
       ``(D) shall conduct oversight of certified plan sponsors, 
     including periodic review, and consistent with section 504, 
     applying the requirements of sections 518, 519, and 520; and
       ``(E) will consult with a State with respect to a small 
     business health plan domiciled in such State regarding the 
     Secretary's authority under this part and other enforcement 
     authority under sections 502 and 504.
       ``(2) Information to be included in application for 
     certification.--An application for certification under this 
     part meets the requirements of this section only if it 
     includes, in a manner and form which shall be prescribed by 
     the applicable authority by regulation, at least the 
     following information:
       ``(A) Identifying information.
       ``(B) States in which the plan intends to do business.
       ``(C) Bonding requirements.
       ``(D) Plan documents.
       ``(E) Agreements with service providers.
       ``(3) Requirements for certified plan sponsors.--Not later 
     than 6 months after the date of enactment of this part, the 
     Secretary shall prescribe by interim final rule requirements 
     for certified plan sponsors that include requirements 
     regarding--
       ``(A) structure and requirements for boards of trustees or 
     plan administrators;
       ``(B) notification of material changes; and
       ``(C) notification for voluntary termination.
       ``(c) Filing Notice of Certification With States.--A 
     certification granted under this part to a small business 
     health plan offered by a health insurance issuer, as 
     described in section 801(a)(1), shall not be effective unless 
     written notice of such certification is filed by the plan 
     sponsor with the applicable authority of each State in which 
     the small business health plan operates.
       ``(d) Expedited and Deemed Certification.--
       ``(1) In general.--If the Secretary fails to act on a 
     complete application for certification under this section 
     within 90 days of receipt of such complete application, the 
     applying small business health plan sponsor shall be deemed 
     certified until such time as the Secretary may deny for cause 
     the application for certification.
       ``(2) Penalty.--The Secretary may assess a penalty against 
     the board of trustees, plan administrator, and plan sponsor 
     (jointly and severally) of a small business health plan 
     sponsor that is deemed certified under paragraph (1) of up to 
     $500,000 in the event the Secretary determines that the 
     application for certification of such small business health 
     plan sponsor was willfully or with gross negligence 
     incomplete or inaccurate.

     ``SEC. 803. PARTICIPATION AND COVERAGE REQUIREMENTS.

       ``(a) Covered Employers and Individuals.--The requirements 
     of this subsection are met with respect to a small business 
     health plan if, under the terms of the plan--
       ``(1) each participating employer must be--
       ``(A) a member of the sponsor;
       ``(B) the sponsor; or
       ``(C) an affiliated member of the sponsor, except that, in 
     the case of a sponsor which is a professional association or 
     other individual-based association, if at least one of the 
     officers, directors, or employees of an employer, or at least 
     one of the individuals who are partners in an employer and 
     who actively participates in the business, is a member or 
     such an affiliated member of the sponsor, participating 
     employers may also include such employer;
       ``(2) a participating employer is not deemed to be a plan 
     sponsor in applying requirements relating to coverage 
     renewal; and
       ``(3) all individuals commencing coverage under the plan 
     after certification under this part must be--
       ``(A) an active or retired owner (including a self-employed 
     individual with or without employees), officer, director, or 
     employee of, or partner in, a participating employer;
       ``(B) an eligible individual; or
       ``(C) a dependent of an individual described in 
     subparagraph (A) or (B).
       ``(b) Prohibition of Discrimination Against Employers and 
     Employees Eligible to Participate.--The requirements of this 
     subsection are met with respect to a small business health 
     plan if--
       ``(1) under the terms of the plan, no participating 
     employer may provide health insurance coverage in the 
     individual market for any employee not covered under the 
     plan, if such exclusion of the employee from coverage under 
     the plan is based on a health status-related factor with 
     respect to the employee and such employee would, but for such 
     exclusion on such basis, be eligible for coverage under the 
     plan; and
       ``(2) information regarding all coverage options available 
     under the plan is made readily available to any employer 
     eligible to participate.

     ``SEC. 804. DEFINITIONS; RENEWAL.

       ``For purposes of this part:
       ``(1) Affiliated member.--The term `affiliated member' 
     means, in connection with a sponsor--
       ``(A) a person who is otherwise eligible to be a member of 
     the sponsor but who elects an affiliated status with the 
     sponsor, or
       ``(B) in the case of a sponsor with members which consist 
     of associations, a person who is a member or employee of any 
     such association and elects an affiliated status with the 
     sponsor.
       ``(2) Applicable authority.--The term `applicable 
     authority' means--
       ``(A) with respect to a health insurance issuer in a State, 
     the State insurance commissioner or official or officials 
     designated by the State to enforce the requirements of title 
     XXVII of the Public Health Service Act for the State involved 
     with respect to such issuer; and
       ``(B) with respect to a group health plan, the Secretary of 
     Labor.
       ``(3) Eligible individual.--The term `eligible individual' 
     means any individual who--
       ``(A) is a member of a sponsor; and
       ``(B)(i) is not employed or self-employed; or
       ``(ii) is employed by an employer who does not offer the 
     individual the option to enroll in a group health plan.
       ``(4) Franchisor; franchisee.--The terms `franchisor' and 
     `franchisee' have the meanings given such terms for purposes 
     of sections 436.2(a) through 436.2(c) of title 16, Code of 
     Federal Regulations (including any such amendments to such 
     regulation after the date of enactment of this part) and, for 
     purposes of this part, franchisor or franchisee employers 
     participating in such a group health plan shall not be 
     treated as the employer, co-employer, or joint employer of 
     the employees of another participating franchisor or 
     franchisee employer for any purpose.
       ``(5) Health plan terms.--The terms `group health plan', 
     `health insurance coverage', and `health insurance issuer' 
     have the meanings given such terms in section 733.
       ``(6) Individual market.--
       ``(A) In general.--The term `individual market' means the 
     market for health insurance coverage offered to individuals 
     other than in connection with a group health plan.
       ``(B) Treatment of very small groups.--
       ``(i) In general.--Subject to clause (ii), such term 
     includes coverage offered in connection with a group health 
     plan that has fewer than 2 participants as current employees 
     or participants described in section 732(d)(3) on the first 
     day of the plan year.

[[Page S4314]]

       ``(ii) State exception.--Clause (i) shall not apply in the 
     case of health insurance coverage offered in a State if such 
     State regulates the coverage described in such clause in the 
     same manner and to the same extent as coverage in the small 
     group market (as defined in section 2791(e)(5) of the Public 
     Health Service Act) is regulated by such State.
       ``(7) Participating employer.--The term `participating 
     employer' means, in connection with a small business health 
     plan, any employer, if any individual who is an employee of 
     such employer, a partner in such employer, or a self-employed 
     individual who is such employer, including a self-employed 
     individual with no additional employees (or any dependent, as 
     defined under the terms of the plan, of such individual) is 
     or was covered under such plan in connection with the status 
     of such individual as such an employee, partner, or self-
     employed individual in relation to the plan.''.
       (c) Preemption Rules.--Section 514 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1144) is 
     amended by adding at the end the following:
       ``(f)(1) Except as provided in subsection (b)(4), the 
     provisions of this title shall supersede any and all State 
     laws insofar as they may now or hereafter preclude a health 
     insurance issuer from offering health insurance coverage in 
     connection with a small business health plan which is 
     certified under part 8 or preclude a self-insured small 
     business health plan which is certified under part 8 from 
     operating.
       ``(2) Nothing in subparagraph (1) shall be construed to 
     limit the authority of a State to otherwise regulate health 
     plans offered by a health insurance issuer in such State.''.
       (d) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C. 
     102(16)(B)) is amended by adding at the end the following new 
     sentence: ``Such term also includes a person serving as the 
     sponsor of a small business health plan under part 8.''.
       (e) Savings Clause.--Section 731(c) of such Act is amended 
     by inserting ``or part 8'' after ``this part''.
       (f) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act. The Secretary of Labor shall first issue all 
     regulations necessary to carry out the amendments made by 
     this section within 6 months after the date of the enactment 
     of this Act.
                                 ______
                                 
  SA 282. Mr. ROUNDS submitted an amendment intended to be proposed by 
him to the bill H.R. 2810, to authorize appropriations for fiscal year 
2018 for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle A of title VII, add the following:

     SEC. 710. EXCEPTION TO INCREASE IN COST-SHARING REQUIREMENTS 
                   FOR TRICARE PHARMACY BENEFITS PROGRAM FOR 
                   BENEFICIARIES WHO LIVE MORE THAN 40 MILES FROM 
                   A MILITARY TREATMENT FACILITY.

       (a) In General.--Notwithstanding paragraph (6) of section 
     1074g(a) of title 10, United States Code, as amended by 
     section 706(a), the Secretary of Defense may not increase 
     after the date of the enactment of this Act any cost-sharing 
     amounts under such paragraph with respect to covered 
     beneficiaries described in subsection (b).
       (b) Covered Beneficiaries Described.--Covered beneficiaries 
     described in this subsection are eligible covered 
     beneficiaries (as defined in section 1074g(g) of title 10, 
     United States Code) who live more than 40 miles driving 
     distance from the closest military treatment facility to the 
     residence of the beneficiary.
       (c) Report on Effect of Increase.--
       (1) In general.--Not later than 60 days after the date of 
     the enactment of this Act, the Secretary of Defense shall 
     submit to the Committees on Armed Services of the Senate and 
     the House of Representatives a report on the potential 
     effect, without regard to subsection (a), of the increase in 
     cost-sharing amounts under section 1074g(a)(6) of title 10, 
     United States Code, on covered beneficiaries described in 
     subsection (b).
       (2) Elements.--The report required by paragraph (1) shall 
     include an assessment of how much additional costs would be 
     required of covered beneficiaries described in subsection (b) 
     per year as a result of increases in cost-sharing amounts 
     described in such paragraph, including the average amount per 
     individual and the aggregate amount.
                                 ______
                                 
  SA 283. Mr. ROUNDS submitted an amendment intended to be proposed by 
him to the bill H.R. 2810, to authorize appropriations for fiscal year 
2018 for military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle C of title XVI, add the following:

     SEC. 1630C. SENSE OF CONGRESS ON USE OF INTERGOVERNMENTAL 
                   PERSONNEL ACT MOBILITY PROGRAM AND DEPARTMENT 
                   OF DEFENSE INFORMATION TECHNOLOGY EXCHANGE 
                   PROGRAM TO OBTAIN PERSONNEL WITH CYBER SKILLS 
                   AND ABILITIES FOR THE DEPARTMENT OF DEFENSE.

       It is the sense of Congress that--
       (1) the Department of Defense should fully use the 
     Intergovernmental Personnel Act Mobility Program (IPAMP) and 
     the Department of Defense Information Technology Exchange 
     Program (ITEP) to obtain cyber personnel across the 
     Government by leveraging cyber capabilities found at the 
     State and local government level and in the private sector in 
     order to meet the needs of the Department for cybersecurity 
     professionals; and
       (2) the Department should implement at the earliest 
     practicable date a strategy that includes policies and plans 
     to fully use such programs to obtain such personnel for the 
     Department.
                                 ______
                                 
  SA 284. Mr. KENNEDY submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. REDUCING MEDICAID FRAUD, WASTE, ABUSE, AND OTHER 
                   IMPROPER PAYMENTS.

       Not later than 6 months after the date of enactment of this 
     Act, the Secretary of Health and Human Services, in 
     consultation with the Comptroller General of the United 
     States and representatives of State auditors, shall issue 
     guidance establishing a national strategy for reducing fraud, 
     waste, abuse, and other improper payments in Medicaid.
                                 ______
                                 
  SA 285. Mr. KENNEDY submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. EXPLANATION OF BENEFITS.

       Subpart I of part A of title XXVII of the Public Health 
     Service Act (42 U.S.C.300gg et seq.) is amended by adding at 
     the end the following:

     ``SEC. 2710. EXPLANATION OF BENEFITS.

       ``Each health insurance issuer offering health insurance 
     coverage in the individual market or group market shall 
     include the Current Procedural Terminology (`CPT') code with 
     each explanation of benefits.''.
                                 ______
                                 
  SA 286. Mr. KENNEDY submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. EMERGENCY ROOM PHYSICIANS.

       The Secretary of Health and Human Services shall promulgate 
     regulations requiring hospitals to employ only emergency room 
     physicians who have a contract with the same health insurance 
     issuers with which the hospital has a contract.
                                 ______
                                 
  SA 287. Mr. KENNEDY submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. WORK REQUIREMENT FOR NONDISABLED, NONELDERLY, 
                   NONPREGNANT INDIVIDUALS.

       Section 1902 of the Social Security Act (42 U.S.C. 1396a), 
     as previously amended, is further amended by adding at the 
     end the following new subsection:
       ``(oo) Work Requirement for Nondisabled, Nonelderly, 
     Nonpregnant Individuals.--
       ``(1) In general.--Beginning October 1, 2017, subject to 
     paragraph (3), States shall condition medical assistance to a 
     nondisabled, nonelderly, nonpregnant individual under this 
     title upon such an individual's satisfaction of a work 
     requirement (as defined in paragraph (2)).
       ``(2) Work requirement defined.--In this section, the term 
     `work requirement' means, with respect to an individual, the 
     individual's participation in work activities (as defined in 
     section 407(d)) for such period of time as determined by the 
     State, and as directed and administered by the State.
       ``(3) Required exceptions.--States may not apply a work 
     requirement under this subsection to--
       ``(A) a woman during pregnancy through the end of the month 
     in which the 60-day period (beginning on the last day of her 
     pregnancy) ends;

[[Page S4315]]

       ``(B) an individual who is under 19 years of age;
       ``(C) an individual who is a regular participant in a drug 
     addiction or alcoholic treatment and rehabilitation program;
       ``(D) an individual who is the only parent or caretaker 
     relative in the family of a child who has not attained 6 
     years of age or who is the only parent or caretaker of a 
     child with disabilities; or
       ``(E) an individual who is married or a head of household 
     and has not attained 20 years of age and who--
       ``(i) maintains satisfactory attendance at secondary school 
     or the equivalent; or
       ``(ii) participates in education directly related to 
     employment.''.
                                 ______
                                 
  SA 288. Mr. Heller submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. SENSE OF THE SENATE.

       It is the Sense of the Senate that--
       (1) the committee of jurisdiction of the Senate--
       (A) should review the issue of Medicaid expansion and 
     coverage for low-income Americans, and the incentives such 
     expansion provides States for certain services;
       (B) should consider legislation that provides incentives 
     for States to prioritize Medicaid services for individuals 
     who have the greatest medical need, including individuals 
     with disabilities;
       (C) should not consider legislation that reduces or 
     eliminates benefits or coverage for individuals who are 
     currently eligible for Medicaid;
       (D) should not consider legislation that prevents or 
     discourages a State from expanding its Medicaid program to 
     include groups or individuals or types of services that are 
     operational under current law; and
       (E) should not consider legislation that shifts costs to 
     States to cover such care;
       (2) Obamacare should be repealed because it increases 
     health care costs, limits patient choice of health plans and 
     doctors, forces Americans to buy insurance that they do not 
     want, cannot afford, or may not be able to access, and 
     increases taxes on middle class families, which is evidenced 
     by the facts that--
       (A) premiums for health plans offered on the Federal 
     Exchange have doubled on average over the last 4 years, and 
     those increases are projected to continue;
       (B) 70 percent of counties have only a few options for 
     Obamacare insurance in 2017, and at least 40 counties are 
     expected to have zero insurers planning on their Exchange for 
     2018;
       (C) 2,300,000 Americans on the Exchange are projected to 
     have only one insurer to choose from for plan year 2018; and
       (D) the Joint Committee on Taxation has identified 
     significant and widespread tax increases on individuals 
     earning less than$200,000; and
       (3) Obamacare should be replaced with patient-centered 
     legislation that--
       (A) provides access to quality, affordable private health 
     care coverage for Americans and their families by increasing 
     competition, State flexibility, and individual choice; and
       (B) strengthens Medicaid and empowers States through 
     increased flexibility to best meet the needs of each State's 
     population.
                                 ______
                                 
  SA 289. Mr. DAINES submitted an amendment intended to be proposed to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       On page 5, strike lines 20 through 22 and insert the 
     following:
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2013.
       (c) Taxpayer Refund Program.--
       (1) In general.--The Secretary of the Treasury shall 
     implement a program under which taxpayers who have paid a 
     penalty under section 5000A of the Internal Revenue Code of 
     1986 for any taxable year receive 1 payment in refund of all 
     such penalties paid, without regard to whether or not an 
     amended return is filed. Such payment shall be made not later 
     than April 15, 2018.
       (2) Waiver of statute of limitations.--Solely for purposes 
     of claiming the refund under paragraph (1), the period 
     prescribed by section 6511(a) of the Internal Revenue Code of 
     1986 with respect to any payment of a penalty under section 
     5000A shall be extended until the date prescribed by law 
     (including extensions) for filing the return of tax for the 
     taxable year that includes December 31, 2017.
                                 ______
                                 
  SA 290. Ms. WARREN (for herself, Mr. Markey, Mr. Carper, Mr. Durbin, 
Ms. Stabenow, Ms. Hirono, Mr. Van Hollen, and Mr. Brown) submitted an 
amendment intended to be proposed by her to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would increase costs for community health centers, 
     including by increasing the number of uninsured individuals 
     or by reducing Federal funding of the Medicaid program that 
     helps provide coverage for many patients receiving care at 
     community health centers, shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 291. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would lead to an increased likelihood of bankruptcies 
     for American families, including provisions that would allow 
     insurers to impose annual or lifetime limits on insurance 
     benefits or that would eliminate insurance coverage, shall be 
     null and void and this Act shall be applied and administered 
     as if such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 292. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would reduce funding for special education programs, 
     including provisions that break President Trump's promise not 
     to cut Medicaid, shall be null and void and this Act shall be 
     applied and administered as if such provisions and amendments 
     had never been enacted.
                                 ______
                                 
  SA 293. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would harm individuals with Alzheimer's disease by 
     increasing their premiums or cutting Federal Medicaid funding 
     that supports those in nursing homes, shall be null and void 
     and this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 294. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would harm babies born prematurely by cutting Federal 
     Medicaid funding that supports medications, special 
     equipment, and therapies to help these babies thrive and 
     protect their family from bankruptcy, shall be null and void 
     and this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 295. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would reduce coverage for prescription drug benefits, 
     lead to increased out-of-pocket prescription drug costs, or 
     allow States to apply for waivers to drop prescription drug 
     coverage from the list of essential health benefits, shall be 
     null and void and this Act shall be applied and administered 
     as if such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 296. Ms. WARREN submitted an amendment intended to be proposed by

[[Page S4316]]

her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would make it harder for a person with breast cancer to 
     access health care, shall be null and void and this Act shall 
     be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 297. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would make it harder for a person with cervical cancer 
     to access health care, shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 298. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would make it harder for a victim of human trafficking 
     to access health care, shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 299. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Actt 
     hat would make it harder for a pregnant woman to access 
     health care, shall be null and void and this Act shall be 
     applied and administered as if such provisions and amendments 
     had never been enacted.
                                 ______
                                 
  SA 300. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would make it harder for a victim of sexual violence to 
     access health care, shall be null and void and this Act shall 
     be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 301. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     children with a rare disease shall be null and void and this 
     Act shall be applied and administered as if such provisions 
     and amendments had never been enacted.
                                 ______
                                 
  SA 302. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     foster children shall be null and void and this Act shall be 
     applied and administered as if such provisions and amendments 
     had never been enacted.
                                 ______
                                 
  SA 303. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with a disability shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 304. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people living in a nursing home shall be null and void and 
     this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 305. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people receiving home and community based services shall be 
     null and void and this Act shall be applied and administered 
     as if such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 306. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people receiving long term services and supports shall be 
     null and void and this Act shall be applied and administered 
     as if such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 307. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people seeking treatment for opioid addiction shall be null 
     and void and this Act shall be applied and administered as if 
     such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 308. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with any substance use disorder shall be null and void 
     and this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 309. Ms. WARREN submitted an amendment intended to be proposed by

[[Page S4317]]

her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people seeking mental health care shall be null and void and 
     this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 310. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with brain cancer shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 311. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people receiving chemotherapy or radiation treatment shall be 
     null and void and this Act shall be applied and administered 
     as if such provisions and amendments had never been enacted.
                                 ______
                                 
  SA 312. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people living in a rural area shall be null and void and this 
     Act shall be applied and administered as if such provisions 
     and amendments had never been enacted.
                                 ______
                                 
  SA 313. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     veterans shall be null and void and this Act shall be applied 
     and administered as if such provisions and amendments had 
     never been enacted.
                                 ______
                                 
  SA 314. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people over the age of 50 shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 315. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with ALS shall be null and void and this Act shall be 
     applied and administered as if such provisions and amendments 
     had never been enacted.
                                 ______
                                 
  SA 316. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with multiple sclerosis shall be null and void and 
     this Act shall be applied and administered as if such 
     provisions and amendments had never been enacted.
                                 ______
                                 
  SA 317. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with diabetes shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 318. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people receiving Social Security benefits, including SSI and 
     SSDI shall be null and void and this Act shall be applied and 
     administered as if such provisions and amendments had never 
     been enacted.
                                 ______
                                 
  SA 319. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with heart disease shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 320. Ms. WARREN submitted an amendment intended to be proposed by 
her to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would threaten to make health insurance unaffordable for 
     people with prostate cancer shall be null and void and this 
     Act shall be applied and administered as if such provisions 
     and amendments had never been enacted.
                                 ______
                                 
  SA 321. Mr. NELSON submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ____. HEALTHCARE FRAUD REMOVAL.

       (a) 10-year Prohibition on Deduction of Trade or Business 
     Expenses for Businesses Engaged in Fraud or Illegal 
     Transactions.--Subsection (c) of section 162 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new paragraph:
       ``(4) 10-year prohibition on deduction of trade or business 
     expenses.--In the case of a taxpayer subject to a criminal 
     penalty for

[[Page S4318]]

     engaging in fraud, an illegal bribe or kickback, or any other 
     illegal transaction (as such term is defined by the 
     Secretary) under any law of the United States, or under any 
     law of a State (but only if such State law is generally 
     enforced), no deduction shall be allowed under subsection (a) 
     for any taxable year during the 10-year period subsequent to 
     the date on which such criminal penalty was imposed.''.
       (b) Health Care Fraud Penalties.--Section 1347(a) of title 
     18, United States Code, is amended, in the undesignated 
     matter following paragraph (2)--
       (1) by striking ``10 years'' and inserting ``15 years''; 
     and
       (2) by striking ``20 years'' and inserting ``25 years''.
       (c) Establishment of Health Care Fraud Excise Tax.--
       (1) Health care fraud excise tax.--
       (A) In general.--Subchapter C of chapter 100 of subtitle K 
     of the Internal Revenue Code of 1986 is amended by adding at 
     the end the following new section:

     ``SEC. 9835. HEALTH CARE FRAUD EXCISE TAX.

       ``(a) In General.--In the case of any payment relating to 
     health care benefits, items, or services which is made by 
     health insurance issuer (as defined in section 9832(c)(2)) to 
     a person engaged in a violation of section 1347(a) of title 
     18, United States Code, there is hereby imposed a tax equal 
     to 20 percent of such payment.
       ``(b) No Knowledge Requirement.--With respect the tax 
     imposed under subsection (a), the health insurance issuer 
     shall not be required to have knowledge of the violation 
     under section 1347(a) of title 18, United States Code.''.
       (B) Clerical amendment.--The table of sections for such 
     subchapter is amended by adding at the end the following new 
     item:

``Sec. 9835. Health care fraud excise tax.''.
       (C) Effective date.--The amendments made by this paragraph 
     shall apply to payments made after the date of the enactment 
     of this Act.
       (2) Health care fraud trust fund.--
       (A) In general.--Subchapter A of chapter 98 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following section:

     ``SEC. 9512. HEALTH CARE FRAUD TRUST FUND.

       ``(a) Creation of Trust Fund.--There is established in the 
     Treasury of the United States a trust fund to be known as the 
     `Health Care Fraud Trust Fund', consisting of any amount 
     appropriated or credited to the Trust Fund as provided in 
     this section or section 9602(b).
       ``(b) Transfers to Trust Fund.--There is hereby 
     appropriated to the Health Care Fraud Trust Fund amounts 
     equivalent to the revenues received in the Treasury from the 
     tax imposed by section 9835.
       ``(c) Expenditures.--Amounts in the Health Care Fraud Trust 
     Fund shall be available, without further appropriation, to 
     the Secretary of Health and Human Services for providing 
     grants to--
       ``(1) local law enforcement authorities for health care 
     fraud prevention efforts, with priority given to authorities 
     operating in areas experiencing high rates of health care 
     fraud or drug abuse, and
       ``(2) qualified drug addiction treatment centers.
       ``(d) Definitions.--
       ``(1) Local law enforcement authority.--The term `local law 
     enforcement authority' means any officially recognized law 
     enforcement agency legally organized under a political 
     subdivision of a state or possession of the United States.
                                 ______
                                 
  SA 322. Mr. HEINRICH submitted an amendment intended to be proposed 
by him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. POINT OF ORDER AGAINST LEGISLATION THAT WOULD 
                   DECREASE MEDICAID OR CHIP ENROLLMENT OF 
                   CHILDREN.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that, as 
     determined by the Director of the Congressional Budget 
     Office, would result in a decrease in the number of children 
     enrolled in Medicaid under title XIX of the Social Security 
     Act (42 U.S.C. 1396 et seq.) or the Children's Health 
     Insurance Program under title XXI of such Act (42 U.S.C. 
     1397aa et seq.).
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).
                                 ______
                                 
  SA 323. Mr. HEINRICH submitted an amendment intended to be proposed 
by him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. POINT OF ORDER AGAINST LEGISLATION THAT WOULD AFFECT 
                   ADVERSELY IMPACT UNINSURED INDIVIDUALS IN RURAL 
                   AREAS,.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     result in an increase in the rate of uninsured individuals in 
     rural areas, a decrease in Medicaid enrollment or a reduction 
     in the scope of Medicaid benefits offered in rural areas, 
     reduced wages or a shortage of employment opportunities in 
     the health care profession for prospective employees and 
     previously insured individuals living in rural areas, or a 
     decrease in revenue or Federal funds available to rural 
     health care providers, including hospitals, clinics, and 
     community health centers.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).
                                 ______
                                 
  SA 324. Mr. HEINRICH (for himself and Mr. Udall) submitted an 
amendment intended to be proposed by him to the bill H.R. 2810, to 
authorize appropriations for fiscal year 2018 for military activities 
of the Department of Defense, for military construction, and for 
defense activities of the Department of Energy, to prescribe military 
personnel strengths for such fiscal year, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end of subtitle B of title XXXI, add the following:

     SEC. 3116. PLUTONIUM CAPABILITIES.

       (a) Report.--Not later than 30 days after the date of the 
     enactment of this Act, the Administrator for Nuclear Security 
     shall submit to the congressional defense committees, the 
     Secretary of Defense, and the Director of Cost Assessment and 
     Program Evaluation of the Department of Defense a report on 
     the recommended alternative endorsed by the Administrator for 
     recapitalization of plutonium science and production 
     capabilities of the nuclear security enterprise. The report 
     shall identify the recommended alternative endorsed by the 
     Administrator and contain the analysis of alternatives, 
     including costs, upon which the Administrator relied in 
     making such endorsement.
       (b) Certification.--Not later than 60 days after the date 
     on which the Secretary of Defense receives the notification 
     under subsection (a), the Chairman of the Nuclear Weapons 
     Council shall submit to the congressional defense committees 
     the written certification of the Chairman regarding whether 
     the recommended alternative endorsed by the Administrator--
       (1) is acceptable to the Secretary of Defense and the 
     Nuclear Weapons Council and meets the requirements of the 
     Secretary for plutonium pit production capacity and 
     capability;
       (2) is likely to meet the pit production timelines and 
     milestones required by section 4219 of the Atomic Energy 
     Defense Act (50 U.S.C. 2538a);
       (3) is likely to meet pit production timelines and 
     requirements responsive to military requirements;
       (4) is cost effective and has reasonable near-term and 
     lifecycle costs that are minimized, to the extent 
     practicable, as compared to other alternatives, and has 
     tested and documented the sensitivity of the cost estimates 
     for each alternative to risks and changes in key assumptions;
       (5) contains minimized and manageable risks as compared to 
     other alternatives;
       (6) can be acceptably reconciled with any differences in 
     the conclusions made by the Office of Cost Assessment and 
     Program Evaluation of the Department of Defense in the 
     business case analysis of plutonium pit production capability 
     issued in 2013; and
       (7) has documented the assumptions and constraints used in 
     the analysis of alternatives.
       (c) Failure to Certify.--If the Chairman is unable to 
     submit the certification under subsection (b), the Chairman 
     shall submit to the congressional defense committees and the 
     Administrator written notification describing why the 
     Chairman is unable to make such certification.
       (d) Assessment.--Not later than 120 days after the date on 
     which the Director of Cost Assessment and Program Evaluation 
     receives the notification under subsection (a), the Director 
     shall provide to the congressional defense committees a 
     briefing containing the assessment of the Director of the 
     analysis of alternatives conducted by the Administrator to 
     select a preferred alternative for recapitalizing plutonium 
     science and production capabilities.
                                 ______
                                 
  SA 325. Mr. HEINRICH (for himself and Mr. Udall) submitted an 
amendment intended to be proposed by him to the bill H.R. 2810, to 
authorize appropriations for fiscal year 2018 for military activities 
of the Department of Defense, for military construction, and for 
defense activities of the Department of Energy, to prescribe military 
personnel strengths for such fiscal year, and for other purposes; which 
was ordered to lie on the table; as follows:


[[Page S4319]]


  

       At the end of subtitle E of title X, add the following:

     SEC. ___. AIR FORCE PILOT PROGRAM ON EDUCATION AND TRAINING 
                   AND CERTIFICATION OF SECONDARY AND POST-
                   SECONDARY STUDENTS AS AIRCRAFT TECHNICIANS.

       (a) Pilot Program Required.--
       (1) In general.--The Secretary of the Air Force shall carry 
     out a pilot program to assess the feasability and 
     advisability of--
       (A) providing education and training to secondary and post-
     secondary students in the skills and qualifications required 
     to lead to certification as an aircraft technician for the 
     Air Force with skills levels 3-5; and
       (B) certifying individuals who successfully complete 
     education and training under the pilot program as aircraft 
     technicians for the Air Force at the applicable skill level.
       (2) Designation.--The pilot program carried out pursuant to 
     this section may be known as the ``Air Force Dual Credit 
     Maintainers Program'' (in this section, referred to as the 
     ``pilot program'').
       (b) Eligible Participants.--Individuals eligible to 
     participate in the pilot program are individuals in secondary 
     or post-secondary school who--
       (1) have education, skills, or both appropriate for further 
     education and training leading to certification as an 
     aircraft technician of the Air Force; and
       (2) seek to pursue education and training under the pilot 
     program in order to become certified as aircraft technicians 
     of the Air Force.
       (c) Secondary Schools and Institutions of Higher 
     Education.--
       (1) In general.--The Secretary shall carry out the pilot 
     program through secondary schools and institutions of higher 
     education selected by the Secretary for purposes of the pilot 
     program.
       (2) Locations.--The secondary schools and institutions of 
     higher education selected pursuant to paragraph (1) shall, to 
     the extent practicable, be located in the vicinity of 
     installations of the Air Force at which there is, or is 
     anticipated to be, a shortfall in aircraft technicians with 
     skill levels 3-5.
       (3) Coordination.--The pilot program may be carried out at 
     a secondary school only with the approval of the local 
     educational agency concerned. The pilot program may be 
     carried out at an institution of higher education only with 
     the approval of the board of trustees or other appropriate 
     leadership of the institution.
       (4) Grants.--In carrying out the pilot program, the 
     Secretary may award a grant to any secondary school or 
     institution of higher education participating in the pilot 
     program for purposes of providing education and training 
     under the pilot program.
       (d) Curriculum and Associated Equipment.--In carrying out 
     the pilot program, the Secretary shall support curriculum 
     development by secondary and post-secondary educational 
     institutions, and any associated training equipment, to be 
     used in providing education and training under the pilot 
     program.
       (e) Employment as Air Force Aircraft Technicians.--As part 
     of the pilot program, the Secretary may employ, and may 
     afford an emphasis on employment, in the Department of the 
     Air Force as aircraft technicians of the Air Force any 
     individuals who obtain certification under the pilot program 
     as aircraft technicians of the Air Force.
       (f) Sunset.--The authority of the Secretary to carry out 
     the pilot program shall expire on the date that is five years 
     after the date of the enactment of this Act. Expiration of 
     the authority to carry out the pilot program shall not be 
     construed to require the termination of any education or 
     training, or the provision of any certifications, for 
     individuals participating in education or training under the 
     pilot program on the date of the expiration of authority to 
     carry out the pilot program
       (g) Funding.--
       (1) In general.--The amount authorized to be appropriated 
     for fiscal year 2018 for the Department of Defense by this 
     division is hereby increased by $5,000,000, with the amount 
     of the increase to be available for the pilot program, 
     including for the award of grants pursuant to subsection 
     (c)(4) and for support of the development of curriculum and 
     training equipment pursuant to subsection (d)
       (2) Offset.--The amount authorized to be appropriated for 
     fiscal year 2018 by section 301 is hereby reduced by 
     $5,000,000, with the amount of the reduction to be applied 
     against amounts available for operation and maintenance, 
     Defense-wide, for SAG 4GTV Office of the Inspector General.
                                 ______
                                 
  SA 326. Mr. LANKFORD (for himself, Mr. Cruz, Mrs. Fischer, and Mr. 
Inhofe) submitted an amendment intended to be proposed by him to the 
bill H.R. 2810, to authorize appropriations for fiscal year 2018 for 
military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. _____. JUDGMENT FUND TRANSPARENCY.

       (a) Transparency Requirement.--Section 1304 of title 31, 
     United States Code, is amended by adding at the end the 
     following:
       ``(d)(1) Unless the disclosure of such information is 
     otherwise prohibited by law (other than section 552a of title 
     5) or court order, the Secretary of the Treasury shall make 
     available to the public on a website, as soon as practicable, 
     but not later than 30 days after the date on which the 
     Secretary makes a payment under this section, the following 
     information with regard to that payment:
       ``(A) The name of the specific agency or entity whose 
     actions gave rise to the claim or judgment.
       ``(B) The name of the plaintiff or claimant who is 18 years 
     or older.
       ``(C) The name of counsel for the plaintiff or claimant.
       ``(D) The amount paid representing principal liability, and 
     any amounts paid representing any ancillary liability, 
     including attorney fees, costs, and interest.
       ``(E) A brief description of the facts that gave rise to 
     the claim.
       ``(F) The name of the agency that submitted the claim.
       ``(2) In addition to the information described in paragraph 
     (1), if a payment under this section is made to a foreign 
     state, the Secretary of the Treasury shall make available to 
     the public in accordance with paragraph (1), the following 
     information with regard to that payment:
       ``(A) A description of the method of payment.
       ``(B) A description of the currency denominations used for 
     the payment.
       ``(C) The name and location of each financial institution 
     owned or controlled, directly or indirectly, by a foreign 
     state or an agent of a foreign state to which the payment was 
     disbursed, including any financial institution owned or 
     controlled, directly or indirectly, by a foreign state or an 
     agent of a foreign state that is holding the payment as of 
     the date on which the information is made available.
       ``(3) In this subsection, the term `foreign state' has the 
     meaning given the term in section 1603 of title 28.
       ``(e) No payment may be made under this section to a state 
     sponsor of terrorism, as defined in section 1605A(h) of title 
     28.''.
       (b) Implementation.--The Secretary of the Treasury shall 
     carry out the amendment made by this section not later than 
     90 days after the date of enactment of this Act.
                                 ______
                                 
  SA 327. Mrs. SHAHEEN (for herself and Mr. Sasse) submitted an 
amendment intended to be proposed by her to the bill H.R. 2810, to 
authorize appropriations for fiscal year 2018 for military activities 
of the Department of Defense, for military construction, and for 
defense activities of the Department of Energy, to prescribe military 
personnel strengths for such fiscal year, and for other purposes; which 
was ordered to lie on the table; as follows:

       At the end of subtitle C of title XII, add the following:

     SEC. ___. SYRIA STUDY GROUP.

       (a) Establishment.--There is hereby established a working 
     group to be known as the ``Syria Study Group'' (in this 
     section referred to as the ``Group'').
       (b) Purpose.--The purpose of the Group is to examine and 
     make recommendations with respect to the military and 
     diplomatic strategy of the United States with respect to the 
     conflict in Syria.
       (c) Composition.--
       (1) Membership.--The Group shall be composed of 8 members 
     appointed as follows:
       (A) One member appointed by the chair of the Committee on 
     Armed Services of the Senate.
       (B) One member appointed by the ranking minority member of 
     the Committee on Armed Services of the Senate.
       (C) One member appointed by the chair of the Committee on 
     Foreign Relations of the Senate.
       (D) One member appointed by the ranking minority member of 
     the Committee on Foreign Relations of the Senate.
       (E) One member appointed by the chair of the Committee on 
     Armed Services of the House of Representatives.
       (F) One member appointed by the ranking minority member of 
     the Committee on Armed Services of the House of 
     Representatives.
       (G) One member appointed by the chair of the Committee on 
     Foreign Affairs of the House of Representatives.
       (H) One member appointed by the ranking minority member of 
     the Committee on Foreign Affairs of the House of 
     Representatives.
       (2) Co-chairs.--
       (A) The chair of the Committee on Armed Services of the 
     Senate, the chair of the Committee on Armed Services of the 
     House of Representatives, the chair of the Committee on 
     Foreign Relations of the Senate, and the chair of the 
     Committee on Foreign Affairs of the House of Representatives 
     shall jointly designate one member of the Group to serve as 
     co-chair of the Group.
       (B) The ranking minority member of the Committee on Armed 
     Services of the Senate, the ranking minority member of the 
     Committee on Armed Services of the House of Representatives, 
     the ranking minority member of the Committee on Foreign 
     Relations of the Senate, and the ranking minority member of 
     the Committee on Foreign Affairs of the House of 
     Representatives shall jointly designate one member of the 
     Group to serve as co-chair of the Group.

[[Page S4320]]

       (3) Period of appointment; vacancies.--Members shall be 
     appointed for the life of the Group. Any vacancy in the Group 
     shall be filled in the same manner as the original 
     appointment.
       (d) Duties.--
       (1) Review.--The Group shall review the current situation 
     with respect to the United States military and diplomatic 
     strategy in Syria, including a review of current United 
     States objectives in Syria and the desired end state in 
     Syria.
       (2) Assessment and recommendations.--The Group shall--
       (A) conduct a comprehensive assessment of the current 
     situation in Syria, its impact on neighboring countries, 
     resulting regional and geopolitical threats to the United 
     States, and current military, diplomatic, and political 
     efforts to achieve a stable Syria; and
       (B) develop recommendations on a military and diplomatic 
     strategy for the United States with respect to the conflict 
     in Syria.
       (e) Cooperation From United States Government.--
       (1) In general.--The Group shall receive the full and 
     timely cooperation of the Secretary of Defense, the Secretary 
     of State, and the Director of National Intelligence in 
     providing the Group with analyses, briefings, and other 
     information necessary for the discharge of the duties of the 
     Group.
       (2) Liaison.--The Secretary of Defense, the Secretary of 
     State, and the Director of National Intelligence shall each 
     designate at least one officer or employee of their 
     respective organizations to serve as a liaison officer to the 
     Group.
       (f) Report.--
       (1) Final report.--Not later than September 30, 2018, the 
     Group shall submit to the President, the Secretary of 
     Defense, the Committee on Armed Services of the Senate, the 
     Committee on Armed Services of the House of Representatives, 
     the Committee on Foreign Relations of the Senate, and the 
     Committee on Foreign Affairs of the House of Representatives 
     a report on the findings, conclusions, and recommendations of 
     the Group under this section. The report shall do each of the 
     following:
       (A) Assess the current security, political, humanitarian, 
     and economic situation in Syria.
       (B) Assess the current participation and objectives of 
     various external actors in Syria.
       (C) Assess the consequences of continued conflict in Syria.
       (D) Provide recommendations for a diplomatic resolution of 
     the conflict in Syria, including options for a gradual 
     political transition to a post-Assad Syria and actions 
     necessary for reconciliation.
       (E) Provide a roadmap for a United States and coalition 
     strategy to reestablish security and governance in Syria, 
     including recommendations for the synchronization of 
     stabilization, development, counterterrorism, and 
     reconstruction efforts.
       (F) Address any other matters with respect to the conflict 
     in Syria that the Group considers appropriate.
       (2) Interim briefing.--Not later than June 30, 2018, the 
     Group shall provide to the Committees on Armed Services of 
     the Senate and the House of Representatives a briefing on the 
     status of its review and assessment under subsection (d), 
     together with a discussion of any interim recommendations 
     developed by the Group as of the date of the briefing.
       (3) Form of report.--The report submitted to Congress under 
     paragraph (1) shall be submitted in unclassified form, but 
     may include a classified annex.
       (g) Facilitation.--The United States Institute of Peace 
     shall take appropriate actions to facilitate the Group in the 
     discharge of its duties under this section.
       (h) Termination.--The Group shall terminate six months 
     after the date on which it submits the report required by 
     subsection (f)(1).
       (i) Funding.--Of the amounts authorized to be appropriated 
     for fiscal year 2018 for the Department of Defense by this 
     Act, $1,500,000 is available to fund the activities of the 
     Group.
                                 ______
                                 
  SA 328. Mrs. SHAHEEN submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the appropriate place, insert the following:

     SEC. __. FOREIGN AGENTS REGISTRATION.

       (a) Short Title.--This section may be cited as the 
     ``Foreign Agents Registration Modernization and Enforcement 
     Act''.
       (b) Civil Investigative Demand Authority.--The Foreign 
     Agents Registration Act of 1938 (22 U.S.C. 611 et seq.) is 
     amended--
       (1) by redesignating sections 8, 9, 10, 11, 12, 13, and 14 
     as sections 9, 10, 11, 12, 13, 14, and 16, respectively; and
       (2) by inserting after section 7 (22 U.S.C. 617) the 
     following:


                 ``CIVIL INVESTIGATIVE DEMAND AUTHORITY

       ``Sec. 8. (a) Whenever the Attorney General has reason to 
     believe that any person or enterprise may be in possession, 
     custody, or control of any documentary material relevant to 
     an investigation under this Act, the Attorney General, before 
     initiating a civil or criminal proceeding with respect to the 
     production of such material, may serve a written demand upon 
     such person to produce such material for examination.
       ``(b) Each such demand under subsection (a) shall--
       ``(1) state the nature of the conduct constituting the 
     alleged violation which is under investigation and the 
     provision of law applicable to such violation;
       ``(2) describe the class or classes of documentary material 
     required to be produced under such demand with such 
     definiteness and certainty as to permit such material to be 
     fairly identified;
       ``(3) state that the demand is immediately returnable or 
     prescribe a return date which will provide a reasonable 
     period within which the material may be assembled and made 
     available for inspection and copying or reproduction; and
       ``(4) identify the custodian to whom such material shall be 
     made available.
       ``(c) A demand under subsection (a) may not--
       ``(1) contain any requirement that would be considered 
     unreasonable if contained in a subpoena duces tecum issued by 
     a court of the United States in aid of grand jury 
     investigation of such alleged violation; or
       ``(2) require the production of any documentary evidence 
     that would be privileged from disclosure if demanded by a 
     subpoena duces tecum issued by a court of the United States 
     in aid of a grand jury investigation of such alleged 
     violation.''.
       (c) Informational Materials.--
       (1) Definitions.--Section 1 of the Foreign Agents 
     Registration Act of 1938, as amended (22 U.S.C. 611) is 
     amended--
       (A) in subsection (c), by striking ``Expect as provided in 
     subsection (d) hereof,'' and inserting ``Except as provided 
     in subsection (d),''; and
       (B) by inserting after subsection (i) the following:
       ``(j) The term `informational materials' means any oral, 
     visual, graphic, written, or pictorial information or matter 
     of any kind, including matter published by means of 
     advertising, books, periodicals, newspapers, lectures, 
     broadcasts, motion pictures, or any means or instrumentality 
     of interstate or foreign commerce or otherwise.''.
       (2) Informational materials.--Section 4 of the such Act (22 
     U.S.C. 614) is amended--
       (A) in subsection (a)--
       (i) by inserting ``, including electronic mail and social 
     media,'' after ``United States mails''; and
       (ii) by striking ``, not later than forty-eight hours after 
     the beginning of the transmittal thereof, file with the 
     Attorney General two copies thereof'' and inserting ``file 
     such materials with the Attorney General in conjunction with, 
     and at the same intervals as, disclosures required under 
     section 2(b).''; and
       (B) in subsection (b)--
       (i) by striking ``It shall'' and inserting ``(1) Except as 
     provided in paragraph (2), it shall''; and
       (ii) by inserting at the end the following:
       ``(2) Foreign agents described in paragraph (1) may omit 
     disclosure required under that paragraph in individual 
     messages, posts, or transmissions on social media on behalf 
     of a foreign principal if the social media account or profile 
     from which the information is sent includes a conspicuous 
     statement that--
       ``(A) the account is operated by, and distributes 
     information on behalf of, the foreign agent; and
       ``(B) additional information about the account is on file 
     with the Department of Justice in Washington, District of 
     Columbia.
       ``(3) Informational materials disseminated by an agent of a 
     foreign principal as part of an activity that is exempt from 
     registration, or an activity which by itself would not 
     require registration, need not be filed under this 
     subsection.''.
       (d) Fees.--
       (1) Repeal.--The Department of Justice and Related Agencies 
     Appropriations Act, 1993 (title I of Public Law 102-395) is 
     amended, under the heading ``salaries and expenses, general 
     legal activities'', by striking ``In addition, 
     notwithstanding 31 U.S.C. 3302, for fiscal year 1993 and 
     thereafter, the Attorney General shall establish and collect 
     fees to recover necessary expenses of the Registration Unit 
     (to include salaries, supplies, equipment and training) 
     pursuant to the Foreign Agents Registration Act, and shall 
     credit such fees to this appropriation, to remain available 
     until expended.''.
       (2) Registration fee.--The Foreign Agents Registration Act 
     of 1938, as amended (22 U.S.C. 611 et seq.), as amended by 
     this Act, is further amended by adding after section 14, as 
     redesignated by subsection (b)(1), the following:


                                 ``FEES

       ``Sec. 15. The Attorney General shall--
       ``(1) establish and collect a registration fee, as part of 
     the initial filing requirement, to help defray the expenses 
     of the FARA Registration Unit; and
       ``(2) credit such fees to the amount appropriated to carry 
     out the activities of the National Security Division, which 
     shall remain available until expended.''.
       (e) Reports to Congress.--Section 12 of the Foreign Agents 
     Registration Act of 1938, as amended, as redesignated by 
     subsection (b)(1), is amended to read as follows:

[[Page S4321]]

  



                         ``REPORTS TO CONGRESS

       ``Sec. 12. The Assistant Attorney General for National 
     Security, through the FARA Registration Unit of the National 
     Security Division, shall submit a semiannual report to 
     Congress regarding the administration of this Act. Each 
     report under this section shall include, for the applicable 
     reporting period, the identification of--
       ``(1) registrations filed pursuant to this Act;
       ``(2) the nature, sources, and content of political 
     propaganda disseminated and distributed by agents of foreign 
     principal;
       ``(3) the number of investigations initiated based upon a 
     perceived violation of section 8; and
       ``(4) the number of such investigations that were referred 
     to the Attorney General for prosecution.''.
                                 ______
                                 
  SA 329. Ms. BALDWIN (for herself, Mr. Reed, Mr. Kaine, and Ms. 
Warren) submitted an amendment intended to be proposed by her to the 
bill H.R. 2810, to authorize appropriations for fiscal year 2018 for 
military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle F of title VIII, add following:

     SEC. ___. SUPPORT OF AMERICA'S DEFENSE WORKERS.

       (a) Short Title.--This section may be cited as the 
     ``Supporting America's Defense Workers Act''.
       (b) Ineffectiveness of Section 863.--Section 863 shall have 
     no force or effect, and the amendments specified in section 
     863 shall not be made.
                                 ______
                                 
  SA 330. Mr. TILLIS submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 104, line 15, strike ``mental health services'' and 
     insert ``mental health services for conditions that are 
     defined in the Diagnostic and Statistical Manual of Mental 
     Disorders at the time of the enrollee's diagnosis, including 
     Autism Spectrum Disorder,''.
                                 ______
                                 
  SA 331. Mr. COONS (for himself and Mr. Blumenthal) submitted an 
amendment intended to be proposed by him to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       Beginning on page 102, strike line 1 and all that follows 
     through page 104, line 12, and insert the following:

     SEC. 203. EXPANSION AND MODIFICATION OF CREDIT FOR EMPLOYEE 
                   HEALTH INSURANCE EXPENSES OF SMALL EMPLOYERS.

       (a) Expansion of Definition of Eligible Small Employer.--
     Subparagraph (A) of section 45R(d)(1) of the Internal Revenue 
     Code of 1986 is amended by striking ``25'' and inserting 
     ``50''.
       (b) Amendment to Phaseout Determination.--Subsection (c) of 
     section 45R of the Internal Revenue Code of 1986 is amended 
     to read as follows:
       ``(c) Phaseout of Credit Amount Based on Number of 
     Employees and Average Wages.--The amount of the credit 
     determined under subsection (b) (without regard to this 
     subsection) shall be adjusted (but not below zero) by 
     multiplying such amount by the product of--
       ``(1) the lesser of--
       ``(A) a fraction the numerator of which is the excess (if 
     any) of 50 over the total number of full-time equivalent 
     employees of the employer and the denominator of which is 30, 
     and
       ``(B) 1, and
       ``(2) the lesser of--
       ``(A) a fraction--
       ``(i) the numerator of which is the excess (if any) of--

       ``(I) the dollar amount in effect under subsection 
     (d)(3)(B) for the taxable year, multiplied by 3, over
       ``(II) the average annual wages of the employer for such 
     taxable year, and

       ``(ii) the denominator of which is the dollar amount so in 
     effect under subsection (d)(3)(B), multiplied by 2, and
       ``(B) 1.''.
       (c) Extension of Credit Period.--Paragraph (2) of section 
     45R(e) of the Internal Revenue Code of 1986 is amended by 
     striking ``2-consecutive-taxable year period'' and all that 
     follows and inserting ``3-consecutive-taxable year period 
     beginning with the 1st taxable year beginning after 2016 in 
     which--
       ``(A) the employer (or any predecessor) offers 1 or more 
     qualified health plans to its employees through an Exchange, 
     and
       ``(B) the employer (or any predecessor) claims the credit 
     under this section.''.
       (d) Average Annual Wage Limitation.--Subparagraph (B) of 
     section 45R(d)(3) of the Internal Revenue Code of 1986 is 
     amended to read as follows:
       ``(B) Dollar amount.--For purposes of paragraph (1)(B) and 
     subsection (c)(2), the dollar amount in effect under this 
     paragraph is the amount equal to 110 percent of the poverty 
     line (within the meaning of section 36B(d)(3)) for a family 
     of 4.''.
       (e) Elimination of Uniform Percentage Contribution 
     Requirement.--Paragraph (4) of section 45R(d) of the Internal 
     Revenue Code of 1986 is amended by striking ``a uniform 
     percentage (not less than 50 percent)'' and inserting ``at 
     least 50 percent''.
       (f) Elimination of Cap Relating to Average Local 
     Premiums.--Subsection (b) of section 45R of the Internal 
     Revenue Code of 1986 is amended by striking ``the lesser of'' 
     and all that follows and inserting ``the aggregate amount of 
     nonelective contributions the employer made on behalf of its 
     employees during the taxable year under the arrangement 
     described in subsection (d)(4) for premiums for qualified 
     health plans offered by the employer to its employees through 
     an Exchange.''.
       (g) Amendment Relating to Annual Wage Limitation.--
     Subparagraph (B) of section 45R(d)(1) of the Internal Revenue 
     Code of 1986 is amended by striking ``twice'' and inserting 
     ``three times''.
       (h) Effective Date.--The amendments made by this section 
     shall apply to amounts paid or incurred in taxable years 
     beginning after December 31, 2016.
                                 ______
                                 
  SA 332. Mr. COONS (for himself and Mr. Blumenthal) submitted an 
amendment intended to be proposed by him to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. ANNUAL AND LIFETIME LIMITS.

       A State granted a waiver under section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052), as 
     amended by this Act, shall ensure that the provisions of 
     section 2711 of the Public Health Service Act (42 U.S.C. 
     300gg-11) shall continue to apply to health insurance issuers 
     in the State with respect to any essential health benefit as 
     defined by the Secretary of Health and Human Services under 
     section 1302(b) of the Patient Protection and Affordable Care 
     Act.
                                 ______
                                 
  SA 333. Mr. COONS (for himself, Mr. Durbin, and Mr. Blumenthal) 
submitted an amendment intended to be proposed by him to the bill H.R. 
1628, to provide for reconciliation pursuant to title II of the 
concurrent resolution on the budget for fiscal year 2017; which was 
ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. LEVEL OF COVERAGE.

       A State granted a waiver with respect to essential health 
     benefits coverage under section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052), as 
     amended by this Act, shall ensure that new essential health 
     benefits provided under the waiver provide at least a level 
     of coverage that is equal to the essential health benefits 
     coverage provided to Members of Congress.
                                 ______
                                 
  SA 334. Mr. COONS (for himself and Mr. Blumenthal) submitted an 
amendment intended to be proposed to amendment SA 267 proposed by Mr. 
McConnell to the bill H.R. 1628, to provide for reconciliation pursuant 
to title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. NOTICE REQUIREMENT.

       The President shall notify in writing any individual who 
     receives a cut in health care benefits, lower quality health 
     insurance, or loses health insurance altogether that these 
     changes are the result of this Act and the amendments made by 
     this Act.
                                 ______
                                 
  SA 335. Mr. KING (for himself, Mr. Blumenthal, Mr. Casey, Mrs. 
Shaheen, and Mr. Coons) submitted an amendment intended to be proposed 
by him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING 
                   PROGRAMS.

       Section 511(j)(1) of the Social Security Act (42 U.S.C. 
     711(j)(1)) is amended--
       (1) in subparagraph (G), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (H), by striking the period at the end 
     and inserting ``; and'';and
       (3) by adding at the end the following new subparagraph:
       ``(I) for each of fiscal years 2018 through 2027, 
     $400,000,000.''.
                                 ______
                                 
  SA 336. Mr. KING (for himself, Mr. Blumenthal, and Mrs. Shaheen) 
submitted an amendment intended to be

[[Page S4322]]

proposed to amendment SA 267 proposed by Mr. McConnell to the bill H.R. 
1628, to provide for reconciliation pursuant to title II of the 
concurrent resolution on the budget for fiscal year 2017; which was 
ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. REDUCING INFANT MORTALITY.

       The Secretary of Health and Human Services shall implement 
     programs to protect, preserve, maintain, sustain, and expand 
     all programs related to addressing, identifying the cause of, 
     and reducing infant mortality.
                                 ______
                                 
  SA 337. Mr. KING (for himself, Mr. Blumenthal, and Mrs. Shaheen) 
submitted an amendment intended to be proposed to amendment SA 267 
proposed by Mr. McConnell to the bill H.R. 1628, to provide for 
reconciliation pursuant to title II of the concurrent resolution on the 
budget for fiscal year 2017; which was ordered to lie on the table; as 
follows:

       At the appropriate place, insert the following:

     SEC. ____. NATIONAL HEALTH SERVICE CORPS.

       There are authorized to be appropriated, and there are 
     appropriated, for each of fiscal years 2018 through 2026, 
     $400,000,000 to carry out the National Health Service Corps 
     program under subpart II of part D of title III of the Public 
     Health Service Act (42 U.S.C. 254d et seq.) and the 
     scholarship program and loan repayment program under subpart 
     III of part D of title III of the Public Health Service Act 
     (42 U.S.C. 254l et seq.).
                                 ______
                                 
  SA 338. Mr. KING (for himself, Mr. Blumenthal, and Mrs. Shaheen) 
submitted an amendment intended to be proposed to amendment SA 267 
proposed by Mr. McConnell to the bill H.R. 1628, to provide for 
reconciliation pursuant to title II of the concurrent resolution on the 
budget for fiscal year 2017; which was ordered to lie on the table; as 
follows:

       Strike section 201.
                                 ______
                                 
  SA 339. Mr. GRASSLEY submitted an amendment intended to be proposed 
to amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PRESERVATION OF RIGHT TO MAINTAIN EXISTING COVERAGE.

       (a) In General.--Section 1251 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18011) is amended:
       (1) in subsection (e), by inserting ``other than a plan or 
     coverage described in subsection (f)'' before the period; and
       (2) by adding at the end the following:
       ``(f) Preservation of Existing Options.--In the case of a 
     group health plan or health insurance coverage (other than a 
     qualified health plan offered on an exchange established 
     pursuant to this Act) offered to the members of an 
     agricultural organization exempt from Federal income tax 
     under section 501(c)(5) of the Internal Revenue Code of 1986, 
     in existence since 1918, that has been providing health 
     coverage to members since 1970, to the extent permitted by 
     applicable State law--
       ``(1) this subtitle and subtitle A (and the amendments made 
     by such subtitles) shall not apply, and
       ``(2) such plan or coverage shall not be subject to any 
     requirement of this Act that does not apply to a 
     grandfathered plan.
     This subsection shall apply to such plan or coverage, 
     including with respect to new enrollees.''.
       (b) Effective Date.--This section shall be effective for 
     plan and policy years beginning on or after January 1, 2018.
                                 ______
                                 
  SA 340. Mr. McCONNELL (for Mr. Daines) proposed an amendment to 
amendment SA 267 proposed by Mr. McConnell to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; as follows:

       In lieu of the matter proposed to be inserted, insert the 
     following:

     1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Expanded & 
     Improved Medicare For All Act''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Definitions and terms.

                   TITLE I--ELIGIBILITY AND BENEFITS

Sec. 101. Eligibility and registration.
Sec. 102. Benefits and portability.
Sec. 103. Qualification of participating providers.
Sec. 104. Prohibition against duplicating coverage.

                           TITLE II--FINANCES

                   Subtitle A--Budgeting and Payments

Sec. 201. Budgeting process.
Sec. 202. Payment of providers and health care clinicians.
Sec. 203. Payment for long-term care.
Sec. 204. Mental health services.
Sec. 205. Payment for prescription medications, medical supplies, and 
              medically necessary assistive equipment.
Sec. 206. Consultation in establishing reimbursement levels.

                          Subtitle B--Funding

Sec. 211. Overview: funding the Medicare For All Program.
Sec. 212. Appropriations for existing programs.

                       TITLE III--ADMINISTRATION

Sec. 301. Public administration; appointment of Director.
Sec. 302. Office of Quality Control.
Sec. 303. Regional and State administration; employment of displaced 
              clerical workers.
Sec. 304. Confidential electronic patient record system.
Sec. 305. National Board of Universal Quality and Access.

                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Treatment of VA and IHS health programs.
Sec. 402. Public health and prevention.
Sec. 403. Reduction in health disparities.

                        TITLE V--EFFECTIVE DATE

Sec. 501. Effective date.

     SEC. 2. DEFINITIONS AND TERMS.

       In this Act:
       (1) Medicare for all program; program.--The terms 
     ``Medicare For All Program'' and ``Program'' mean the program 
     of benefits provided under this Act and, unless the context 
     otherwise requires, the Secretary with respect to functions 
     relating to carrying out such program.
       (2) National board of universal quality and access.--The 
     term ``National Board of Universal Quality and Access'' means 
     such Board established under section 305.
       (3) Regional office.--The term ``regional office'' means a 
     regional office established under section 303.
       (4) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (5) Director.--The term ``Director'' means, in relation to 
     the Program, the Director appointed under section 301.

                   TITLE I--ELIGIBILITY AND BENEFITS

     SEC. 101. ELIGIBILITY AND REGISTRATION.

       (a) In General.--All individuals residing in the United 
     States (including any territory of the United States) are 
     covered under the Medicare For All Program entitling them to 
     a universal, best quality standard of care. Each such 
     individual shall receive a card with a unique number in the 
     mail. An individual's Social Security number shall not be 
     used for purposes of registration under this section.
       (b) Registration.--Individuals and families shall receive a 
     Medicare For All Program Card in the mail, after filling out 
     a Medicare For All Program application form at a health care 
     provider. Such application form shall be no more than 2 pages 
     long.
       (c) Presumption.--Individuals who present themselves for 
     covered services from a participating provider shall be 
     presumed to be eligible for benefits under this Act, but 
     shall complete an application for benefits in order to 
     receive a Medicare For All Program Card and have payment made 
     for such benefits.
       (d) Residency Criteria.--The Secretary shall promulgate a 
     rule that provides criteria for determining residency for 
     eligibility purposes under the Medicare For All Program.
       (e) Coverage for Visitors.--The Secretary shall promulgate 
     a rule regarding visitors from other countries who seek 
     premeditated non-emergency surgical procedures. Such a rule 
     should facilitate the establishment of country-to-country 
     reimbursement arrangements or self pay arrangements between 
     the visitor and the provider of care.

     SEC. 102. BENEFITS AND PORTABILITY.

       (a) In General.--The health care benefits under this Act 
     cover all medically necessary services, including at least 
     the following:
       (1) Primary care and prevention.
       (2) Approved dietary and nutritional therapies.
       (3) Inpatient care.
       (4) Outpatient care.
       (5) Emergency care.
       (6) Prescription drugs.
       (7) Durable medical equipment.
       (8) Long-term care.
       (9) Palliative care.
       (10) Mental health services.
       (11) The full scope of dental services, services, including 
     periodontics, oral surgery, and endodontics, but not 
     including cosmetic dentistry.
       (12) Substance abuse treatment services.
       (13) Chiropractic services, not including electrical 
     stimulation.
       (14) Basic vision care and vision correction (other than 
     laser vision correction for cosmetic purposes).
       (15) Hearing services, including coverage of hearing aids.
       (16) Podiatric care.
       (b) Portability.--Such benefits are available through any 
     licensed health care clinician anywhere in the United States 
     that is legally qualified to provide the benefits.

[[Page S4323]]

       (c) No Cost-Sharing.--No deductibles, copayments, 
     coinsurance, or other cost-sharing shall be imposed with 
     respect to covered benefits.

     SEC. 103. QUALIFICATION OF PARTICIPATING PROVIDERS.

       (a) Requirement To Be Public or Non-Profit.--
       (1) In general.--No institution may be a participating 
     provider unless it is a public or not-for-profit institution. 
     Private physicians, private clinics, and private health care 
     providers shall continue to operate as private entities, but 
     are prohibited from being investor owned.
       (2) Conversion of investor-owned providers.--For-profit 
     providers of care opting to participate shall be required to 
     convert to not-for-profit status.
       (3) Private delivery of care requirement.--For-profit 
     providers of care that convert to non-profit status shall 
     remain privately owned and operated entities.
       (4) Compensation for conversion.--The owners of such for-
     profit providers shall be compensated for reasonable 
     financial losses incurred as a result of the conversion from 
     for-profit to non-profit status.
       (5) Funding.--There are authorized to be appropriated from 
     the Treasury such sums as are necessary to compensate 
     investor-owned providers as provided for under paragraph (3).
       (6) Requirements.--The payments to owners of converting 
     for-profit providers shall occur during a 15-year period, 
     through the sale of U.S. Treasury Bonds. Payment for 
     conversions under paragraph (3) shall not be made for loss of 
     business profits.
       (7) Mechanism for conversion process.--The Secretary shall 
     promulgate a rule to provide a mechanism to further the 
     timely, efficient, and feasible conversion of for-profit 
     providers of care.
       (b) Quality Standards.--
       (1) In general.--Health care delivery facilities must meet 
     State quality and licensing guidelines as a condition of 
     participation under such program, including guidelines 
     regarding safe staffing and quality of care.
       (2) Licensure requirements.--Participating clinicians must 
     be licensed in their State of practice and meet the quality 
     standards for their area of care. No clinician whose license 
     is under suspension or who is under disciplinary action in 
     any State may be a participating provider.
       (c) Participation of Health Maintenance Organizations.--
       (1) In general.--Non-profit health maintenance 
     organizations that deliver care in their own facilities and 
     employ clinicians on a salaried basis may participate in the 
     program and receive global budgets or capitation payments as 
     specified in section 202.
       (2) Exclusion of certain health maintenance 
     organizations.--Other health maintenance organizations which 
     principally contract to pay for services delivered by non-
     employees shall be classified as insurance plans. Such 
     organizations shall not be participating providers, and are 
     subject to the regulations promulgated by reason of section 
     104(a) (relating to prohibition against duplicating 
     coverage).
       (d) Freedom of Choice.--Patients shall have free choice of 
     participating physicians and other clinicians, hospitals, and 
     inpatient care facilities.

     SEC. 104. PROHIBITION AGAINST DUPLICATING COVERAGE.

       (a) In General.--It is unlawful for a private health 
     insurer to sell health insurance coverage that duplicates the 
     benefits provided under this Act.
       (b) Construction.--Nothing in this Act shall be construed 
     as prohibiting the sale of health insurance coverage for any 
     additional benefits not covered by this Act, such as for 
     cosmetic surgery or other services and items that are not 
     medically necessary.

                           TITLE II--FINANCES

                   Subtitle A--Budgeting and Payments

     SEC. 201. BUDGETING PROCESS.

       (a) Establishment of Operating Budget and Capital 
     Expenditures Budget.--
       (1) In general.--To carry out this Act there are 
     established on an annual basis consistent with this title--
       (A) an operating budget, including amounts for optimal 
     physician, nurse, and other health care professional 
     staffing;
       (B) a capital expenditures budget;
       (C) reimbursement levels for providers consistent with 
     subtitle B; and
       (D) a health professional education budget, including 
     amounts for the continued funding of resident physician 
     training programs.
       (2) Regional allocation.--After Congress appropriates 
     amounts for the annual budget for the Medicare For All 
     Program, the Director shall provide the regional offices with 
     an annual funding allotment to cover the costs of each 
     region's expenditures. Such allotment shall cover global 
     budgets, reimbursements to clinicians, health professional 
     education, and capital expenditures. Regional offices may 
     receive additional funds from the national program at the 
     discretion of the Director.
       (b) Operating Budget.--The operating budget shall be used 
     for--
       (1) payment for services rendered by physicians and other 
     clinicians;
       (2) global budgets for institutional providers;
       (3) capitation payments for capitated groups; and
       (4) administration of the Program.
       (c) Capital Expenditures Budget.--The capital expenditures 
     budget shall be used for funds needed for--
       (1) the construction or renovation of health facilities; 
     and
       (2) for major equipment purchases.
       (d) Prohibition Against Co-Mingling Operations and Capital 
     Improvement Funds.--It is prohibited to use funds under this 
     Act that are earmarked--
       (1) for operations for capital expenditures; or
       (2) for capital expenditures for operations.

     SEC. 202. PAYMENT OF PROVIDERS AND HEALTH CARE CLINICIANS.

       (a) Establishing Global Budgets; Monthly Lump Sum.--
       (1) In general.--The Medicare For All Program, through its 
     regional offices, shall pay each institutional provider of 
     care, including hospitals, nursing homes, community or 
     migrant health centers, home care agencies, or other 
     institutional providers or pre-paid group practices, a 
     monthly lump sum to cover all operating expenses under a 
     global budget.
       (2) Establishment of global budgets.--The global budget of 
     a provider shall be set through negotiations between 
     providers, State directors, and regional directors, but are 
     subject to the approval of the Director. The budget shall be 
     negotiated annually, based on past expenditures, projected 
     changes in levels of services, wages and input, costs, a 
     provider's maximum capacity to provide care, and proposed new 
     and innovative programs.
       (b) Three Payment Options for Physicians and Certain Other 
     Health Professionals.--
       (1) In general.--The Program shall pay physicians, 
     dentists, doctors of osteopathy, pharmacists, psychologists, 
     chiropractors, doctors of optometry, nurse practitioners, 
     nurse midwives, physicians' assistants, and other advanced 
     practice clinicians as licensed and regulated by the States 
     by the following payment methods:
       (A) Fee for service payment under paragraph (2).
       (B) Salaried positions in institutions receiving global 
     budgets under paragraph (3).
       (C) Salaried positions within group practices or non-profit 
     health maintenance organizations receiving capitation 
     payments under paragraph (4).
       (2) Fee for service.--
       (A) In general.--The Program shall negotiate a simplified 
     fee schedule that is fair and optimal with representatives of 
     physicians and other clinicians, after close consultation 
     with the National Board of Universal Quality and Access and 
     regional and State directors. Initially, the current 
     prevailing fees or reimbursement would be the basis for the 
     fee negotiation for all professional services covered under 
     this Act.
       (B) Considerations.--In establishing such schedule, the 
     Director shall take into consideration the following:
       (i) The need for a uniform national standard.
       (ii) The goal of ensuring that physicians, clinicians, 
     pharmacists, and other medical professionals be compensated 
     at a rate which reflects their expertise and the value of 
     their services, regardless of geographic region and past fee 
     schedules.
       (C) State physician practice review boards.--The State 
     director for each State, in consultation with representatives 
     of the physician community of that State, shall establish and 
     appoint a physician practice review board to assure quality, 
     cost effectiveness, and fair reimbursements for physician 
     delivered services.
       (D) Final guidelines.--The Director shall be responsible 
     for promulgating final guidelines to all providers.
       (E) Billing.--Under this Act physicians shall submit bills 
     to the regional director on a simple form, or via computer. 
     Interest shall be paid to providers who are not reimbursed 
     within 30 days of submission.
       (F) No balance billing.--Licensed health care clinicians 
     who accept any payment from the Medicare For All Program may 
     not bill any patient for any covered service.
       (G) Uniform computer electronic billing system.--The 
     Director shall create a uniform computerized electronic 
     billing system, including those areas of the United States 
     where electronic billing is not yet established.
       (3) Salaries within institutions receiving global 
     budgets.--
       (A) In general.--In the case of an institution, such as a 
     hospital, health center, group practice, community and 
     migrant health center, or a home care agency that elects to 
     be paid a monthly global budget for the delivery of health 
     care as well as for education and prevention programs, 
     physicians and other clinicians employed by such institutions 
     shall be reimbursed through a salary included as part of such 
     a budget.
       (B) Salary ranges.--Salary ranges for health care providers 
     shall be determined in the same way as fee schedules under 
     paragraph (2).
       (4) Salaries within capitated groups.--
       (A) In general.--Health maintenance organizations, group 
     practices, and other institutions may elect to be paid 
     capitation payments to cover all outpatient, physician, and 
     medical home care provided to individuals enrolled to receive 
     benefits through the organization or entity.
       (B) Scope.--Such capitation may include the costs of 
     services of licensed physicians and other licensed, 
     independent practitioners provided to inpatients. Other costs 
     of

[[Page S4324]]

     inpatient and institutional care shall be excluded from 
     capitation payments, and shall be covered under institutions' 
     global budgets.
       (C) Prohibition of selective enrollment.--Patients shall be 
     permitted to enroll or disenroll from such organizations or 
     entities without discrimination and with appropriate notice.
       (D) Health maintenance organizations.--Under this Act--
       (i) health maintenance organizations shall be required to 
     reimburse physicians based on a salary; and
       (ii) financial incentives between such organizations and 
     physicians based on utilization are prohibited.

     SEC. 203. PAYMENT FOR LONG-TERM CARE.

       (a) Allotment for Regions.--The Program shall provide for 
     each region a single budgetary allotment to cover a full 
     array of long-term care services under this Act.
       (b) Regional Budgets.--Each region shall provide a global 
     budget to local long-term care providers for the full range 
     of needed services, including in-home, nursing home, and 
     community based care.
       (c) Basis for Budgets.--Budgets for long-term care services 
     under this section shall be based on past expenditures, 
     financial and clinical performance, utilization, and 
     projected changes in service, wages, and other related 
     factors.
       (d) Favoring Non-Institutional Care.--All efforts shall be 
     made under this Act to provide long-term care in a home- or 
     community-based setting, as opposed to institutional care.

     SEC. 204. MENTAL HEALTH SERVICES.

       (a) In General.--The Program shall provide coverage for all 
     medically necessary mental health care on the same basis as 
     the coverage for other conditions. Licensed mental health 
     clinicians shall be paid in the same manner as specified for 
     other health professionals, as provided for in section 
     202(b).
       (b) Favoring Community-Based Care.--The Medicare For All 
     Program shall cover supportive residences, occupational 
     therapy, and ongoing mental health and counseling services 
     outside the hospital for patients with serious mental 
     illness. In all cases the highest quality and most effective 
     care shall be delivered, and, for some individuals, this may 
     mean institutional care.

     SEC. 205. PAYMENT FOR PRESCRIPTION MEDICATIONS, MEDICAL 
                   SUPPLIES, AND MEDICALLY NECESSARY ASSISTIVE 
                   EQUIPMENT.

       (a) Negotiated Prices.--The prices to be paid each year 
     under this Act for covered pharmaceuticals, medical supplies, 
     and medically necessary assistive equipment shall be 
     negotiated annually by the Program.
       (b) Prescription Drug Formulary.--
       (1) In general.--The Program shall establish a prescription 
     drug formulary system, which shall encourage best-practices 
     in prescribing and discourage the use of ineffective, 
     dangerous, or excessively costly medications when better 
     alternatives are available.
       (2) Promotion of use of generics.--The formulary shall 
     promote the use of generic medications but allow the use of 
     brand-name and off-formulary medications.
       (3) Formulary updates and petition rights.--The formulary 
     shall be updated frequently and clinicians and patients may 
     petition their region or the Director to add new 
     pharmaceuticals or to remove ineffective or dangerous 
     medications from the formulary.

     SEC. 206. CONSULTATION IN ESTABLISHING REIMBURSEMENT LEVELS.

       Reimbursement levels under this subtitle shall be set after 
     close consultation with regional and State Directors and 
     after the annual meeting of National Board of Universal 
     Quality and Access.

                          Subtitle B--Funding

     SEC. 211. OVERVIEW: FUNDING THE MEDICARE FOR ALL PROGRAM.

       (a) In General.--The Medicare For All Program is to be 
     funded as provided in subsection (c)(1).
       (b) Medicare For All Trust Fund.--There shall be 
     established a Medicare For All Trust Fund in which funds 
     provided under this section are deposited and from which 
     expenditures under this Act are made.
       (c) Funding.--
       (1) In general.--There are appropriated to the Medicare For 
     All Trust Fund amounts sufficient to carry out this Act from 
     the following sources:
       (A) Existing sources of Federal Government revenues for 
     health care.
       (B) Increasing personal income taxes on the top 5 percent 
     income earners.
       (C) Instituting a modest and progressive excise tax on 
     payroll and self-employment income.
       (D) Instituting a modest tax on unearned income.
       (E) Instituting a small tax on stock and bond transactions.
       (2) System savings as a source of financing.--Funding 
     otherwise required for the Program is reduced as a result 
     of--
       (A) vastly reducing paperwork;
       (B) requiring a rational bulk procurement of medications 
     under section 205(a); and
       (C) improved access to preventive health care.
       (3) Additional annual appropriations to medicare for all 
     program.--Additional sums are authorized to be appropriated 
     annually as needed to maintain maximum quality, efficiency, 
     and access under the Program.

     SEC. 212. APPROPRIATIONS FOR EXISTING PROGRAMS.

       Notwithstanding any other provision of law, there are 
     hereby transferred and appropriated to carry out this Act, 
     amounts from the Treasury equivalent to the amounts the 
     Secretary estimates would have been appropriated and expended 
     for Federal public health care programs, including funds that 
     would have been appropriated under the Medicare program under 
     title XVIII of the Social Security Act, under the Medicaid 
     program under title XIX of such Act, and under the Children's 
     Health Insurance Program under title XXI of such Act.

                       TITLE III--ADMINISTRATION

     SEC. 301. PUBLIC ADMINISTRATION; APPOINTMENT OF DIRECTOR.

       (a) In General.--Except as otherwise specifically provided, 
     this Act shall be administered by the Secretary through a 
     Director appointed by the Secretary.
       (b) Long-Term Care.--The Director shall appoint a director 
     for long-term care who shall be responsible for 
     administration of this Act and ensuring the availability and 
     accessibility of high quality long-term care services.
       (c) Mental Health.--The Director shall appoint a director 
     for mental health who shall be responsible for administration 
     of this Act and ensuring the availability and accessibility 
     of high quality mental health services.

     SEC. 302. OFFICE OF QUALITY CONTROL.

       The Director shall appoint a director for an Office of 
     Quality Control. Such director shall, after consultation with 
     State and regional directors, provide annual recommendations 
     to Congress, the President, the Secretary, and other Program 
     officials on how to ensure the highest quality health care 
     service delivery. The director of the Office of Quality 
     Control shall conduct an annual review on the adequacy of 
     medically necessary services, and shall make recommendations 
     of any proposed changes to the Congress, the President, the 
     Secretary, and other Medicare For All Program officials.

     SEC. 303. REGIONAL AND STATE ADMINISTRATION; EMPLOYMENT OF 
                   DISPLACED CLERICAL WORKERS.

       (a) Establishment of Medicare For All Program Regional 
     Offices.--The Secretary shall establish and maintain Medicare 
     For All regional offices for the purpose of distributing 
     funds to providers of care. Whenever possible, the Secretary 
     should incorporate pre-existing Medicare infrastructure for 
     this purpose.
       (b) Appointment of Regional and State Directors.--In each 
     such regional office there shall be--
       (1) one regional director appointed by the Director; and
       (2) for each State in the region, a deputy director (in 
     this Act referred to as a ``State Director'') appointed by 
     the governor of that State.
       (c) Regional Office Duties.--Regional offices of the 
     Program shall be responsible for--
       (1) coordinating funding to health care providers and 
     physicians; and
       (2) coordinating billing and reimbursements with physicians 
     and health care providers through a State-based reimbursement 
     system.
       (d) State Director's Duties.--Each State Director shall be 
     responsible for the following duties:
       (1) Providing an annual State health care needs assessment 
     report to the National Board of Universal Quality and Access, 
     and the regional board, after a thorough examination of 
     health needs, in consultation with public health officials, 
     clinicians, patients, and patient advocates.
       (2) Health planning, including oversight of the placement 
     of new hospitals, clinics, and other health care delivery 
     facilities.
       (3) Health planning, including oversight of the purchase 
     and placement of new health equipment to ensure timely access 
     to care and to avoid duplication.
       (4) Submitting global budgets to the regional director.
       (5) Recommending changes in provider reimbursement or 
     payment for delivery of health services in the State.
       (6) Establishing a quality assurance mechanism in the State 
     in order to minimize both under utilization and over 
     utilization and to assure that all providers meet high 
     quality standards.
       (7) Reviewing program disbursements on a quarterly basis 
     and recommending needed adjustments in fee schedules needed 
     to achieve budgetary targets and assure adequate access to 
     needed care.
       (e) First Priority in Retraining and Job Placement; 2 Years 
     of Salary Parity Benefits.--The Program shall provide that 
     clerical, administrative, and billing personnel in insurance 
     companies, doctors offices, hospitals, nursing facilities, 
     and other facilities whose jobs are eliminated due to reduced 
     administration--
       (1) should have first priority in retraining and job 
     placement in the new system; and
       (2) shall be eligible to receive two years of Medicare For 
     All employment transition benefits with each year's benefit 
     equal to salary earned during the last 12 months of 
     employment, but shall not exceed $100,000 per year.
       (f) Establishment of Medicare For All Employment Transition 
     Fund.--The Secretary shall establish a trust fund from

[[Page S4325]]

     which expenditures shall be made to recipients of the 
     benefits allocated in subsection (e).
       (g) Annual Appropriations to Medicare For All Employment 
     Transition Fund.--Sums are authorized to be appropriated 
     annually as needed to fund the Medicare For All Employment 
     Transition Benefits.
       (h) Retention of Right to Unemployment Benefits.--Nothing 
     in this section shall be interpreted as a waiver of Medicare 
     For All Employment Transition benefit recipients' right to 
     receive Federal and State unemployment benefits.

     SEC. 304. CONFIDENTIAL ELECTRONIC PATIENT RECORD SYSTEM.

       (a) In General.--The Secretary shall create a standardized, 
     confidential electronic patient record system in accordance 
     with laws and regulations to maintain accurate patient 
     records and to simplify the billing process, thereby reducing 
     medical errors and bureaucracy.
       (b) Patient Option.--Notwithstanding that all billing shall 
     be preformed electronically, patients shall have the option 
     of keeping any portion of their medical records separate from 
     their electronic medical record.

     SEC. 305. NATIONAL BOARD OF UNIVERSAL QUALITY AND ACCESS.

       (a) Establishment.--
       (1) In general.--There is established a National Board of 
     Universal Quality and Access (in this section referred to as 
     the ``Board'') consisting of 15 members appointed by the 
     President, by and with the advice and consent of the Senate.
       (2) Qualifications.--The appointed members of the Board 
     shall include at least one of each of the following:
       (A) Health care professionals.
       (B) Representatives of institutional providers of health 
     care.
       (C) Representatives of health care advocacy groups.
       (D) Representatives of labor unions.
       (E) Citizen patient advocates.
       (3) Terms.--Each member shall be appointed for a term of 6 
     years, except that the President shall stagger the terms of 
     members initially appointed so that the term of no more than 
     3 members expires in any year.
       (4) Prohibition on conflicts of interest.--No member of the 
     Board shall have a financial conflict of interest with the 
     duties before the Board.
       (b) Duties.--
       (1) In general.--The Board shall meet at least twice per 
     year and shall advise the Secretary and the Director on a 
     regular basis to ensure quality, access, and affordability.
       (2) Specific issues.--The Board shall specifically address 
     the following issues:
       (A) Access to care.
       (B) Quality improvement.
       (C) Efficiency of administration.
       (D) Adequacy of budget and funding.
       (E) Appropriateness of reimbursement levels of physicians 
     and other providers.
       (F) Capital expenditure needs.
       (G) Long-term care.
       (H) Mental health and substance abuse services.
       (I) Staffing levels and working conditions in health care 
     delivery facilities.
       (3) Establishment of universal, best quality standard of 
     care.--The Board shall specifically establish a universal, 
     best quality of standard of care with respect to--
       (A) appropriate staffing levels;
       (B) appropriate medical technology;
       (C) design and scope of work in the health workplace;
       (D) best practices; and
       (E) salary level and working conditions of physicians, 
     clinicians, nurses, other medical professionals, and 
     appropriate support staff.
       (4) Twice-a-year report.--The Board shall report its 
     recommendations twice each year to the Secretary, the 
     Director, Congress, and the President.
       (c) Compensation, etc.--The following provisions of section 
     1805 of the Social Security Act shall apply to the Board in 
     the same manner as they apply to the Medicare Payment 
     Assessment Commission (except that any reference to the 
     Commission or the Comptroller General shall be treated as 
     references to the Board and the Secretary, respectively):
       (1) Subsection (c)(4) (relating to compensation of Board 
     members).
       (2) Subsection (c)(5) (relating to chairman and vice 
     chairman).
       (3) Subsection (c)(6) (relating to meetings).
       (4) Subsection (d) (relating to director and staff; experts 
     and consultants).
       (5) Subsection (e) (relating to powers).

                    TITLE IV--ADDITIONAL PROVISIONS

     SEC. 401. TREATMENT OF VA AND IHS HEALTH PROGRAMS.

       (a) VA Health Programs.--This Act provides for health 
     programs of the Department of Veterans' Affairs to initially 
     remain independent for the 10-year period that begins on the 
     date of the establishment of the Medicare For All Program. 
     After such 10-year period, the Congress shall reevaluate 
     whether such programs shall remain independent or be 
     integrated into the Medicare For All Program.
       (b) Indian Health Service Programs.--This Act provides for 
     health programs of the Indian Health Service to initially 
     remain independent for the 5-year period that begins on the 
     date of the establishment of the Medicare For All Program, 
     after which such programs shall be integrated into the 
     Medicare For All Program.

     SEC. 402. PUBLIC HEALTH AND PREVENTION.

       It is the intent of this Act that the Program at all times 
     stress the importance of good public health through the 
     prevention of diseases.

     SEC. 403. REDUCTION IN HEALTH DISPARITIES.

       It is the intent of this Act to reduce health disparities 
     by race, ethnicity, income and geographic region, and to 
     provide high quality, cost-effective, culturally appropriate 
     care to all individuals regardless of race, ethnicity, sexual 
     orientation, or language.

                        TITLE V--EFFECTIVE DATE

     SEC. 501. EFFECTIVE DATE.

       Except as otherwise specifically provided, this Act shall 
     take effect on the first day of the first year that begins 
     more than 1 year after the date of the enactment of this Act, 
     and shall apply to items and services furnished on or after 
     such date.
                                 ______
                                 
  SA 341. Mr. UDALL (for himself, Ms. Cantwell, Ms. Cortez Masto, Ms. 
Heitkamp, Mr. Franken, Mrs. Murray, Mr. Schatz, Ms. Stabenow, Mr. 
Tester, and Mr. Merkley) submitted an amendment intended to be proposed 
by him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. POINT OF ORDER AGAINST LEGISLATION THAT WOULD REDUCE 
                   OR LIMIT FEDERAL PAYMENTS FOR HEALTH INSURANCE 
                   OR HEALTH CARE FOR AMERICAN INDIANS OR ALASKA 
                   NATIVES.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that 
     would--
       (1) reduce or limit Federal payments to help cover the cost 
     of private health insurance with respect to private health 
     insurance purchased by American Indians or Alaska Natives; or
       (2) reduce or limit Federal payments for spending under the 
     Medicaid program with respect to services provided by the 
     Indian Health Service, an Indian Health Program, an Urban 
     Indian Organization, or Indian tribes or other tribal 
     organizations, or with respect to services provided to 
     individuals who are American Indians or Alaska Natives.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).
                                 ______
                                 
  SA 342. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in increased premiums under employer-sponsored insurance.
                                 ______
                                 
  SA 343. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in increased deductibles under employer-sponsored insurance.
                                 ______
                                 
  SA 344. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in the loss of pregnancy, maternity, and newborn care (both 
     before and after birth) under qualified health plans.

[[Page S4326]]

  

                                 ______
                                 
  SA 345. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in the loss of mental health and substance use disorder 
     services, including behavioral health treatment (including 
     counseling and psychotherapy) under qualified health plans.
                                 ______
                                 
  SA 346. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. NO INCREASES IN DEDUCTIBLES.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in increased deductibles under qualified health plans.
                                 ______
                                 
  SA 347. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in the loss of coverage for people under qualified health 
     plans.
                                 ______
                                 
  SA 348. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. NO INCREASES IN UNCOMPENSATED CARE.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not increase 
     uncompensated care at nonprofit or hospitals operated by the 
     Federal Government.
                                 ______
                                 
  SA 349. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO OPIOID ADDICTION.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment for opioid addiction. Funds 
     appropriated under this section shall remain available until 
     expended.
                                 ______
                                 
  SA 350. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH PLANS.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in individuals losing access to their current health plans, 
     if such individuals wish to keep such plans.
                                 ______
                                 
  SA 351. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO DOMESTIC VIOLENCE.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support assistance for victims of domestic 
     violence. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 352. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO PEDIATRIC CANCERS.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of pediatric cancers. Funds 
     appropriated under this section shall remain available until 
     expended.
                                 ______
                                 
  SA 353. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO CANCER.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of adults with cancer. Funds 
     appropriated under this section shall remain available until 
     expended.
                                 ______
                                 
  SA 354. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO CHILDREN WITH PRE-
                   EXISTING CONDITIONS.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of children with pre-existing 
     conditions. Funds appropriated under this section shall 
     remain available until expended.
                                 ______
                                 
  SA 355. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO ADULTS WITH PRE-
                   EXISTING CONDITIONS.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of adults with pre-existing 
     conditions. Funds appropriated under this section shall 
     remain available until expended.
                                 ______
                                 
  SA 356. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO DEPRESSION.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with depression. 
     Funds appropriated under this section shall remain available 
     until expended.
                                 ______
                                 
  SA 357. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:


[[Page S4327]]


  

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO MENTAL ILLNESS.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with mental 
     illness. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 358. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO HEART DISEASE.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with heart 
     disease. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 359. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO ALZHEIMER'S DISEASE.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with Alzheimer's 
     disease. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 360. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO BREAST CANCER.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with breast 
     cancer. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 361. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO PARKINSON'S DISEASE.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with Parkinson's 
     disease. Funds appropriated under this section shall remain 
     available until expended.
                                 ______
                                 
  SA 362. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO POST-TRAUMATIC STRESS 
                   DISORDER.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with post-
     traumatic stress disorder. Funds appropriated under this 
     section shall remain available until expended.
                                 ______
                                 
  SA 363. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       On page 129, strike lines 3 through 10 and insert the 
     following:

     SEC. 221. SUPPORT FOR STATE RESPONSE TO DIABETES.

       There is authorized to be appropriated, and is 
     appropriated, out of monies in the Treasury not otherwise 
     obligated, $10,000,000,000 for fiscal year 2018 to the 
     Secretary of Health and Human Services to provide grants to 
     States to support treatment of individuals with diabetes. 
     Funds appropriated under this section shall remain available 
     until expended.
                                 ______
                                 
  SA 364. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH CARE.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in the loss of coverage under the Medicaid program.
                                 ______
                                 
  SA 365. Mr. MURPHY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. PROTECTION OF INDIVIDUALS' HEALTH CARE.

       This Act (and the amendments made by this Act) shall not 
     take effect until the Chief Actuary of the Centers for 
     Medicare & Medicaid Services certifies to Congress that the 
     implementation of this Act (and amendments) will not result 
     in the loss of mental health and substance use disorder 
     services, including behavioral health treatment (including 
     counseling and psychotherapy) under the Medicaid program.
                                 ______
                                 
  SA 366. Mr. KAINE (for himself, Mr. Blumenthal, Mr. Carper, and Mrs. 
Shaheen) submitted an amendment intended to be proposed by him to the 
bill H.R. 1628, to provide for reconciliation pursuant to title II of 
the concurrent resolution on the budget for fiscal year 2017; which was 
ordered to lie on the table; as follows:

       Strike subtitles B through C of title I.
                                 ______
                                 
  SA 367. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       On page 312, strike line 21 and all that follows through 
     page 313, line 9.
                                 ______
                                 
  SA 368. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       Strike section 821.
                                 ______
                                 
  SA 369. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle H of title V, add the following:

     SEC. ___. REPORT ON POSSIBLE IMPROVEMENTS TO PROCESSING 
                   RETIREMENTS AND MEDICAL DISCHARGES.

       (a) Report Required.--Not later than 180 days after the 
     date of the enactment of this Act, the Secretary of Defense 
     shall, in consultation with the Secretary of Veterans 
     Affairs, submit to the congressional defense committees and 
     the Committees on Veterans' Affairs of the Senate and the 
     House of Representatives a report on possible improvements to 
     the transition of members of the Armed Forces to veteran 
     status.

[[Page S4328]]

       (b) Elements.--The report under subsection (a) shall 
     address the following:
       (1) Feasibility of requiring members of the Armed Forces to 
     apply for benefits administered by the Secretary of Veterans 
     Affairs before such members complete discharge from the Armed 
     Forces.
       (2) Feasibility of requiring members of the Armed Forces to 
     undergo compensation and pension examinations (to be 
     administered by the Secretary of Defense) for purposes of 
     obtaining benefits described in paragraph (1) before such 
     members complete discharge from the Armed Forces.
       (3) Possible improvements to the timeliness of the process 
     for transitioning members who undergo medical discharge to 
     care provided by the Secretary of Veterans Affairs.
                                 ______
                                 
  SA 370. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle B of title VII, add the following:

     SEC. ___. TRAINING REQUIREMENT FOR HEALTH CARE PROFESSIONALS 
                   OF THE DEPARTMENT OF DEFENSE PRESCRIBING 
                   OPIOIDS FOR TREATMENT OF PAIN.

       (a) Training.--
       (1) In general.--The Secretary of Defense shall ensure that 
     health care professionals of the Department of Defense, other 
     than pharmacists, who are authorized to prescribe or 
     otherwise dispense opioids for the treatment of pain--
       (A) complete the training described in paragraph (2) not 
     less frequently than once every three years; or
       (B) are licensed in a State that requires training that is 
     equivalent to or greater than the training described in 
     paragraph (2) with respect to the prescribing or dispensing 
     of opioids for the treatment of pain.
       (2) Training described.--
       (A) In general.--The training described in this paragraph 
     is not fewer than 12 hours of training (through classroom 
     situations, seminars at professional society meetings, 
     electronic communications, or otherwise) that is provided by 
     organizations specified in subparagraph (B) with respect to--
       (i) pain management treatment guidelines and best 
     practices;
       (ii) early detection of opioid addiction; and
       (iii) the treatment and management of opioid-dependent 
     patients.
       (B) Organizations specified.--The organizations specified 
     in this subparagraph are the following:
       (i) The American Society of Addiction Medicine.
       (ii) The American Academy of Addiction Psychiatry.
       (iii) The American Medical Association.
       (iv) The American Osteopathic Association.
       (v) The American Psychiatric Association.
       (vi) The American Academy of Pain Management.
       (vii) The American Pain Society.
       (viii) The American Academy of Pain Medicine.
       (ix) The American Board of Pain Medicine.
       (x) The American Society of Interventional Pain Physicians.
       (xi) Such other organizations as the Secretary of Defense 
     determines appropriate for purposes of this subsection.
       (b) Establishment of Training Modules.--
       (1) In general.--The Secretary of Defense shall establish 
     or support the establishment of one or more training modules 
     to be used to provide the training required under subsection 
     (a).
       (2) Support for organizations.--The Secretary may support 
     the establishment of a training module under paragraph (1) 
     by--
       (A) an organization specified in paragraph (2)(B) of 
     subsection (a); or
       (B) any other organization that the Secretary determines is 
     appropriate to provide the training required under such 
     subsection.
                                 ______
                                 
  SA 371. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle C of title VII, add the following:

     SEC. ___. PROVISION OF SUPPORT BY DEPARTMENT OF DEFENSE TO 
                   DEPARTMENT OF VETERANS AFFAIRS REGARDING 
                   ELECTRONIC HEALTH RECORD SYSTEM.

       (a) In General.--The Secretary of Defense may support the 
     Secretary of Veterans Affairs, to the extent the Secretary of 
     Defense and the Secretary of Veterans Affairs jointly 
     consider feasible and advisable, in the development and 
     implementation of an electronic health record system that--
       (1) is derivative of the Military Health System Genesis 
     record being developed and implemented by the Secretary of 
     Defense as of the date of the enactment of this Act; and
       (2) achieves complete interoperability with the Military 
     Health System Genesis.
       (b) Annual Review.--The Secretary of Defense and the 
     Secretary of Veterans Affairs shall jointly conduct an annual 
     review of the efforts undertaken by the Secretary of Defense 
     and the Secretary of Veterans Affairs to achieve complete 
     interoperability between the electronic health record of the 
     Department of Veterans Affairs and the Military Health System 
     Genesis.
       (c) Annual Report.--
       (1) Reports.--Not later than 60 days after completing each 
     annual review under subsection (b), the Secretary of Defense 
     and the Secretary of Veterans Affairs shall jointly submit to 
     the Committee on Armed Services and the Committee on 
     Veterans' Affairs of the Senate and the Committee on Armed 
     Services and the Committee on Veterans' Affairs of the House 
     of Representatives a report on the review.
       (2) Elements.--Each report under paragraph (1) shall 
     include an assessment of the following:
       (A) Milestones reached as part of the schedule developed by 
     the Department of Defense and the Department of Veterans 
     Affairs of the development and implementation of an 
     electronic health record system under subsection (a).
       (B) Costs associated with such development and 
     implementation.
       (C) Actions, if any, of the Secretary of Defense in 
     supporting the Secretary of Veterans Affairs pursuant to 
     subsection (a) with respect to the development and 
     implementation of an electronic health record system and in 
     achieving complete interoperability with the Military Health 
     System Genesis.
       (D) Status of the adoption of the national standards and 
     architectural requirements identified by the Interagency 
     Program Office of the Department of Defense and the 
     Department of Veterans Affairs in collaboration with the 
     Office of the National Coordinator for Health Information 
     Technology of the Department of Health and Human Services.
       (d) Termination.--The requirements under subsections (b) 
     and (c) shall terminate on the date on which the Secretary of 
     Defense and the Secretary of Veterans Affairs jointly certify 
     to the Committee on Armed Services and the Committee on 
     Veterans' Affairs of the Senate and the Committee on Armed 
     Services and the Committee on Veterans' Affairs of the House 
     of Representatives that the electronic health records of both 
     the Department of Defense and the Department of Veterans 
     Affairs are completely interoperable.
       (e) Interoperability Defined.--In this section, the term 
     ``interoperability'' means the ability of different 
     electronic health records systems or software to meaningfully 
     exchange information in real time and provide useful results 
     to one or more systems.
                                 ______
                                 
  SA 372. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle A of title VII, add the following:

     SEC. ___. COUNSELING AND TREATMENT FOR SUBSTANCE USE 
                   DISORDERS AND CHRONIC PAIN MANAGEMENT FOR 
                   MEMBERS WHO SEPARATE FROM THE ARMED FORCES.

       Section 1145(a)(6)(B)(i) of title 10, United States Code, 
     is amended--
       (1) in subclause (I)--
       (A) by inserting ``, substance use disorder,'' after 
     ``post-traumatic stress disorder''; and
       (B) by striking ``and'' at the end;
       (2) by redesignating subclause (II) as subclause (III); and
       (3) by inserting after subclause (I) the following new 
     subclause (II):
       ``(II) chronic pain management services, including 
     counseling and treatment of co-occurring mental health 
     disorders and alternatives to opioid analgesics; and''.
                                 ______
                                 
  SA 373. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the appropriate place, insert the following:

     SEC. __. RESPONSIBILITIES OF COMMERCIAL MARKET 
                   REPRESENTATIVES.

       Section 4(h) of the Small Business Act (15 U.S.C. 633(h)) 
     is amended to read as follows:
       ``(h) Commercial Market Representatives.--

[[Page S4329]]

       ``(1) Duties.--The principal duties of a commercial market 
     representative employed by the Administrator and reporting to 
     the senior official appointed by the Administrator with 
     responsibilities under sections 8, 15, 31, and 36 (or the 
     designee of the official) shall be to advance the policies 
     established in section 8(d)(1) relating to subcontracting, 
     including--
       ``(A) helping prime contractors to find small business 
     concerns that are capable of performing subcontracts;
       ``(B) for contractors awarded contracts containing the 
     clause described in section 8(d)(3), providing--
       ``(i) counseling on the responsibility of the contractor to 
     maximize subcontracting opportunities for small business 
     concerns;
       ``(ii) instruction on methods and tools to identify 
     potential subcontractors that are small business concerns; 
     and
       ``(iii) assistance to increase awards to subcontractors 
     that are small business concerns through visits, training, 
     and reviews of past performance;
       ``(C) providing counseling on how a small business concern 
     may promote the capacity of the small business concern to 
     contractors awarded contracts containing the clause described 
     in section 8(d)(3); and
       ``(D) conducting periodic reviews of contractors awarded 
     contracts containing the clause described in section 8(d)(3) 
     to assess compliance with subcontracting plans required under 
     section 8(d)(6).
       ``(2) Certification requirements.--
       ``(A) In general.--Consistent with the requirements of 
     subparagraph (B), a commercial market representative referred 
     to in section 15(q)(3) shall have a Level I Federal 
     Acquisition Certification in Contracting (or any successor 
     certification) or the equivalent Department of Defense 
     certification.
       ``(B) Delay of certification requirement.--The 
     certification described in subparagraph (A) is not required--
       ``(i) for any person serving as a commercial market 
     representative on the date of enactment of the National 
     Defense Authorization Act for Fiscal Year 2018, until the 
     date that is 1 calendar year after the date on which the 
     person was appointed as a commercial market representative; 
     or
       ``(ii) for any person serving as a commercial market 
     representative on or before November 25, 2015, until November 
     25, 2020.
       ``(3) Job posting requirements.--The duties and 
     certification requirements described in this subsection shall 
     be included in any initial job posting for the position of a 
     commercial market representative.''.
                                 ______
                                 
  SA 374. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle A of title IX, add the following:

     SEC. ___. DESIGNATION OF OFFICE WITHIN OFFICE OF THE 
                   SECRETARY OF DEFENSE TO OVERSEE USE OF FOOD 
                   ASSISTANCE PROGRAMS BY MEMBERS OF THE ARMED 
                   FORCES ON ACTIVE DUTY.

       Not later than 90 days after the date of the enactment of 
     this Act, the Secretary of Defense shall designate an office 
     or official within the Office of the Secretary of Defense for 
     purposes as follows:
       (1) To discharge responsibility for overseeing the efforts 
     of the Department of Defense to collect, analyze, and monitor 
     data on the use of food assistance programs by members of the 
     Armed Forces on active duty.
       (2) To establish and maintain relationships with other 
     departments and agencies of the Federal Government to 
     facilitate the discharge of the responsibility specified in 
     paragraph (1).
                                 ______
                                 
  SA 375. Ms. DUCKWORTH submitted an amendment intended to be proposed 
by her to the bill H.R. 2810, to authorize appropriations for fiscal 
year 2018 for military activities of the Department of Defense, for 
military construction, and for defense activities of the Department of 
Energy, to prescribe military personnel strengths for such fiscal year, 
and for other purposes; which was ordered to lie on the table; as 
follows:

       At the end of subtitle B of title VIII, add the following:

     SEC. 832. OPTIMIZATION OF MICRO-PURCHASE THRESHOLD TO 
                   INCREASE GOVERNMENT EFFICIENCY.

       (a) Increase in Threshold.--Section 1902(a)(1) of title 41, 
     United States Code, is amended--
       (1) by striking ``sections 2338 and 2339'' and inserting 
     ``section 2339''; and
       (2) by striking ``$3,000'' and inserting ``$10,000''.
       (b) Conforming and Clerical Amendments.--
       (1) Section 2338 of title 10, United States Code, is 
     repealed.
       (2) The table of sections at the beginning of chapter 137 
     of such title is amended by striking the item relating to 
     section 2338.
       (c) Convenience Checks.--A convenience check may not be 
     used for an amount in excess of one half of the micro-
     purchase threshold under section 1902(a) of title 41, United 
     States Code, or a lower amount set by the head of the agency. 
     Use of convenience checks shall comply with controls 
     prescribed in Office of Management and Budget Circular A-123, 
     Appendix B.
                                 ______
                                 
  SA 376. Ms. DUCKWORTH (for herself, Mr. Durbin, Mrs. Ernst, and Mr. 
Grassley) submitted an amendment intended to be proposed by her to the 
bill H.R. 2810, to authorize appropriations for fiscal year 2018 for 
military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle B of title XXVIII, add the 
     following:

     SEC. ___. CERTIFICATION RELATED TO CERTAIN ACQUISITIONS OR 
                   LEASES OF REAL PROPERTY.

       Section 2662(a) of title 10, United States Code, is 
     amended--
       (1) in paragraph (2), by striking the period at the end and 
     inserting the following: ``, as well as the certification 
     described in paragraph (5).''; and
       (2) by adding at the end the following:
       ``(5) For purposes of paragraph (2), the certification 
     described in this paragraph with respect to an acquisition or 
     lease of real property is a certification that the Secretary 
     concerned--
       ``(A) evaluated the feasibility of using space in property 
     under the jurisdiction of the Department of Defense to 
     satisfy the purposes of the acquisition or lease; and
       ``(B) determined that--
       ``(i) space in property under the jurisdiction of the 
     Department of Defense is not reasonably available to be used 
     to satisfy the purposes of the acquisition or lease;
       ``(ii) acquiring the property or entering into the lease 
     would be more cost-effective than the use of the Department 
     of Defense property; or
       ``(iii) the use of the Department of Defense property would 
     interfere with the ongoing military mission of the 
     property.''.
                                 ______
                                 
  SA 377. Mr. MENENDEZ (for himself, Mr. Durbin, Mr. Blumenthal, Mr. 
Booker, and Mr. Heinrich) submitted an amendment intended to be 
proposed by him to the bill H.R. 1628, to provide for reconciliation 
pursuant to title II of the concurrent resolution on the budget for 
fiscal year 2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. POINT OF ORDER AGAINST ELIMINATING OR REDUCING 
                   FEDERAL FUNDING TO STATES UNDER THE MEDICAID 
                   EXPANSION.

       (a) Point of Order.--It shall not be in order in the Senate 
     to consider any bill, joint resolution, motion, amendment, 
     amendment between the Houses, or conference report that would 
     eliminate or reduce funding to States available under law in 
     effect on the date of the adoption of this section to provide 
     comprehensive, affordable health care to low-income Americans 
     by eliminating or reducing the availability of Federal 
     financial assistance to States available under section 
     1905(y)(1) or 1905(z)(2) of the Social Security Act (42 
     U.S.C. 1396d(y)(1), 1396d(z)(2)) or other means, unless the 
     Director of the Congressional Budget Office certifies that 
     the legislation would not--
       (1) increase the number of uninsured Americans;
       (2) decrease Medicaid enrollment in States that have opted 
     to expand eligibility for medical assistance under that 
     program for low-income, non-elderly individuals under the 
     eligibility option established by the Affordable Care Act 
     under section 1902(a)(10)(A)(i)(VIII) of the Social Security 
     Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII));
       (3) reduce the likelihood that any State that, as of the 
     date of the adoption of this section, has not opted to expand 
     Medicaid under the eligibility option established by the 
     Affordable Care Act under section 1902(a)(10)(A)(i)(VIII) of 
     the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)(VIII)) 
     would opt to use that eligibility option to expand 
     eligibility for medical assistance under that program for 
     low-income, non-elderly individuals; and
       (4) increase the State share of Medicaid spending under 
     that eligibility option.
       (b) Waiver and Appeal.--Subsection (a) may be waived or 
     suspended in the Senate only by an affirmative vote of three-
     fifths of the Members, duly chosen and sworn. An affirmative 
     vote of three-fifths of the Members of the Senate, duly 
     chosen and sworn, shall be required to sustain an appeal of 
     the ruling of the Chair on a point of order raised under 
     subsection (a).
                                 ______
                                 
  SA 378. Mr. MARKEY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:


[[Page S4330]]


  

       At the appropriate place, insert the following:

     SEC. __. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would reduce the Federal Government's financial 
     commitment to currently active and successful Medicaid 
     waivers under section 1115 of the Social Security Act that 
     are promoting the objectives of title XIX of such Act shall 
     be null and void and this Act shall be applied and 
     administered as if such provisions and amendments had never 
     been enacted.
                                 ______
                                 
  SA 379. Mr. MARKEY (for himself, Ms. Warren, Mr. Carper, Mr. Casey, 
Mr. Brown, Ms. Hirono, Ms. Stabenow, Mr. Menendez, and Mr. Van Hollen) 
submitted an amendment intended to be proposed by him to the bill H.R. 
1628, to provide for reconciliation pursuant to title II of the 
concurrent resolution on the budget for fiscal year 2017; which was 
ordered to lie on the table; as follows:
       At the appropriate place, insert the following:

     SEC. __. NULLIFICATION OF CERTAIN PROVISIONS.

       If the Congressional Budget Office determines that the 
     provisions of, or the amendments made by, this Act would 
     increase the amount of uncompensated care provided by 
     hospitals, such provisions or amendments shall be null and 
     void and this Act shall be applied and administered as if 
     such provisions and amendments had not been enacted.
                                 ______
                                 
  SA 380. Mr. MARKEY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. MEMBERS OF CONGRESS.

       Notwithstanding any other provision of law, if, as a result 
     of the enactment of this Act, the rate of uninsured 
     individuals in the United States is higher on the date that 
     is 1 year after the date of enactment of this Act than such 
     rate was on the date of enactment of this Act, Members of 
     Congress shall not be eligible for an employer contribution 
     to their health plan premiums until the rate of uninsured 
     individuals in the United States is equal to or lower than 
     such rate on the date of enactment of this Act.
                                 ______
                                 
  SA 381. Mr. MARKEY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

     :  At the appropriate place, insert the following:

     SEC. __. NULLIFICATION OF CERTAIN PROVISIONS.

       If the Congressional Budget Office determines that the 
     provisions of, or the amendments made by, this Act would 
     increase the average premium or out-of-pocket health care 
     costs for individuals who have attained 50 years of age, such 
     provisions or amendments shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had not been enacted.
                                 ______
                                 
  SA 382. Mr. MARKEY submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. REPEAL OF CERTAIN PROVISIONS IF PERCENTAGE OF 
                   UNINSURED INCREASES.

       Not later than 30 days after the date that is 1 year after 
     the date of enactment of this Act, the Director of the 
     Congressional Budget Office shall determine whether the 
     percentage of uninsured individuals in America is higher than 
     the percentage of such individuals as of such date of 
     enactment. If the percentage of such individuals has 
     increased during that 1-year period as a result of changes 
     made by this Act, effective as of the date of such 
     determination, the provisions of, and the amendments made by, 
     this Act that terminate the Medicaid expansion and impose 
     Medicaid per capita caps shall be null and void and this Act 
     shall be applied and administered as if such provisions and 
     amendments had never been enacted.
                                 ______
                                 
  SA 383. Mr. FRANKEN (for himself, Mr. Cornyn, Ms. Heitkamp, and Ms. 
Baldwin) submitted an amendment intended to be proposed by him to the 
bill H.R. 2810, to authorize appropriations for fiscal year 2018 for 
military activities of the Department of Defense, for military 
construction, and for defense activities of the Department of Energy, 
to prescribe military personnel strengths for such fiscal year, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle B of title V, add the following:

               PART II--RESERVE COMPONENT BENEFITS PARITY

     SEC. ___. ELIGIBILITY OF RESERVE COMPONENT MEMBERS FOR PRE-
                   MOBILIZATION HEALTH CARE.

       Section 1074(d)(2) of title 10, United States Code, is 
     amended by striking ``in support of a contingency operation 
     under'' and inserting ``under section 12304b of this title 
     or''.

     SEC. ___. ELIGIBILITY OF RESERVE COMPONENT MEMBERS FOR 
                   TRANSITIONAL HEALTH CARE.

       Section 1145(a)(2)(B) of title 10, United States Code, is 
     amended by striking ``in support of a contingency operation'' 
     and inserting ``under section 12304b of this title or a 
     provision of law referred to in section 101(a)(13)(B) of this 
     title''.

     SEC. ___. CONSIDERATION OF SERVICE ON ACTIVE DUTY TO REDUCE 
                   AGE FOR ELIGIBILITY FOR RETIRED PAY FOR NON-
                   REGULAR SERVICE.

       Section 12731(f)(2)(B)(i) of title 10, United States Code, 
     is amended by striking ``under a provision of law referred to 
     in section 101(a)(13)(B) or under section 12301(d)'' and 
     inserting ``under section 12301(d) or 12304b of this title or 
     a provision of law referred to in section 101(a)(13)(B)''.

     SEC. ___. ELIGIBILITY OF RESERVE COMPONENT MEMBERS FOR HIGH-
                   DEPLOYMENT ALLOWANCE FOR LENGTHY OR NUMEROUS 
                   DEPLOYMENTS AND FREQUENT MOBILIZATIONS.

       Section 436(a)(2)(C)(ii) of title 37, United States Code, 
     is amended by inserting after ``under'' the first place it 
     appears the following: ``section 12304b of title 10 or''.

     SEC. ___. ELIGIBILITY OF RESERVE COMPONENT MEMBERS FOR POST-
                   9/11 EDUCATIONAL ASSISTANCE.

       Section 3301(1)(B) of title 38, United States Code, is 
     amended by striking ``or 12304'' and inserting ``12304, 
     12304a, or 12304b''.

     SEC. ___. ELIGIBILITY OF RESERVE COMPONENT MEMBERS FOR 
                   NONREDUCTION IN PAY WHILE SERVING IN THE 
                   UNIFORMED SERVICES OR NATIONAL GUARD.

       Section 5538(a) of title 5, United States Code, is amended 
     in the matter preceding paragraph (1) by inserting after 
     ``under'' the following: ``section 12304b of title 10 or''.

     SEC. ___. EFFECT OF ORDER TO SERVE ON ACTIVE DUTY ON 
                   ELIGIBILITY FOR OR USE OF CERTAIN MILITARY 
                   BENEFITS.

       (a) Exception to Voluntary Separation Pay Repayment 
     Requirement for Members Who Return to Active Duty.--Section 
     1175a(j)(2) of title 10, United States Code, is amended by 
     striking ``or 12304'' and inserting ``12304, 12304a, or 
     12304b''.
       (b) Time Limitation for Training and Rehabilitation for 
     Veterans With Service-Connected Disabilities.--Section 
     3103(f) of title 38, United States Code, is amended by 
     striking ``or 12304'' and inserting ``12304, 12304a, or 
     12304b''.

     SEC. ___. RETROACTIVE APPLICABILITY OF AMENDMENTS.

       The amendments made by this part shall apply with respect 
     to any order for a member of a reserve component to serve on 
     active duty under section 12304a or 12304b of title 10, 
     United States Code, issued on or after January 1, 2012.
                                 ______
                                 
  SA 384. Mr. MANCHIN (for himself, Mr. Murphy, Mr. Whitehouse, Mr. 
King, Ms. Klobuchar, Mr. Nelson, Ms. Heitkamp, Mrs. Shaheen, Ms. 
Baldwin, Mr. Blumenthal, and Ms. Warren) submitted an amendment 
intended to be proposed to amendment SA 267 proposed by Mr. McConnell 
to the bill H.R. 1628, to provide for reconciliation pursuant to title 
II of the concurrent resolution on the budget for fiscal year 2017; 
which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __01. STEWARDSHIP FEE ON OPIOID PAIN RELIEVERS.

       (a) In General.--Subchapter E of chapter 32 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new section:

     ``SEC. 4192. OPIOID PAIN RELIEVERS.

       ``(a) In General.--There is hereby imposed on the sale of 
     any active opioid by the manufacturer, producer, or importer 
     a fee equal to 1 cent per milligram so sold.
       ``(b) Active Opioid.--For purposes of this section--
       ``(1) In general.--The term `active opioid' means any 
     controlled substance (as defined in section 102 of the 
     Controlled Substances Act, as in effect on the date of the 
     enactment of this section) which is opium, an opiate, or any 
     derivative thereof.
       ``(2) Exclusion for certain prescription medications.--Such 
     term shall not include any prescribed drug which is used 
     exclusively for the treatment of opioid addiction as part of 
     a medically assisted treatment effort.
       ``(3) Exclusion of other ingredients.--In the case of a 
     product that includes an active opioid and another 
     ingredient, subsection (a) shall apply only to the portion of 
     such product that is an active opioid.''.
       (b) Clerical Amendments.--
       (1) The heading of subchapter E of chapter 32 of the 
     Internal Revenue Code of 1986 is amended by striking 
     ``Medical Devices'' and inserting ``Other Medical Products''.
       (2) The table of subchapters for chapter 32 of such Code is 
     amended by striking the item

[[Page S4331]]

     relating to subchapter E and inserting the following new 
     item:

               ``subchapter e. other medical products''.

       (3) The table of sections for subchapter E of chapter 32 of 
     such Code is amended by adding at the end the following new 
     item:

``Sec. 4192. Opioid pain relievers.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to sales on or after the date that is 1 year 
     after the date of the enactment of this Act.
       (d) Rebate or Discount Program for Certain Cancer and 
     Hospice Patients.--
       (1) In general.--The Secretary of Health and Human 
     Services, in consultation with patient advocacy groups and 
     other relevant stakeholders as determined by such Secretary, 
     shall establish a mechanism by which--
       (A) any amount paid by an eligible patient in connection 
     with the stewardship fee under section 4192 of the Internal 
     Revenue Code of 1986 (as added by this section) shall be 
     rebated to such patient in as timely a manner as possible, or
       (B) amounts paid by an eligible patient for active opioids 
     (as defined in section 4192(b) of such Code) are discounted 
     at time of payment or purchase to ensure that such patient 
     does not pay any amount attributable to such fee,
     with as little burden on the patient as possible. The 
     Secretary shall choose whichever of the options described in 
     subparagraph (A) or (B) is, in the Secretary's determination, 
     most effective and efficient in ensuring eligible patients 
     face no economic burden from such fee.
       (2) Eligible patient.--For purposes of this section, the 
     term ``eligible patient'' means--
       (A) a patient for whom any active opioid (as so defined) is 
     prescribed to treat pain relating to cancer or cancer 
     treatment;
       (B) a patient participating in hospice care; and
       (C) in the case of the death or incapacity of a patient 
     described in subparagraph (A) or (B) or any similar situation 
     as determined by the Secretary of Health and Human Services, 
     the appropriate family member, medical proxy, or similar 
     representative or the estate of such patient.

     SEC. __02. BLOCK GRANTS FOR PREVENTION AND TREATMENT OF 
                   SUBSTANCE ABUSE.

       (a) Grants to States.--Section 1921(b) of the Public Health 
     Service Act (42 U.S.C. 300x-21(b)) is amended by inserting 
     ``, and, as applicable, for carrying out section 1923A'' 
     before the period.
       (b) Nonapplicability of Prevention Program Provision.--
     Section 1922(a)(1) of the Public Health Service Act (42 
     U.S.C. 300x-22(a)(1)) is amended by inserting ``except with 
     respect to amounts made available as described in section 
     1923A,'' before ``will expend''.
       (c) Opioid Treatment Programs.--Subpart II of part B of 
     title XIX of the Public Health Service Act (42 U.S.C. 300x-21 
     et seq.) is amended by inserting after section 1923 the 
     following:

     ``SEC. 1923A. ADDITIONAL SUBSTANCE ABUSE TREATMENT PROGRAMS.

       ``A funding agreement for a grant under section 1921 is 
     that the State involved shall provide that any amounts made 
     available by any increase in revenues to the Treasury in the 
     previous fiscal year resulting from the enactment of section 
     4192 of the Internal Revenue Code of 1986, reduced by any 
     amounts rebated or discounted under section _01(d) of the 
     _______ Act (as described in section 1933(a)(1)(B)(i)) be 
     used exclusively for substance abuse (including opioid abuse) 
     treatment efforts in the State, including--
       ``(1) treatment programs--
       ``(A) establishing new addiction treatment facilities, 
     residential and outpatient, including covering capital costs;
       ``(B) establishing sober living facilities;
       ``(C) recruiting and increasing reimbursement for certified 
     mental health providers providing substance abuse treatment 
     in medically underserved communities or communities with high 
     rates of prescription drug abuse;
       ``(D) expanding access to long-term, residential treatment 
     programs for opioid addicts (including  30-, 60-, and 90-day 
     programs);
       ``(E) establishing or operating support programs that offer 
     employment services, housing, and other support services to 
     help recovering addicts transition back into society;
       ``(F) establishing or operating housing for children whose 
     parents are participating in substance abuse treatment 
     programs, including capital costs;
       ``(G) establishing or operating facilities to provide care 
     for babies born with neonatal abstinence syndrome, including 
     capital costs; and
       ``(H) other treatment programs, as the Secretary determines 
     appropriate; and
       ``(2) recruitment and training of substance use disorder 
     professionals to work in rural and medically underserved 
     communities.''.
       (d) Additional Funding.--Section 1933(a)(1)(B)(i) of the 
     Public Health Service Act (42 U.S.C. 300x-33(a)(1)(B)(i)) is 
     amended by inserting ``, plus any increase in revenues to the 
     Treasury in the previous fiscal year resulting from the 
     enactment of section 4192 of the Internal Revenue Code of 
     1986, reduced by any amounts rebated or discounted under 
     section _01(d) of the _______ Act'' before the period.

     SEC. __03. REPORT.

       Not later than 2 years after the date described in section 
     __01(c), the Secretary of Health and Human Services shall 
     submit to Congress a report on the impact of the amendments 
     made by sections _01 and _02 on--
       (1) the retail cost of active opioids (as defined in 
     section 4192 of the Internal Revenue Code of 1986, as added 
     by section __01);
       (2) patient access to such opioids, particularly cancer and 
     hospice patients, including the effect of the discount or 
     rebate on such opioids for cancer and hospice patients under 
     section _01(d);
       (3) how the increase in revenue to the Treasury resulting 
     from the enactment of section 4192 of the Internal Revenue 
     Code of 1986 is used to improve substance abuse treatment 
     efforts in accordance with section 1923A of the Public Health 
     Service Act (as added by section _02); and
       (4) suggestions for improving--
       (A) access to opioids for cancer and hospice patients; and
       (B) substance abuse treatment efforts under such section 
     1923A.
                                 ______
                                 
  SA 385. Mr. MANCHIN (for himself and Mr. Blumenthal) submitted an 
amendment intended to be proposed by him to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. HEALTH EDUCATION AND LITERACY FOR MEDICAID 
                   BENEFICIARIES.

       (a) Guidelines.--Not later than 1 year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services (in this section referred to as the ``Secretary)'' 
     shall issue guidelines that require States to provide health 
     education and literacy training to Medicaid enrollees. The 
     guidelines shall include information on the following:
       (1) Making healthy choices, including nutrition, exercise, 
     and smoking cessation.
       (2) How to manage chronic diseases.
       (3) How to navigate the healthcare system, including 
     finding a primary care physician and seeking care at the 
     appropriate location.
       (4) Helping Medicaid enrollees select a primary care 
     physician and make appointments, when appropriate.
       (b) State Implementation.--Not later than 2 years after the 
     date of enactment of this Act, each State with a State 
     Medicaid plan under title XIX of the Social Security Act 
     shall implement the guidelines issued under subsection (a) 
     and demonstrate to the Secretary that enrollees are receiving 
     the health education and literacy training required under 
     such guidelines. In implementing such guidelines, a State 
     shall take into consideration barriers to enrollee 
     participation, including transportation, health status, 
     language barriers, and such other barriers as the Secretary 
     may designate.
                                 ______
                                 
  SA 386. Mr. MANCHIN (for himself, Mr. Brown, Mr. Warner, Mr. Kaine, 
Mr. Coons, and Mr. Casey) submitted an amendment intended to be 
proposed by him to the bill H.R. 1628, to provide for reconciliation 
pursuant to title II of the concurrent resolution on the budget for 
fiscal year 2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. NULLIFICATION OF CERTAIN PROVISIONS.

       The provisions of, and the amendments made by, this Act 
     that would weaken the financial viability of the Black Lung 
     Clinics serving coal miners with pneumoconiosis, including 
     any provision that would cause an increase in the rate of 
     uninsured individuals in the communities served by those 
     clinics, shall be null and void and this Act shall be applied 
     and administered as if such provisions and amendments had 
     never been enacted.
                                 ______
                                 
  SA 387. Mr. CARDIN (for himself, Mr. Carper, Mr. Nelson, Ms. Warren, 
Mr. Blumenthal, Mr. Brown, Mr. Van Hollen, Ms. Stabenow, Ms. Duckworth, 
and Mr. Markey) submitted an amendment intended to be proposed by him 
to the bill H.R. 1628, to provide for reconciliation pursuant to title 
II of the concurrent resolution on the budget for fiscal year 2017; 
which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. __. STRIKING PROVISIONS THAT WEAKEN THE ACCESSIBILITY 
                   AND AFFORDABILITY OF HEALTH BENEFITS AND 
                   SERVICES.

       Any provision of this Act that would weaken access to 
     essential health benefits, reduce access to affordable 
     preventive services, or undermine the prohibition of annual 
     and lifetime limits and caps on out-of-pocket expenditures 
     for health insurance plans shall be null and void and of no 
     effect.
                                 ______
                                 
  SA 388. Mr. CRAPO (for himself and Mr. Risch) submitted an amendment 
intended to be proposed by him to the bill H.R. 2810, to authorize 
appropriations for fiscal year 2018 for military activities of the 
Department of Defense, for military construction, and

[[Page S4332]]

for defense activities of the Department of Energy, to prescribe 
military personnel strengths for such fiscal year, and for other 
purposes; which was ordered to lie on the table; as follows:

       At the end of subtitle C of title XXVIII, add the 
     following:

     SEC. 2826. LAND CONVEYANCE, MOUNTAIN HOME AIR FORCE BASE, 
                   IDAHO.

       (a) Conveyance Authorized.--The Secretary of the Air Force 
     may convey, without consideration, to the City of Mountain 
     Home, Idaho (in this section referred to as the ``City''), 
     all right, title, and interest of the United States in and to 
     a parcel of real property, including improvements thereon, 
     consisting of approximately 4.25 miles of railroad spur 
     located near Mountain Home Air Force Base, Idaho, as further 
     described in subsection (b), for the purpose of economic 
     development.
       (b) Map and Legal Description.--
       (1) Finalizing legal descriptions.--As soon as practicable 
     after the date of the enactment of this Act, the Secretary of 
     the Air Force shall finalize a map and the legal description 
     of the property to be conveyed under subsection (a).
       (2) Minor errors.--The Secretary of the Air Force may 
     correct any minor errors in the map or the legal description.
       (3) Availability.--The map and legal description shall be 
     on file and available for public inspection.
       (c) Payment of Costs of Conveyance.--
       (1) Payment required.--The Secretary may require the City 
     to cover all costs (except costs for environmental 
     remediation of the property) to be incurred by the Secretary, 
     or to reimburse the Secretary for costs incurred by the 
     Secretary, to carry out the conveyance under this section, 
     including survey costs, costs for environmental 
     documentation, and any other administrative costs related to 
     the conveyance. If amounts are collected from the City in 
     advance of the Secretary incurring the actual costs, and the 
     amount collected exceeds the costs actually incurred by the 
     Secretary to carry out the conveyance, the Secretary shall 
     refund the excess amount to the City.
       (2) Treatment of amounts received.--Amounts received under 
     paragraph (1) as reimbursement for costs incurred by the 
     Secretary to carry out the conveyance under subsection (a) 
     shall be credited to the fund or account that was used to 
     cover the costs incurred by the Secretary in carrying out the 
     conveyance, or to an appropriate fund or account currently 
     available to the Secretary for the purposes for which the 
     costs were paid. Amounts so credited shall be merged with 
     amounts in such fund or account and shall be available for 
     the same purposes, and subject to the same conditions and 
     limitations, as amounts in such fund or account.
       (d) Use Reservation.--The Secretary may reserve a right to 
     temporarily use, for urgent reasons of national defense and 
     at no cost to the United States, all or a portion of the 
     railroad spur conveyed under subsection (a).
       (e) Additional Terms and Conditions.--The Secretary may 
     require such additional terms and conditions in connection 
     with the conveyance under subsection (a) as the Secretary 
     considers appropriate to protect the interests of the United 
     States.
                                 ______
                                 
  SA 389. Mr. STRANGE submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. 1__. PREMIUM ASSISTANCE FOR LOW INCOME INDIVIDUALS.

       (a) In General.--Subsection (h) of section 2105 of the 
     Social Security Act (42 U.S.C. 1397ee), as added by this Act, 
     is amended to read as follows:
       ``(h) Short-term Assistance to Address Coverage and Access 
     Disruption and Provide Support for States and Direct Premium 
     Assistance.--
       ``(1) Appropriation.--There are authorized to be 
     appropriated, and are appropriated, out of monies in the 
     Treasury not otherwise obligated--
       ``(A) $15,000,000,000 for each of calendar years 2018 and 
     2019, and $10,000,000,000 for each of calendar years 2020 and 
     2021, to remain available until expended, to the 
     Administrator of the Centers for Medicare & Medicaid Services 
     (in this subsection and subsection (i) referred to as the 
     `Administrator') to fund arrangements with health insurance 
     issuers to assist in the purchase of health benefits coverage 
     by addressing coverage and access disruption and responding 
     to urgent health care needs within States; and
       ``(B) such sums as are necessary for calendar year 2019 and 
     each calendar year thereafter to the Secretary of the 
     Treasury for the purpose of making payments to the 
     Administrator to allow the Administrator to make the premium 
     assistance payments described in paragraph (2).
       ``(2) Premium assistance payments.--For calendar year 2019 
     and each calendar year thereafter, with respect to each 
     individual enrolled in a qualified health plan (as defined in 
     section 1301(a) of the Patient Protection and Affordable Care 
     Act) for whom an advance payment has been determined under 
     section 1412 of such Act (as reported by the Secretary under 
     subsection (c)(4)(B) of such section), the Administrator 
     shall pay to the issuer of such plan the amount described in 
     subsection (c)(4)(D) of such section.
       ``(3) Participation requirements.--
       ``(A) Guidance.--Not later than 30 days after the date of 
     enactment of this subsection, the Administrator shall issue 
     guidance to health insurance issuers regarding how to submit 
     a notice of intent to participate in the program established 
     under this subsection.
       ``(B) Notice of intent to participate.--To be eligible for 
     funding under this subsection, a health insurance issuer 
     shall submit to the Administrator a notice of intent to 
     participate at such time (but, in the case of funding for 
     calendar year 2018, not later than 35 days after the date of 
     enactment of this subsection and, in the case of funding for 
     any subsequent calendar year, not later than March 31 of the 
     previous year) and in such form and manner as specified by 
     the Administrator and containing--
       ``(i) a certification that the health insurance issuer will 
     use the funds in accordance with the requirements of 
     paragraph (6); and
       ``(ii) such information as the Administrator may require to 
     carry out this subsection.
       ``(4) Procedure for distribution of funds.--The 
     Administrator shall determine an appropriate procedure for 
     providing and distributing funds under this subsection that 
     includes reserving an amount equal to 1 percent of the amount 
     appropriated under paragraph (1)(A) for a calendar year for 
     providing and distributing funds to health insurance issuers 
     in States where the cost of insurance premiums are at least 
     75 percent higher than the national average.
       ``(5) No match.--Neither the State percentage applicable to 
     payments to States under subsection (i)(5)(B) nor any other 
     matching requirement shall apply to funds provided to health 
     insurance issuers under this subsection.
       ``(6) Use of funds.--Funds provided to a health insurance 
     issuer under paragraphs (1) and (2) shall be subject to the 
     requirements of paragraphs (1)(D) and (7) of subsection (i) 
     in the same manner as such requirements apply to States 
     receiving payments under subsection (i) and shall be used 
     only for the activities specified in paragraph (1)(A)(ii) of 
     subsection (i) or, in the case of funds provided under 
     paragraph (2), for reducing the amount of the premiums 
     charged to individuals as required under section 
     1412(c)(4)(E) of the Patient Protection and Affordable Care 
     Act.
       ``(7) Misuse of funds.--If the Administrator determines 
     that a health insurance issuer is not using funds provided 
     under this subsection in a manner consistent with the 
     requirements applicable to such funds, the Administrator may 
     withhold payments, reduce payments, or recover previous 
     payments to such health insurance issuer under this 
     subsection as the Administrator deems appropriate.''.
       (b) Pass-through of Funding.--Subsection (i) of section 
     2105 of the Social Security Act (42 U.S.C. 1397ee), as added 
     by this Act, is amended by adding at the end the following 
     new paragraph:
       ``(8) Pass-through of funding.--Beginning in calendar year 
     2019, notwithstanding the other requirements of funds 
     provided to States under this subsection, except for the 
     requirements of paragraphs (1)(D) and (7), with respect to a 
     State waiver under section 1332 of the Patient Protection and 
     Affordable Care Act under which, due to the structure of the 
     State plan, individuals would not qualify for advance 
     payments under section 1412 of such Act (or under which the 
     amount of such payments would be reduced), the Secretary 
     shall provide for an alternative means by which the aggregate 
     amount of such payments which would have been paid on behalf 
     of participants in the Exchange established under such Act 
     for or by the State if the State had not received such a 
     waiver, shall be paid to the State for the purpose of 
     assisting in the purchase of health benefits coverage by 
     implementing the State plan under the waiver. Such amount 
     shall be determined annually by the Secretary, taking into 
     consideration the experience of other States with respect to 
     participation in an Exchange and payments provided under such 
     section to residents of the other States. A State may request 
     that all of, or any portion of, the amount determined under 
     this paragraph for the State for a year be paid to the State 
     as described in subsection (h)(2).''.
       (c) Conforming Amendments.--
       (1) Section 2101(a) of the Social Security Act (42 U.S.C. 
     1397aa(a)), as previously amended by this Act, is amended in 
     the matter preceding paragraph (1), by striking ``short-term 
     assistance''.
       (2) Section 2105(c)(1) of the Social Security Act (42 
     U.S.C. 1397ee(c)(1)), as previously amended by this Act, is 
     amended by striking ``short-term assistance''.
       (3) Section 1332(a) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18052(a)), as previously 
     amended by this Act, is amended--
       (A) in paragraph (2), by adding at the end the following 
     new subparagraph:
       ``(E) Section 2105(h)(1)(B) of the Social Security Act.''; 
     and
       (B) in paragraph (3), by striking subparagraph (A) and 
     redesignating subparagraphs (B) and (C) as subparagraphs (A) 
     and (B), respectively.
       (d) Phasedown of Tax Credits.--
       (1) In general.--Subsection (b) of section 36B of the 
     Internal Revenue Code of 1986, as amended by section 102, is 
     further amended

[[Page S4333]]

     by adding at the end the following new paragraph:
       ``(4) Phasedown of premium assistance credit amount in 
     years after 2018.--In the case of any taxable year beginning 
     after 2018, the premium assistance credit amount is 1/10 of 
     the amount determined under paragraph (1) (without regard to 
     this paragraph).''.
       (2) Coordination with direct premium assistance.--
       (A) In general.--Subsection (c) of section 1412 of the 
     Patient Protection and Affordable Care Act is amended by 
     adding at the end the following new paragraph:
       ``(4) Coordination with direct premium assistance.--In the 
     case of calendar, taxable, and plan years beginning after 
     December 31, 2018--
       ``(A) solely for purposes of this section, the premium tax 
     credit under section 36B of the Internal Revenue Code of 1986 
     shall be determined without regard to subsection (b)(4) 
     thereof;
       ``(B) in addition to the persons described in paragraph 
     (1), the Secretary shall notify the Administrator of the 
     Centers for Medicare and Medicaid Services of the advance 
     determination under this section;
       ``(C) notwithstanding subparagraph (A), only \1/10\ of the 
     advance payment determined under this section (but for this 
     paragraph) shall be paid to the issuer of a qualified health 
     plan as provided in paragraph (2);
       ``(D) the remaining \9/10\ of the advance payment so 
     determined shall be paid to the Administrator of the Centers 
     for Medicare and Medicaid Services for the purposes described 
     in section 2105(h)(2) of the Social Security Act; and
       ``(E) an issuer of a qualified health plan receiving a 
     payment from the Administrator of the Centers for Medicare 
     and Medicaid Services under section 2105(h)(2) of the Social 
     Security Act shall treat such payment for purposes of 
     paragraph (2)(B) in the same manner as an advance payment 
     under paragraph (2).''.
       (B) Recapture of excess payments and information 
     reporting.--Subsection (f) of section 36B of the Internal 
     Revenue Code of 1986 is amended--
       (i) by striking ``advance payments to a taxpayer under 
     section 1412 of the Patient Protection and Affordable Care 
     Act for a taxable year exceed'' in paragraph (2)(A) and 
     inserting ``aggregate sum of any advance payments to a 
     taxpayer under section 1412 of the Patient Protection and 
     Affordable Care Act and any premium assistance paid to a 
     health insurance issuer with respect to such taxpayer under 
     section 2105(h)(2) of the Social Security Act for a taxable 
     year exceeds'',
       (ii) by inserting ``or subsection (b)(4)'' after 
     ``paragraph (1)'' in paragraph (2)(A),
       (iii) by striking ``or cost-sharing reductions under 
     section 1402 of such Act'' in paragraph (3)(B) and inserting 
     ``, premium assistance under section 2105(h)(2) of the Social 
     Security Act, or cost-sharing reductions under section 1402 
     of the Patient Protection and Affordable Care Act'',
       (iv) by striking ``such Act'' in paragraph (3)(C) and 
     inserting ``the Patient Protection and Affordable Care Act, 
     and any premium assistance under section 2105(h)(2) of the 
     Social Security Act'', and
       (v) by striking ``excess advance payments'' in paragraph 
     (3)(F) and inserting ``an excess aggregate amount of advance 
     payments and premium assistance payments for purposes of 
     paragraph (2)''.
       (C) Regulations.--Subsection (g) of section 36B of such 
     Code is amended by inserting ``and payments for premium 
     assistance'' after ``the credit'' both places it appears.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to years beginning after December 31, 2018.
                                 ______
                                 
  SA 390. Mr. BLUNT submitted an amendment intended to be proposed by 
him to the bill H.R. 1628, to provide for reconciliation pursuant to 
title II of the concurrent resolution on the budget for fiscal year 
2017; which was ordered to lie on the table; as follows:

       At the appropriate place, insert the following:

     SEC. ___. SIMPLIFICATION OF SEASONAL RULES FOR PURPOSES OF 
                   EMPLOYER SHARED RESPONSIBILITY REQUIREMENT.

       (a) Full-Time Employee Exception for Determining Assessable 
     Payment.--Paragraph (4) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended--
       (1) by redesignating subparagraph (B) as subparagraph (C), 
     and
       (2) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Exception for seasonal employees.--Such term shall 
     not include any seasonal employee.''.
       (b) Applicable Large Employer.--Subparagraph (B) of section 
     4980H(c)(2) of the Internal Revenue Code of 1986 is amended 
     to read as follows:
       ``(B) Exception for seasonal employees.--For purposes of 
     this paragraph, seasonal employees shall not be taken into 
     account as employees.''.
       (c) Seasonal Employee.--Subsection (c) of section 4980H of 
     the Internal Revenue Code of 1986 is amended--
       (1) by redesignating paragraphs (5), (6), and (7) as 
     paragraphs (6), (7), and (8), respectively, and
       (2) by inserting after paragraph (4) the following new 
     paragraph:
       ``(5) Seasonal employee.--The term `seasonal employee' 
     means an employee who is employed in a position for which the 
     customary annual employment is not more than 6 months and 
     which requires performing labor or services which are 
     ordinarily performed at certain seasons or periods of the 
     year.''.
       (d) Effective Date.--The amendments made by this section 
     shall take effect as if included in section 1513 of the 
     Patient Protection and Affordable Care Act.
                                 ______
                                 
  SA 391. Mr. GRAHAM (for himself and Mr. Cassidy) submitted an 
amendment intended to be proposed by him to the bill H.R. 1628, to 
provide for reconciliation pursuant to title II of the concurrent 
resolution on the budget for fiscal year 2017; which was ordered to lie 
on the table; as follows:

       Strike all after the enacting clause and insert the 
     following:

                                TITLE I

     SEC. 101. ELIMINATION OF LIMITATION ON RECAPTURE OF EXCESS 
                   ADVANCE PAYMENTS OF PREMIUM TAX CREDITS.

       Subparagraph (B) of section 36B(f)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new clause:
       ``(iii) Nonapplicability of limitation.--This subparagraph 
     shall not apply to taxable years ending after December 31, 
     2017.''.

     SEC. 102. PREMIUM TAX CREDIT.

       (a) Premium Tax Credit.--
       (1) Modification of definition of qualified health plan.--
       (A) In general.--Section 36B(c)(3)(A) of the Internal 
     Revenue Code of 1986 is amended by inserting before the 
     period at the end the following: ``or a plan that includes 
     coverage for abortions (other than any abortion necessary to 
     save the life of the mother or any abortion with respect to a 
     pregnancy that is the result of an act of rape or incest)''.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2017.
       (2) Repeal.--
       (A) In general.--Subpart C of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 is amended by 
     striking section 36B.
       (B) Effective date.--The amendment made by this paragraph 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Repeal of Eligibility Determinations.--
       (1) In general.--The following sections of the Patient 
     Protection and Affordable Care Act are repealed:
       (A) Section 1411 (other than subsection (i), the last 
     sentence of subsection (e)(4)(A)(ii), and such provisions of 
     such section solely to the extent related to the application 
     of the last sentence of subsection (e)(4)(A)(ii)).
       (B) Section 1412.
       (2) Effective date.--The repeals in paragraph (1) shall 
     take effect on January 1, 2020.
       (c) Protecting Americans by Repeal of Disclosure Authority 
     To Carry Out Eligibility Requirements for Certain Programs.--
       (1) In general.--Paragraph (21) of section 6103(l) of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new subparagraph:
       ``(D) Termination.--No disclosure may be made under this 
     paragraph after December 31, 2019.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on January 1, 2020.

     SEC. 103. MODIFICATIONS TO SMALL BUSINESS TAX CREDIT.

       (a) Sunset.--
       (1) In general.--Section 45R of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     subsection:
       ``(j) Shall Not Apply.--This section shall not apply with 
     respect to amounts paid or incurred in taxable years 
     beginning after December 31, 2019.''.
       (2) Effective date.--The amendment made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2019.
       (b) Disallowance of Small Employer Health Insurance Expense 
     Credit for Plan Which Includes Coverage for Abortion.--
       (1) In general.--Subsection (h) of section 45R of the 
     Internal Revenue Code of 1986 is amended--
       (A) by striking ``Any term'' and inserting the following:
       ``(1) In general.--Any term'', and
       (B) by adding at the end the following new paragraph:
       ``(2) Exclusion of health plans including coverage for 
     abortion.--The term `qualified health plan' does not include 
     any health plan that includes coverage for abortions (other 
     than any abortion necessary to save the life of the mother or 
     any abortion with respect to a pregnancy that is the result 
     of an act of rape or incest).''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 104. INDIVIDUAL MANDATE.

       (a) In General.--Section 5000A(c) of the Internal Revenue 
     Code of 1986 is amended--
       (1) in paragraph (2)(B)(iii), by striking ``2.5 percent'' 
     and inserting ``Zero percent'', and
       (2) in paragraph (3)--
       (A) by striking ``$695'' in subparagraph (A) and inserting 
     ``$0'', and
       (B) by striking subparagraph (D).
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 105. EMPLOYER MANDATE.

       (a) In General.--

[[Page S4334]]

       (1) Paragraph (1) of section 4980H(c) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$2,000''.
       (2) Paragraph (1) of section 4980H(b) of the Internal 
     Revenue Code of 1986 is amended by inserting ``($0 in the 
     case of months beginning after December 31, 2015)'' after 
     ``$3,000''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2015.

     SEC. 106. SHORT TERM ASSISTANCE FOR STATES AND MARKET-BASED 
                   HEALTH CARE GRANT PROGRAM.

       (a) In General.--Section 2105 of the Social Security Act 
     (42 U.S.C. 1397ee) is amended by adding at the end the 
     following new subsections:
       ``(h) Short-term Assistance to Address Coverage and Access 
     Disruption and Provide Support for States.--
       ``(1) Appropriation.--There are authorized to be 
     appropriated, and are appropriated, out of monies in the 
     Treasury not otherwise obligated, $20,000,000,000 for each of 
     calendar years 2018 and 2019, and $15,000,000,000 for 
     calendar year 2020, to the Administrator of the Centers for 
     Medicare & Medicaid Services (in this subsection and 
     subsection (i) referred to as the `Administrator') to fund 
     arrangements with health insurance issuers to assist in the 
     purchase of health benefits coverage by addressing coverage 
     and access disruption and responding to urgent health care 
     needs within States. Funds appropriated under this paragraph 
     shall remain available until expended.
       ``(2) Participation requirements.--
       ``(A) Guidance.--Not later than 30 days after the date of 
     enactment of this subsection, the Administrator shall issue 
     guidance to health insurance issuers regarding how to submit 
     a notice of intent to participate in the program established 
     under this subsection.
       ``(B) Notice of intent to participate.--To be eligible for 
     funding under this subsection, a health insurance issuer 
     shall submit to the Administrator a notice of intent to 
     participate at such time (but, in the case of funding for 
     calendar year 2018, not later than 35 days after the date of 
     enactment of this subsection and, in the case of funding for 
     calendar year 2019, 2020, or 2021, not later than March 31 of 
     the previous year) and in such form and manner as specified 
     by the Administrator and containing--
       ``(i) a certification that the health insurance issuer will 
     use the funds in accordance with the requirements of 
     paragraph (5); and
       ``(ii) such information as the Administrator may require to 
     carry out this subsection.
       ``(3) Procedure for distribution of funds.--The 
     Administrator shall determine an appropriate procedure for 
     providing and distributing funds under this subsection.
       ``(4) Use of funds.--Funds provided to a health insurance 
     issuer under paragraph (1) shall be subject to the 
     requirements of paragraphs (1)(D) and (7) of subsection (i) 
     in the same manner as such requirements apply to States 
     receiving payments under subsection (i) and shall be used 
     only for the activities specified in paragraph (1)(A)(ii) of 
     subsection (i).
       ``(i) Market-based Health Care Grant Program.--
       ``(1) Application and certification requirements.--To be 
     eligible for an allotment of funds under this subsection, a 
     State shall submit to the Administrator an application, not 
     later than March 31, 2019, in the case of allotments for 
     calendar year 2020, and not later than March 31 of the 
     previous year, in the case of allotments for any subsequent 
     calendar year) and in such form and manner as specified by 
     the Administrator, that contains the following:
       ``(A) A description of how the funds will be used to do 1 
     or more of the following:
       ``(i) To establish or maintain a program or mechanism to 
     help high-risk individuals in the purchase of health benefits 
     coverage, including by reducing premium costs for such 
     individuals, who have or are projected to have a high rate of 
     utilization of health services, as measured by cost, and who 
     do not have access to health insurance coverage offered 
     through an employer, enroll in health insurance coverage 
     under a plan offered in the individual market (within the 
     meaning of section 5000A(f)(1)(C) of the Internal Revenue 
     Code of 1986).
       ``(ii) To establish or maintain a program to enter into 
     arrangements with health insurance issuers to assist in the 
     purchase of health benefits coverage by stabilizing premiums 
     and promoting State health insurance market participation and 
     choice in plans offered in the individual market (within the 
     meaning of section 5000A(f)(1)(C) of the Internal Revenue 
     Code of 1986).
       ``(iii) To provide payments for health care providers for 
     the provision of health care services, as specified by the 
     Administrator.
       ``(iv) To provide health insurance coverage by funding 
     assistance to reduce out-of-pocket costs, such as copayments, 
     coinsurance, and deductibles, of individuals enrolled in 
     plans offered in the individual market (within the meaning of 
     section 5000A(f)(1)(C) of the Internal Revenue Code of 1986).
       ``(v) To establish or maintain a program or mechanism to 
     help individuals purchase health benefits coverage, including 
     by reducing premium costs for plans offered in the individual 
     market (within the meaning of section 5000A(f)(1)(C) of the 
     Internal Revenue Code of 1986) for individuals who do not 
     have access to health insurance coverage offered through an 
     employer.
       ``(vi) Subject to paragraph (4)(B)(iii), to provide 
     wraparound, optional services to individuals enrolled in the 
     State plan for medical assistance under title XIX who are not 
     only eligible for such assistance on the basis of section 
     1902(a)(10)(A)(ii)(XXIII).
       ``(B) A certification that the State shall make, from non-
     Federal funds, expenditures for 1 or more of the activities 
     specified in subparagraph (A) in an amount that is not less 
     than the State percentage required for the year under 
     paragraph (5)(B)(ii).
       ``(C) A certification that the funds provided under this 
     subsection shall only be used for the activities specified in 
     subparagraph (A).
       ``(D) A certification that none of the funds provided under 
     this subsection shall be used by the State for an expenditure 
     that is attributable to an intergovernmental transfer, 
     certified public expenditure, or any other expenditure to 
     finance the non-Federal share of expenditures required under 
     any provision of law, including under the State plans 
     established under this title and title XIX or under a waiver 
     of such plans.
       ``(E) Such other information as necessary for the 
     Administrator to carry out this subsection.
       ``(2) Eligibility.--Only the 50 States and the District of 
     Columbia shall be eligible for an allotment and payments 
     under this subsection and all references in this subsection 
     to a State shall be treated as only referring to the 50 
     States and the District of Columbia.
       ``(3) One-time application.--If an application of a State 
     submitted under this subsection is approved by the 
     Administrator for a year, the application shall be deemed to 
     be approved by the Administrator for that year and each 
     subsequent year through December 31, 2026.
       ``(4) Market-based health care grant allotments.--
       ``(A) Appropriation.--For the purpose of providing 
     allotments to States under this subsection, there is 
     appropriated, out of any money in the Treasury not otherwise 
     appropriated--
       ``(i) for calendar year 2020, [$140,000,000,000];
       ``(ii) for calendar year 2021, [$143,000,000,000];
       ``(iii) for calendar year 2022, [$146,000,000,000];
       ``(iv) for calendar year 2023, [$149,000,000,000];
       ``(v) for calendar year 2024, [$152,000,000,000];
       ``(vi) for calendar year 2025, [$155,000,000,000]; and
       ``(vii) for calendar year 2026, [$158,000,000,000].
       ``(B) Allotments; availability of allotments.--
       ``(i) In general.--In the case of a State with an 
     application approved under this subsection with respect to a 
     year, the Administrator shall allot to the State for the 
     year, from amounts appropriated for such year under 
     subparagraph (A), the amount determined for the State and 
     year under paragraph (5).
       ``(ii) Availability of allotments; unused amounts.--

       ``(I) In general.--Amounts allotted to a State for a 
     calendar year under this subparagraph shall remain available 
     for obligation by the State through March 31 of the second 
     calendar year following the year for which the allotment is 
     made.
       ``(II) Unused amounts to be used for deficit reduction.--
     Amounts allotted to a State for a calendar year that remain 
     unobligated on April 1 of the following year shall be 
     deposited into the general fund of the Treasury and shall be 
     used for deficit reduction.

       ``(iii) Limitation.--In no case may a State use more than 
     10 percent of the amount allotted to the State for a year 
     under this subparagraph for the purpose described in clause 
     (vi) of paragraph (1)(A).
       ``(5) Determination of allotment amounts.--
       ``(A) Calendar year 2020.--Subject to subparagraph (B), the 
     amount determined under this paragraph for a State for 
     calendar year 2020 shall be equal to the sum of each of the 
     following component amounts which is applicable to the State:
       ``(i) With respect to each State, an amount equal to 10 
     percent of the amount appropriated for calendar year 2020 
     under paragraph (4)(A) multiplied by the ratio of--

       ``(I) the number of individuals in the State whose income 
     for calendar year 2019 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as defined in 
     section 2110(c)(5)) applicable to a family of the size 
     involved; over
       ``(II) the number of individuals in all States whose income 
     for calendar year 2019 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as so defined) 
     applicable to a family of the size involved.

       ``(ii) With respect to each State, an amount equal to 20 
     percent of the amount so appropriated multiplied by the ratio 
     of--

       ``(I) the number of individuals in the State who are not 
     less than 45 and not more than 64 years old; over
       ``(II) the number of individuals in all States who are not 
     less than 45 and not more than 64 years old.

       ``(iii) With respect to each State that, for calendar year 
     2016, had a State average per capita income that did not 
     exceed $52,500, an

[[Page S4335]]

     amount equal to 25 percent of the amount so appropriated 
     multiplied by the ratio of--

       ``(I) the number of individuals in the State whose income 
     for calendar year 2019 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as defined in 
     section 2110(c)(5)) applicable to a family of the size 
     involved; over
       ``(II) the number of individuals in all States that, for 
     calendar year 2016, had a State average per capita income 
     that did not exceed $52,500, whose income for calendar year 
     2019 was not less than 100 percent, and not greater than 138 
     percent, of the poverty line (as so defined) applicable to a 
     family of the size involved.

       ``(iv) With respect to each State that, for calendar year 
     2016, had an average population density of fewer than 15 
     individuals per square mile, an amount equal to 1 percent of 
     the amount so appropriated divided by the number of such 
     States.
       ``(v) With respect to each State that, for calendar year 
     2016, had an average population density that was greater than 
     14 individuals per square mile but fewer than 80 individuals 
     per square mile, an amount equal to 3.5 percent of the amount 
     so appropriated, divided by the number of such States.
       ``(vi) With respect to each State that, for calendar year 
     2016, had an average population density that was greater than 
     79 individuals per square mile but fewer than 115 individuals 
     per square mile, an amount equal to 5.5 percent of the amount 
     so appropriated, divided by the number of such States.
       ``(vii) With respect to each State that was an expansion 
     State for calendar year 2017, an amount equal to 35 percent 
     of the amount so appropriated multiplied by the ratio of--

       ``(I) the number of individuals in the State whose income 
     for calendar year 2016 was not less than 100 percent, and not 
     greater than 138 percent of the poverty line (as defined in 
     section 2110(c)(5)) applicable to a family of the size 
     involved; over
       ``(II) the number of individuals in all States that were 
     expansion States for calendar year 2017 whose income for 
     calendar year 2016 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as so defined) 
     applicable to a family of the size involved.

       ``(B) Calendar year 2020 allotment parameters.--The 
     Secretary shall adjust the amounts of allotments determined 
     under this paragraph for States for calendar year 2020 under 
     subparagraph (A) as necessary to ensure that a State's 
     allotment for calendar year 2026 (prior to any redistribution 
     of unallotted funds under subparagraph (G)) shall in no case 
     be--
       ``(i) greater than 3 times the sum of--

       ``(I) the amount of Federal payments made to the State for 
     calendar year 2016 for medical assistance provided to 
     individuals under clause (i)(VIII) or (ii)(XX) of section 
     1902(a)(10)(A) (including medical assistance provided to 
     individuals who are not newly eligible (as defined in section 
     1905(y)(2)) individuals described in subclause (VIII) of 
     section 1902(a)(10)(A)(i));
       ``(II) the amount of Federal payments made to the State for 
     calendar year 2016 for operating a Basic Health Program under 
     section 1331 of the Patient Protection and Affordable Care 
     Act for such year;
       ``(III) the amount of advance payments of premium 
     assistance credits allowable under section 36B of the 
     Internal Revenue Code of 1986 made under section 1412(a) of 
     the Patient Protection and Affordable Care Act in calendar 
     year 2016 on behalf of individuals who purchased insurance 
     through the Exchange established for or by the State pursuant 
     to title I of such Act; and
       ``(IV) the amount of Federal payments for cost-sharing 
     reductions provided for calendar year 2016 under section 1402 
     of such Act to individuals who purchased insurance through 
     the Exchange established for or by the State pursuant to 
     title I of such Act; or

       ``(ii) less than 75 percent of the sum of the amounts 
     described in subclauses (I) through (IV) of clause (i).
       ``(C) Calendar years after 2020 and before 2026.--Subject 
     to subparagraph (F), For calendar years after 2020 and before 
     2026, the amount determined under this paragraph for a State 
     and year shall be equal to--
       ``(i) for calendar years before 2025--

       ``(I) the amount determined for the State under 
     subparagraph (A) (after adjustment under subparagraph (B), if 
     applicable) or this subparagraph for the previous year; 
     increased by
       ``(II) the percentage increase in the medical care 
     component of the consumer price index for all urban consumers 
     (U.S. city average) from October 1 of the previous calendar 
     year to October 1 of the calendar year involved;

       ``(ii) for calendar year 2025--

       ``(I) the amount determined for the State under this 
     subparagraph for the previous year; increased by
       ``(II) the percentage increase in the consumer price index 
     for all urban consumers (U.S. city average) from October 1 of 
     the previous calendar year to October 1 of the calendar year 
     involved.

       ``(D) Calendar year 2026.--Subject to subparagraph (E), the 
     amount determined under this paragraph for a State for 
     calendar year 2026 shall be equal to the sum of each of the 
     following component amounts which is applicable to the State:
       ``(i) With respect to each State, an amount equal to 15.5 
     percent of the amount appropriated for calendar year 2026 
     under paragraph (4)(A) multiplied by the ratio of--

       ``(I) the number of individuals in the State whose income 
     for calendar year 2025 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as defined in 
     section 2110(c)(5)) applicable to a family of the size 
     involved; over
       ``(II) the number of individuals in all States whose income 
     for calendar year 2025 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as so defined) 
     applicable to a family of the size involved.

       ``(ii) With respect to each State, an amount equal to 30 
     percent of the amount so appropriated multiplied by the ratio 
     of--

       ``(I) the number of individuals in the State who are not 
     less than 45 and not more than 64 years old; over
       ``(II) the number of individuals in all States who are not 
     less than 45 and not more than 64 years old.

       ``(iii) With respect to each State that, for calendar year 
     2025, had a State average per capita income that did not 
     exceed $52,500, an amount equal to 39 percent of the amount 
     so appropriated multiplied by the ratio of--

       ``(I) the number of individuals in the State whose income 
     for calendar year 2025 was not less than 100 percent, and not 
     greater than 138 percent, of the poverty line (as defined in 
     section 2110(c)(5)) applicable to a family of the size 
     involved; over
       ``(II) the number of individuals in all States that, for 
     calendar year 2025, had a State average per capita income 
     that did not exceed $52,500, whose income for calendar year 
     2019 was not less than 100 percent, and not greater than 138 
     percent, of the poverty line (as so defined) applicable to a 
     family of the size involved.

       ``(iv) With respect to each State that, for calendar year 
     2025, had an average population density of fewer than 15 
     individuals per square mile, an amount equal to 1.5 percent 
     of the amount so appropriated divided by the number of such 
     States.
       ``(v) With respect to each State that, for calendar year 
     2025, had an average population density that was greater than 
     14 individuals per square mile but fewer than 80 individuals 
     per square mile, an amount equal to 5.5 percent of the amount 
     so appropriated, divided by the number of such States.
       ``(vi) With respect to each State that, for calendar year 
     2025, had an average population density that was greater than 
     79 individuals per square mile but fewer than 115 individuals 
     per square mile, an amount equal to 8.5 percent of the amount 
     so appropriated, divided by the number of such States.
       ``(E) Calendar year 2026 allotment parameters.--The 
     Secretary shall adjust the amounts of allotments determined 
     under this paragraph for States for calendar year 2026 as 
     necessary to ensure that a State's allotment for calendar 
     year 2026 (prior to any adjustment which may be applicable 
     under subparagraph (F) or distribution under subparagraph 
     (G)) shall in no case be--
       ``(i) greater than 3.5 times the sum of--

       ``(I) the amount of Federal payments made to the State for 
     calendar year 2016 for medical assistance provided to 
     individuals under clause (i)(VIII) or (ii)(XX) of section 
     1902(a)(10)(A) (including medical assistance provided to 
     individuals who are not newly eligible (as defined in section 
     1905(y)(2)) individuals described in subclause (VIII) of 
     section 1902(a)(10)(A)(i));
       ``(II) the amount of Federal payments made to the State for 
     calendar year 2016 for operating a Basic Health Program under 
     section 1331 of the Patient Protection and Affordable Care 
     Act for such year;
       ``(III) the amount of advance payments of premium 
     assistance credits allowable under section 36B of the 
     Internal Revenue Code of 1986 made under section 1412(a) of 
     the Patient Protection and Affordable Care Act in calendar 
     year 2016 on behalf of individuals who purchased insurance 
     through the Exchange established for or by the State pursuant 
     to title I of such Act; and
       ``(IV) the amount of Federal payments for cost-sharing 
     reductions provided for calendar year 2016 under section 1402 
     of such Act to individuals who purchased insurance through 
     the Exchange established for or by the State pursuant to 
     title I of such Act; or

       ``(ii) less than 75 percent of the sum of the amounts 
     described in subclauses (I) through (IV) of clause (i).
       ``(F) Low income population adjustment.--
       ``(i) For calendar years 2021 through 2025.--For each of 
     calendar years 2021, 2022, 2023, 2024, and 2025 if a State's 
     low income per capita allotment amount for the year (as 
     defined in clause (iii))--

       ``(I) exceeds the mean low income per capita allotment 
     amount for all States for the year by not less than 15 
     percent, the State's allotment for the year (as determined 
     under subparagraph (C)) shall be reduced by a percentage that 
     shall be determined by the Secretary but which shall not be 
     less than 0.5 percent or greater than 5 percent; or
       ``(II) is not less than 15 percent below the mean low 
     income per capita allotment amount for all States for the 
     year, the State's allotment for the year (as so determined) 
     shall be increased by a percentage that shall be determined 
     by the Secretary but which shall not be less than 0.5 percent 
     or greater than 5 percent.

       ``(ii) For calendar year 2026.--For calendar year 2026, 
     Secretary shall adjust the allotment for the year for each 
     State with a low income per capita allotment amount (as 
     defined in clause (iii)) that exceeds the mean low income per 
     capita allotment amount for

[[Page S4336]]

     all States for the year by more than 10 percent or is below 
     such mean amount by not less than 10 percent in such a manner 
     that the low income per capita allotment for each such State 
     (after the adjustment under this clause) is within 10 percent 
     of such mean amount.
       ``(iii) Low income per capita allotment amount.--The term 
     `low income per capita allotment amount' means, with respect 
     to a State and year--

       ``(I) the State's allotment for the year, as determined 
     under subparagraph (C); divided by
       ``(II) the number of individuals in the State--

       ``(aa) whose income for the previous calendar year did not 
     exceed 138 percent of the poverty line (as defined in section 
     2110(c)(5)) applicable to a family of the size involved; and
       ``(bb) who, during the previous calendar year, were not 
     enrolled under the State plan under title XIX (except that, 
     in the case of an individual who is enrolled under the State 
     plan under clause (i)(VIII), (ii)(XX), or (ii)(XXIII) of 
     section 1902(a)(10)(A) or is described in any such clause and 
     is enrolled under a waiver of such plan, shall not be 
     considered to be enrolled under such State plan for purposes 
     of this clause).
       ``(iv) Rules of application.--

       ``(I) Budget neutrality requirement.--In determining the 
     appropriate percentages by which to adjust States' allotments 
     for a calendar year under this subparagraph, the Secretary 
     shall make such adjustments in a manner that does not result 
     in a net increase in Federal payments under this section for 
     such year, and if the Secretary cannot adjust such 
     expenditures in such a manner there shall be no adjustment 
     under this paragraph for such year.
       ``(II) Nonapplication to low-density states.--This 
     paragraph shall not apply to any State that has a population 
     density of less than 15 individuals per square mile, based on 
     the most recent data available from the Bureau of the Census.

       ``(G) Distribution of unallotted funds.--To the extent that 
     any funds appropriated for a calendar year under paragraph 
     (4)(A) remain unallotted after the determinations and 
     adjustments made under the preceding subparagraphs of this 
     paragraph, the Secretary shall increase the allotments so 
     determined and adjusted for States that have a low income per 
     capita allotment amount that is below the mean low income per 
     capita allotment amount for all States in a manner to be 
     determined by the Secretary.
       ``(H) Expansion state defined.--In this paragraph, the term 
     `expansion State' means, with respect to a State and year, a 
     State that provided for eligibility for medical assistance 
     under the State plan established under title XIX on the basis 
     of clause (i)(VIII) or (ii)(XX) of section 1902(a)(10)(A) (or 
     provided eligibility for individuals described in either such 
     clause under a waiver approved under section 1115) during 
     calendar year 2017.
       ``(6) Payments.--
       ``(A) Annual payment of allotments.--Subject to 
     subparagraph (B), the Administrator shall pay to each State 
     that has an application approved under this subsection for a 
     year, from the amount allotted to the State under paragraph 
     (4)(B) for the year, an amount equal to the Federal 
     percentage of the State's expenditures for the year.
       ``(B) State expenditures required beginning 2022.--For 
     purposes of subparagraph (A), the Federal percentage is equal 
     to 100 percent reduced by the State percentage for that year, 
     and the State percentage is equal to--
       ``(i) in the case of calendar year 2020, 3 percent;
       ``(ii) in the case of calendar year 2021, 3 percent;
       ``(iii) in the case of calendar year 2022, 4 percent;
       ``(iv) in the case of calendar year 2023, 4 percent;
       ``(v) in the case of calendar year 2024, 5 percent;
       ``(vi) in the case of calendar year 2025, 5 percent; and
       ``(vii) in the case of calendar year 2026, 5 percent.
       ``(C) Advance payment; retrospective adjustment.--
       ``(i) In general.--If the Administrator deems it 
     appropriate, the Administrator shall make payments under this 
     subsection for each year on the basis of advance estimates of 
     expenditures submitted by the State and such other 
     investigation as the Administrator shall find necessary, and 
     shall reduce or increase the payments as necessary to adjust 
     for any overpayment or underpayment for prior years.
       ``(ii) Misuse of funds.--If the Administrator determines 
     that a State is not using funds paid to the State under this 
     subsection in a manner consistent with the description 
     provided by the State in its application approved under 
     paragraph (1), the Administrator may withhold payments, 
     reduce payments, or recover previous payments to the State 
     under this subsection as the Administrator deems appropriate.
       ``(D) Flexibility in submittal of claims.--Nothing in this 
     subsection shall be construed as preventing a State from 
     claiming as expenditures in the year expenditures that were 
     incurred in a previous year.
       ``(7) Exemptions.--Paragraphs (2), (3), (5), (6), (8), 
     (10), and (11) of subsection (c) do not apply to payments 
     under this subsection.''.
       (b) Other Title XXI Amendments.--
       (1) Section 2101 of such Act (42 U.S.C. 1397aa) is 
     amended--
       (A) in subsection (a), in the matter preceding paragraph 
     (1), by striking ``The purpose'' and inserting ``Except with 
     respect to short-term assistance activities under section 
     2105(h) and the Market-Based Health Care Grant Program 
     established in section 2105(i), the purpose''; and
       (B) in subsection (b), in the matter preceding paragraph 
     (1), by inserting ``subsection (a) or (g) of'' before 
     ``section 2105''.
       (2) Section 2105(c)(1) of such Act (42 U.S.C. 1397ee(c)(1)) 
     is amended by striking ``and may not include'' and inserting 
     ``or to carry out short-term assistance activities under 
     subsection (h) or the Market-Based Health Care Grant Program 
     established in subsection (i) and, except in the case of 
     funds made available under subsection (h) or (i), may not 
     include''.
       (3) Section 2106(a)(1) of such Act (42 U.S.C. 1397ff(a)(1)) 
     is amended by inserting ``subsection (a) or (g) of'' before 
     ``section 2105''.

     SEC. 107. BETTER CARE RECONCILIATION IMPLEMENTATION FUND.

       (a) In General.--There is hereby established a Better Care 
     Reconciliation Implementation Fund (referred to in this 
     section as the ``Fund'') within the Department of Health and 
     Human Services to provide for Federal administrative expenses 
     in carrying out this Act.
       (b) Funding.--There is appropriated to the Fund, out of any 
     funds in the Treasury not otherwise appropriated, 
     $2,000,000,000.

     SEC. 108. REPEAL OF THE TAX ON EMPLOYEE HEALTH INSURANCE 
                   PREMIUMS AND HEALTH PLAN BENEFITS.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to taxable years beginning after December 31, 
     2019.
       (c) Subsequent Effective Date.--The amendment made by 
     subsection (a) shall not apply to taxable years beginning 
     after December 31, 2025, and chapter 43 of the Internal 
     Revenue Code of 1986 is amended to read as such chapter would 
     read if such subsection had never been enacted.

     SEC. 109. REPEAL OF TAX ON OVER-THE-COUNTER MEDICATIONS.

       (a) HSAs.--Subparagraph (A) of section 223(d)(2) of the 
     Internal Revenue Code of 1986 is amended by striking ``Such 
     term'' and all that follows through the period.
       (b) Archer MSAs.--Subparagraph (A) of section 220(d)(2) of 
     the Internal Revenue Code of 1986 is amended by striking 
     ``Such term'' and all that follows through the period.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of the Internal 
     Revenue Code of 1986 is amended by striking subsection (f).
       (d) Effective Dates.--
       (1) Distributions from savings accounts.--The amendments 
     made by subsections (a) and (b) shall apply to amounts paid 
     with respect to taxable years beginning after December 31, 
     2016.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred with respect to taxable 
     years beginning after December 31, 2016.

     SEC. 110. REPEAL OF TAX ON HEALTH SAVINGS ACCOUNTS.

       (a) HSAs.--Section 223(f)(4)(A) of the Internal Revenue 
     Code of 1986 is amended by striking ``20 percent'' and 
     inserting ``10 percent''.
       (b) Archer MSAs.--Section 220(f)(4)(A) of the Internal 
     Revenue Code of 1986 is amended by striking ``20 percent'' 
     and inserting ``15 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2016.

     SEC. 111. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       Section 4191 of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new subsection:
       ``(d) Applicability.--The tax imposed under subsection (a) 
     shall not apply to sales after December 31, 2017.''.

     SEC. 112. REPEAL OF ELIMINATION OF DEDUCTION FOR EXPENSES 
                   ALLOCABLE TO MEDICARE PART D SUBSIDY.

       (a) In General.--Section 139A of the Internal Revenue Code 
     of 1986 is amended by adding at the end the following new 
     sentence: ``This section shall not be taken into account for 
     purposes of determining whether any deduction is allowable 
     with respect to any cost taken into account in determining 
     such payment.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 113. REPEAL OF CHRONIC CARE TAX.

       (a) In General.--Subsection (a) of section 213 of the 
     Internal Revenue Code of 1986 is amended by striking ``10 
     percent'' and inserting ``7.5 percent''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 114. PURCHASE OF INSURANCE FROM HEALTH SAVINGS ACCOUNT.

       (a) In General.--Paragraph (2) of section 223(d) of the 
     Internal Revenue Code of 1986 is amended--
       (1) by striking ``and any dependent (as defined in section 
     152, determined without regard to subsections (b)(1), (b)(2), 
     and (d)(1)(B)

[[Page S4337]]

     thereof) of such individual'' in subparagraph (A) and 
     inserting ``any dependent (as defined in section 152, 
     determined without regard to subsections (b)(1), (b)(2), and 
     (d)(1)(B) thereof) of such individual, and any child (as 
     defined in section 152(f)(1)) of such individual who has not 
     attained the age of 27 before the end of such individual's 
     taxable year'',
       (2) by striking subparagraph (B) and inserting the 
     following:
       ``(B) Health insurance may not be purchased from account.--
     Except as provided in subparagraph (C), subparagraph (A) 
     shall not apply to any payment for insurance.'', and
       (3) by striking ``or'' at the end of subparagraph (C)(iii), 
     by striking the period at the end of subparagraph (C)(iv) and 
     inserting ``, or'', and by adding at the end the following:
       ``(v) a high deductible health plan but only to the extent 
     of the portion of such expense in excess of--

       ``(I) any amount allowable as a credit under section 36B 
     for the taxable year with respect to such coverage,
       ``(II) any amount allowable as a deduction under section 
     162(l) with respect to such coverage, or
       ``(III) any amount excludable from gross income with 
     respect to such coverage under section 106 (including by 
     reason of section 125) or 402(l).''.

       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to amounts paid for expenses 
     incurred for, and distributions made for, coverage under a 
     high deductible health plan beginning after December 31, 
     2017.

     SEC. 115. PRIMARY CARE ENHANCEMENT.

       (a) Treatment of Direct Primary Care Service 
     Arrangements.--Section 223(c) of the Internal Revenue Code of 
     1986 is amended by adding at the end the following new 
     paragraph:
       ``(6) Treatment of direct primary care service 
     arrangements.--An arrangement under which an individual is 
     provided coverage restricted to primary care services in 
     exchange for a fixed periodic fee or payment for such 
     services--
       ``(A) shall not be treated as a health plan for purposes of 
     paragraph (1)(A)(ii), and
       ``(B) shall not be treated as insurance for purposes of 
     subsection (d)(2)(B).''.
       (b) Certain Provider Fees to Be Treated as Medical Care.--
     Section 213(d) of the Internal Revenue Code of 1986 is 
     amended by adding at the end the following new paragraph:
       ``(12) Periodic provider fees.--The term `medical care' 
     shall include periodic fees paid for a defined set of primary 
     care medical services provided on an as-needed basis.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2016.

     SEC. 116. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS 
                   ACCOUNT INCREASED TO AMOUNT OF DEDUCTIBLE AND 
                   OUT-OF-POCKET LIMITATION.

       (a) Self-Only Coverage.--Section 223(b)(2)(A) of the 
     Internal Revenue Code of 1986 is amended by striking 
     ``$2,250'' and inserting ``the amount in effect under 
     subsection (c)(2)(A)(ii)(I)''.
       (b) Family Coverage.--Section 223(b)(2)(B) of such Code is 
     amended by striking ``$4,500'' and inserting ``the amount in 
     effect under subsection (c)(2)(A)(ii)(II)''.
       (c) Cost-of-living Adjustment.--Section 223(g)(1) of such 
     Code is amended--
       (1) by striking ``subsections (b)(2) and'' both places it 
     appears and inserting ``subsection'', and
       (2) in subparagraph (B), by striking ``determined by'' and 
     all that follows through `` `calendar year 2003'.'' and 
     inserting ``determined by substituting `calendar year 2003' 
     for `calendar year 1992' in subparagraph (B) thereof.''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 117. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS 
                   TO THE SAME HEALTH SAVINGS ACCOUNT.

       (a) In General.--Section 223(b)(5) of the Internal Revenue 
     Code of 1986 is amended to read as follows:
       ``(5) Special rule for married individuals with family 
     coverage.--
       ``(A) In general.--In the case of individuals who are 
     married to each other, if both spouses are eligible 
     individuals and either spouse has family coverage under a 
     high deductible health plan as of the first day of any 
     month--
       ``(i) the limitation under paragraph (1) shall be applied 
     by not taking into account any other high deductible health 
     plan coverage of either spouse (and if such spouses both have 
     family coverage under separate high deductible health plans, 
     only one such coverage shall be taken into account),
       ``(ii) such limitation (after application of clause (i)) 
     shall be reduced by the aggregate amount paid to Archer MSAs 
     of such spouses for the taxable year, and
       ``(iii) such limitation (after application of clauses (i) 
     and (ii)) shall be divided equally between such spouses 
     unless they agree on a different division.
       ``(B) Treatment of additional contribution amounts.--If 
     both spouses referred to in subparagraph (A) have attained 
     age 55 before the close of the taxable year, the limitation 
     referred to in subparagraph (A)(iii) which is subject to 
     division between the spouses shall include the additional 
     contribution amounts determined under paragraph (3) for both 
     spouses. In any other case, any additional contribution 
     amount determined under paragraph (3) shall not be taken into 
     account under subparagraph (A)(iii) and shall not be subject 
     to division between the spouses.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2017.

     SEC. 118. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED 
                   BEFORE ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.

       (a) In General.--Section 223(d)(2) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(D) Treatment of certain medical expenses incurred before 
     establishment of account.--If a health savings account is 
     established during the 60-day period beginning on the date 
     that coverage of the account beneficiary under a high 
     deductible health plan begins, then, solely for purposes of 
     determining whether an amount paid is used for a qualified 
     medical expense, such account shall be treated as having been 
     established on the date that such coverage begins.''.
       (b) Effective Date.--The amendment made by this subsection 
     shall apply with respect to coverage under a high deductible 
     health plan beginning after December 31, 2017.

     SEC. 119. EXCLUSION FROM HSAS OF HIGH DEDUCTIBLE HEALTH PLANS 
                   INCLUDING COVERAGE FOR ABORTION.

       (a) In General.--Subparagraph (C) of section 223(d)(2) of 
     the Internal Revenue Code of 1986 is amended by adding at the 
     end the following flush sentence:

     ``A high deductible health plan shall not be treated as 
     described in clause (v) if such plan includes coverage for 
     abortions (other than any abortion necessary to save the life 
     of the mother or any abortion with respect to a pregnancy 
     that is the result of an act of rape or incest).''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to coverage under a high deductible 
     health plan beginning after December 31, 2017.

     SEC. 120. FEDERAL PAYMENTS TO STATES.

       (a) In General.--Notwithstanding section 504(a), 
     1902(a)(23), 1903(a), 2002, 2005(a)(4), 2102(a)(7), or 
     2105(a)(1) of the Social Security Act (42 U.S.C. 704(a), 
     1396a(a)(23), 1396b(a), 1397a, 1397d(a)(4), 1397bb(a)(7), 
     1397ee(a)(1)), or the terms of any Medicaid waiver in effect 
     on the date of enactment of this Act that is approved under 
     section 1115 or 1915 of the Social Security Act (42 U.S.C. 
     1315, 1396n), for the 1-year period beginning on the date of 
     enactment of this Act, no Federal funds provided from a 
     program referred to in this subsection that is considered 
     direct spending for any year may be made available to a State 
     for payments to a prohibited entity, whether made directly to 
     the prohibited entity or through a managed care organization 
     under contract with the State.
       (b) Definitions.--In this section:
       (1) Prohibited entity.--The term ``prohibited entity'' 
     means an entity, including its affiliates, subsidiaries, 
     successors, and clinics--
       (A) that, as of the date of enactment of this Act--
       (i) is an organization described in section 501(c)(3) of 
     the Internal Revenue Code of 1986 and exempt from tax under 
     section 501(a) of such Code;
       (ii) is an essential community provider described in 
     section 156.235 of title 45, Code of Federal Regulations (as 
     in effect on the date of enactment of this Act), that is 
     primarily engaged in family planning services, reproductive 
     health, and related medical care; and
       (iii) provides for abortions, other than an abortion--

       (I) if the pregnancy is the result of an act of rape or 
     incest; or
       (II) in the case where a woman suffers from a physical 
     disorder, physical injury, or physical illness that would, as 
     certified by a physician, place the woman in danger of death 
     unless an abortion is performed, including a life-endangering 
     physical condition caused by or arising from the pregnancy 
     itself; and

       (B) for which the total amount of Federal and State 
     expenditures under the Medicaid program under title XIX of 
     the Social Security Act in fiscal year 2014 made directly to 
     the entity and to any affiliates, subsidiaries, successors, 
     or clinics of the entity, or made to the entity and to any 
     affiliates, subsidiaries, successors, or clinics of the 
     entity as part of a nationwide health care provider network, 
     exceeded $1,000,000.
       (2) Direct spending.--The term ``direct spending'' has the 
     meaning given that term under section 250(c) of the Balanced 
     Budget and Emergency Deficit Control Act of 1985 (2 U.S.C. 
     900(c)).

     SEC. 121. MEDICAID.

       The Social Security Act (42 U.S.C. 301 et seq.) is 
     amended--
       (1) in section 1902--
       (A) in subsection (a)(10)(A), in each of clauses (i)(VIII) 
     and (ii)(XX), by inserting ``and ending December 31, 2019,'' 
     after ``January 1, 2014,''; and
       (B) in subsection (a)(47)(B), by inserting ``and provided 
     that any such election shall cease to be effective on January 
     1, 2020, and no such election shall be made after that date'' 
     before the semicolon at the end;
       (2) in section 1905--
       (A) in the first sentence of subsection (b), by inserting 
     ``(50 percent on or after January 1, 2020)'' after ``55 
     percent'';
       (B) in subsection (y)(1), by striking the semicolon at the 
     end of subparagraph (D) and all that follows through 
     ``thereafter''; and
       (C) in subsection (z)(2)--

[[Page S4338]]

       (i) in subparagraph (A), by inserting ``through 2019'' 
     after ``each year thereafter''; and
       (ii) in subparagraph (B)(ii)(VI), by striking ``and each 
     subsequent year'';
       (3) in section 1915(k)(2), by striking ``during the period 
     described in paragraph (1)'' and inserting ``on or after the 
     date referred to in paragraph (1) and before January 1, 
     2020'';
       (4) in section 1920(e), by adding at the end the following: 
     ``This subsection shall not apply after December 31, 2019.'';
       (5) in section 1937(b)(5), by adding at the end the 
     following: ``This paragraph shall not apply after December 
     31, 2019.''; and
       (6) in section 1943(a), by inserting ``and before January 
     1, 2020,'' after ``January 1, 2014,''.

     SEC. 122. REPEAL OF MEDICAID EXPANSION.

       Title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.) is amended--
       (1) in section 1902 (42 U.S.C. 1396a)--
       (A) in subsection (a)(10)(A)--
       (i) in clause (i)(VIII), by inserting ``and ending December 
     31, 2019,'' after ``2014,'';
       (ii) in clause (ii)(XX), by inserting ``and ending December 
     31, 2017,'' after ``2014,''; and
       (iii) in clause (ii), by adding at the end the following 
     new subclause:
       ``(XXIII) beginning January 1, 2020, who are expansion 
     enrollees (as defined in subsection (nn)(1));''; and
       (B) by adding at the end the following new subsection:
       ``(nn) Expansion Enrollees.--In this title:
       ``(1) In general.--The term `expansion enrollee' means an 
     individual--
       ``(A) who is under 65 years of age;
       ``(B) who is not pregnant;
       ``(C) who is not entitled to, or enrolled for, benefits 
     under part A of title XVIII, or enrolled for benefits under 
     part B of title XVIII;
       ``(D) who is not described in any of subclauses (I) through 
     (VII) of subsection (a)(10)(A)(i); and
       ``(E) whose income (as determined under subsection (e)(14)) 
     does not exceed 133 percent of the poverty line (as defined 
     in section 2110(c)(5)) applicable to a family of the size 
     involved.
       ``(2) Application of related provisions.--Any reference in 
     subsection (a)(10)(G), (k), or (gg) of this section or in 
     section 1903, 1905(a), 1920(e), or 1937(a)(1)(B) to 
     individuals described in subclause (VIII) of subsection 
     (a)(10)(A)(i) shall be deemed to include a reference to 
     expansion enrollees.''; and
       (2) in section 1905 (42 U.S.C. 1396d)--
       (A) in subsection (y)(1), by striking ``; and'' at the end 
     of subparagraph (D) and all that follows through 
     ``thereafter''; and
       (B) in subsection (z)(2)--
       (i) in subparagraph (A), by striking ``each year 
     thereafter'' and inserting ``through 2019''; and
       (ii) in subparagraph (B)(ii), by striking ``is 80 percent'' 
     in subclause (IV) and all that follows through ``100 
     percent'' and inserting ``and subsequent years is 80 
     percent''.

     SEC. 123. REDUCING STATE MEDICAID COSTS.

       (a) In General.--
       (1) State plan requirements.--Section 1902(a)(34) of the 
     Social Security Act (42 U.S.C. 1396a(a)(34)) is amended by 
     striking ``in or after the third month'' and all that follows 
     through ``individual)'' and inserting ``in or after the month 
     in which the individual (or, in the case of a deceased 
     individual, another individual acting on the individual's 
     behalf) made application (or, in the case of an individual 
     who is 65 years of age or older or who is eligible for 
     medical assistance under the plan on the basis of being blind 
     or disabled, in or after the third month before such 
     month)''.
       (2) Definition of medical assistance.--Section 1905(a) of 
     the Social Security Act (42 U.S.C. 1396d(a)) is amended by 
     striking ``in or after the third month before the month in 
     which the recipient makes application for assistance'' and 
     inserting ``in or after the month in which the recipient 
     makes application for assistance, or, in the case of a 
     recipient who is 65 years of age or older or who is eligible 
     for medical assistance on the basis of being blind or 
     disabled at the time application is made, in or after the 
     third month before the month in which the recipient makes 
     application for assistance,''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to medical assistance with respect to individuals 
     whose eligibility for such assistance is based on an 
     application for such assistance made (or deemed to be made) 
     on or after October 1, 2017.

     SEC. 124. ELIGIBILITY REDETERMINATIONS.

       (a) In General.--Section 1902(e)(14) of the Social Security 
     Act (42 U.S.C. 1396a(e)(14)) (relating to modified adjusted 
     gross income) is amended by adding at the end the following:
       ``(J) Frequency of eligibility redeterminations.--Beginning 
     on October 1, 2017, and notwithstanding subparagraph (H), in 
     the case of an individual whose eligibility for medical 
     assistance under the State plan under this title (or a waiver 
     of such plan) is determined based on the application of 
     modified adjusted gross income under subparagraph (A) and who 
     is so eligible on the basis of clause (i)(VIII), (ii)(XX), or 
     (ii)(XXIII) of subsection (a)(10)(A), at the option of the 
     State, the State plan may provide that the individual's 
     eligibility shall be redetermined every 6 months (or such 
     shorter number of months as the State may elect).''.
       (b) Increased Administrative Matching Percentage.--For each 
     calendar quarter during the period beginning on October 1, 
     2017, and ending on December 31, 2019, the Federal matching 
     percentage otherwise applicable under section 1903(a) of the 
     Social Security Act (42 U.S.C. 1396b(a)) with respect to 
     State expenditures during such quarter that are attributable 
     to meeting the requirement of section 1902(e)(14) (relating 
     to determinations of eligibility using modified adjusted 
     gross income) of such Act shall be increased by 5 percentage 
     points with respect to State expenditures attributable to 
     activities carried out by the State (and approved by the 
     Secretary) to exercise the option described in subparagraph 
     (J) of such section (relating to eligibility redeterminations 
     made on a 6-month or shorter basis) (as added by subsection 
     (a)) to increase the frequency of eligibility 
     redeterminations.

     SEC. 125. OPTIONAL WORK REQUIREMENT FOR NONDISABLED, 
                   NONELDERLY, NONPREGNANT INDIVIDUALS.

       (a) In General.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a), as previously amended, is further amended 
     by adding at the end the following new subsection:
       ``(oo) Optional Work Requirement for Nondisabled, 
     Nonelderly, Nonpregnant Individuals.--
       ``(1) In general.--Beginning October 1, 2017, subject to 
     paragraph (3), a State may elect to condition medical 
     assistance to a nondisabled, nonelderly, nonpregnant 
     individual under this title upon such an individual's 
     satisfaction of a work requirement (as defined in paragraph 
     (2)).
       ``(2) Work requirement defined.--In this section, the term 
     `work requirement' means, with respect to an individual, the 
     individual's participation in work activities (as defined in 
     section 407(d)) for such period of time as determined by the 
     State, and as directed and administered by the State.
       ``(3) Required exceptions.--States administering a work 
     requirement under this subsection may not apply such 
     requirement to--
       ``(A) a woman during pregnancy through the end of the month 
     in which the 60-day period (beginning on the last day of her 
     pregnancy) ends;
       ``(B) an individual who is under 19 years of age;
       ``(C) an individual who is the only parent or caretaker 
     relative in the family of a child who has not attained 6 
     years of age or who is the only parent or caretaker of a 
     child with disabilities; or
       ``(D) an individual who is married or a head of household 
     and has not attained 20 years of age and who--
       ``(i) maintains satisfactory attendance at secondary school 
     or the equivalent; or
       ``(ii) participates in education directly related to 
     employment.''.
       (b) Increase in Matching Rate for Implementation.--Section 
     1903 of the Social Security Act (42 U.S.C. 1396b) is amended 
     by adding at the end the following:
       ``(aa) The Federal matching percentage otherwise applicable 
     under subsection (a) with respect to State administrative 
     expenditures during a calendar quarter for which the State 
     receives payment under such subsection shall, in addition to 
     any other increase to such Federal matching percentage, be 
     increased for such calendar quarter by 5 percentage points 
     with respect to State expenditures attributable to activities 
     carried out by the State (and approved by the Secretary) to 
     implement subsection (oo) of section 1902.''.

     SEC. 126. PROVIDER TAXES.

       Section 1903(w)(4)(C) of the Social Security Act (42 U.S.C. 
     1396b(w)(4)(C)) is amended by adding at the end the following 
     new clause:
       ``(iii) For purposes of clause (i), a determination of the 
     existence of an indirect guarantee shall be made under 
     paragraph (3)(i) of section 433.68(f) of title 42, Code of 
     Federal Regulations, as in effect on June 1, 2017, except 
     that--

       ``(I) for fiscal year 2021, `5.8 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(II) for fiscal year 2022, `5.6 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(III) for fiscal year 2023, `5.4 percent' shall be 
     substituted for `6 percent' each place it appears;
       ``(IV) for fiscal year 2024, `5.2 percent' shall be 
     substituted for `6 percent' each place it appears; and
       ``(V) for fiscal year 2025 and each subsequent fiscal year, 
     `5 percent' shall be substituted for `6 percent' each place 
     it appears.''.

     SEC. 127. PER CAPITA ALLOTMENT FOR MEDICAL ASSISTANCE.

       (a) In General.--Title XIX of the Social Security Act is 
     amended--
       (1) in section 1903 (42 U.S.C. 1396b)--
       (A) in subsection (a), in the matter before paragraph (1), 
     by inserting ``and section 1903A(a)'' after ``except as 
     otherwise provided in this section''; and
       (B) in subsection (d)(1), by striking ``to which'' and 
     inserting ``to which, subject to section 1903A(a),''; and
       (2) by inserting after such section 1903 the following new 
     section:

     ``SEC. 1903A. PER CAPITA-BASED CAP ON PAYMENTS FOR MEDICAL 
                   ASSISTANCE.

       ``(a) Application of Per Capita Cap on Payments for Medical 
     Assistance Expenditures.--
       ``(1) In general.--If a State which is one of the 50 States 
     or the District of Columbia has excess aggregate medical 
     assistance expenditures (as defined in paragraph (2)) for a 
     fiscal year (beginning with fiscal year 2020), the amount of 
     payment to the State under section 1903(a)(1) for each 
     quarter in the following fiscal year shall be reduced by \1/
     4\ of

[[Page S4339]]

     the excess aggregate medical assistance payments (as defined 
     in paragraph (3)) for that previous fiscal year. In this 
     section, the term `State' means only the 50 States and the 
     District of Columbia.
       ``(2) Excess aggregate medical assistance expenditures.--In 
     this subsection, the term `excess aggregate medical 
     assistance expenditures' means, for a State for a fiscal 
     year, the amount (if any) by which--
       ``(A) the amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     and fiscal year; exceeds
       ``(B) the amount of the target total medical assistance 
     expenditures (as defined in subsection (c)) for the State and 
     fiscal year.
       ``(3) Excess aggregate medical assistance payments.--In 
     this subsection, the term `excess aggregate medical 
     assistance payments' means, for a State for a fiscal year, 
     the product of--
       ``(A) the excess aggregate medical assistance expenditures 
     (as defined in paragraph (2)) for the State for the fiscal 
     year; and
       ``(B) the Federal average medical assistance matching 
     percentage (as defined in paragraph (4)) for the State for 
     the fiscal year.
       ``(4) Federal average medical assistance matching 
     percentage.--In this subsection, the term `Federal average 
     medical assistance matching percentage' means, for a State 
     for a fiscal year, the ratio (expressed as a percentage) of--
       ``(A) the amount of the Federal payments that would be made 
     to the State under section 1903(a)(1) for medical assistance 
     expenditures for calendar quarters in the fiscal year if 
     paragraph (1) did not apply; to
       ``(B) the amount of the medical assistance expenditures for 
     the State and fiscal year.
       ``(5) Per capita base period.--
       ``(A) In general.--In this section, the term `per capita 
     base period' means, with respect to a State, a period of 8 
     (or, in the case of a State selecting a period under 
     subparagraph (D), not less than 4) consecutive fiscal 
     quarters selected by the State.
       ``(B) Timeline.--Each State shall submit its selection of a 
     per capita base period to the Secretary not later than 
     January 1, 2018.
       ``(C) Parameters.--In selecting a per capita base period 
     under this paragraph, a State shall--
       ``(i) only select a period of 8 (or, in the case of a State 
     selecting a base period under subparagraph (D), not less than 
     4) consecutive fiscal quarters for which all the data 
     necessary to make determinations required under this section 
     is available, as determined by the Secretary; and
       ``(ii) shall not select any period of 8 (or, in the case of 
     a State selecting a base period under subparagraph (D), not 
     less than 4) consecutive fiscal quarters that begins with a 
     fiscal quarter earlier than the first quarter of fiscal year 
     2014 or ends with a fiscal quarter later than the third 
     fiscal quarter of 2017.
       ``(D) Base period for late-expanding states.--
       ``(i) In general.--In the case of a State that did not 
     provide for medical assistance for the 1903A enrollee 
     category described in subsection (e)(2)(D) as of the first 
     day of the fourth fiscal quarter of fiscal year 2015 but 
     which provided for such assistance for such category in a 
     subsequent fiscal quarter that is not later than the fourth 
     quarter of fiscal year 2016, the State may select a per 
     capita base period that is less than 8 consecutive fiscal 
     quarters, but in no case shall the period selected be less 
     than 4 consecutive fiscal quarters.
       ``(ii) Application of other requirements.--Except for the 
     requirement that a per capita base period be a period of 8 
     consecutive fiscal quarters, all other requirements of this 
     paragraph shall apply to a per capita base period selected 
     under this subparagraph.
       ``(iii) Application of base period adjustments.--The 
     adjustments to amounts for per capita base periods required 
     under subsections (b)(5) and (d)(4)(E) shall be applied to 
     amounts for per capita base periods selected under this 
     subparagraph by substituting `divided by the ratio that the 
     number of quarters in the base period bears to 4' for 
     `divided by 2'.
       ``(E) Adjustment by the secretary.--If the Secretary 
     determines that a State took actions after the date of 
     enactment of this section (including making retroactive 
     adjustments to supplemental payment data in a manner that 
     affects a fiscal quarter in the per capita base period) to 
     diminish the quality of the data from the per capita base 
     period used to make determinations under this section, the 
     Secretary may adjust the data as the Secretary deems 
     appropriate.
       ``(b) Adjusted Total Medical Assistance Expenditures.--
     Subject to subsection (g), the following shall apply:
       ``(1) In general.--In this section, the term `adjusted 
     total medical assistance expenditures' means, for a State--
       ``(A) for the State's per capita base period (as defined in 
     subsection (a)(5)), the product of--
       ``(i) the amount of the medical assistance expenditures (as 
     defined in paragraph (2) and adjusted under paragraph (5)) 
     for the State and period, reduced by the amount of any 
     excluded expenditures (as defined in paragraph (3) and 
     adjusted under paragraph (5)) for the State and period 
     otherwise included in such medical assistance expenditures; 
     and
       ``(ii) the 1903A base period population percentage (as 
     defined in paragraph (4)) for the State; or
       ``(B) for fiscal year 2019 or a subsequent fiscal year, the 
     amount of the medical assistance expenditures (as defined in 
     paragraph (2)) for the State and fiscal year that is 
     attributable to 1903A enrollees, reduced by the amount of any 
     excluded expenditures (as defined in paragraph (3)) for the 
     State and fiscal year otherwise included in such medical 
     assistance expenditures and includes non-DSH supplemental 
     payments (as defined in subsection (d)(4)(A)(ii)) and 
     payments described in subsection (d)(4)(A)(iii) but shall not 
     be construed as including any expenditures attributable to 
     the program under section 1928 (relating to State pediatric 
     vaccine distribution programs). In applying subparagraph (B), 
     non-DSH supplemental payments (as defined in subsection 
     (d)(4)(A)(ii)) and payments described in subsection 
     (d)(4)(A)(iii) shall be treated as fully attributable to 
     1903A enrollees.
       ``(2) Medical assistance expenditures.--In this section, 
     the term `medical assistance expenditures' means, for a State 
     and fiscal year or per capita base period, the medical 
     assistance payments as reported by medical service category 
     on the Form CMS-64 quarterly expense report (or successor to 
     such a report form, and including enrollment data and 
     subsequent adjustments to any such report, in this section 
     referred to collectively as a `CMS-64 report') for quarters 
     in the year or base period for which payment is (or may 
     otherwise be) made pursuant to section 1903(a)(1), adjusted, 
     in the case of a per capita base period, under paragraph (5).
       ``(3) Excluded expenditures.--In this section, the term 
     `excluded expenditures' means, for a State and fiscal year or 
     per capita base period, expenditures under the State plan (or 
     under a waiver of such plan) that are attributable to any of 
     the following:
       ``(A) DSH.--Payment adjustments made for disproportionate 
     share hospitals under section 1923.
       ``(B) Medicare cost-sharing.--Payments made for medicare 
     cost-sharing (as defined in section 1905(p)(3)).
       ``(C) Safety net provider payment adjustments in non-
     expansion states.--Payment adjustments under subsection (a) 
     of section 1923A for which payment is permitted under 
     subsection (c) of such section.
       ``(D) Expenditures for public health emergencies.--Any 
     expenditures that are subject to a public health emergency 
     exclusion under paragraph (6).
       ``(4) 1903A base period population percentage.--In this 
     subsection, the term `1903A base period population 
     percentage' means, for a State, the Secretary's calculation 
     of the percentage of the actual medical assistance 
     expenditures, as reported by the State on the CMS-64 reports 
     for calendar quarters in the State's per capita base period, 
     that are attributable to 1903A enrollees (as defined in 
     subsection (e)(1)).
       ``(5) Adjustments for per capita base period.--In 
     calculating medical assistance expenditures under paragraph 
     (2) and excluded expenditures under paragraph (3) for a State 
     for the State's per capita base period, the total amount of 
     each type of expenditure for the State and base period shall 
     be divided by 2.
       ``(6) Authority to exclude state expenditures from caps 
     during public health emergency.--
       ``(A) In general.--During the period that begins on January 
     1, 2020, and ends on December 31, 2024, the Secretary may 
     exclude, from a State's medical assistance expenditures for a 
     fiscal year or portion of a fiscal year that occurs during 
     such period, an amount that shall not exceed the amount 
     determined under subparagraph (B) for the State and year or 
     portion of a year if--
       ``(i) a public health emergency declared by the Secretary 
     pursuant to section 319 of the Public Health Service Act 
     existed within the State during such year or portion of a 
     year; and
       ``(ii) the Secretary determines that such an exemption 
     would be appropriate.
       ``(B) Maximum amount of adjustment.--The amount excluded 
     for a State and fiscal year or portion of a fiscal year under 
     this paragraph shall not exceed the amount by which--
       ``(i) the amount of State expenditures for medical 
     assistance for 1903A enrollees in areas of the State which 
     are subject to a declaration described in subparagraph (A)(i) 
     for the fiscal year or portion of a fiscal year; exceeds
       ``(ii) the amount of such expenditures for such enrollees 
     in such areas during the most recent fiscal year or portion 
     of a fiscal year of equal length to the portion of a fiscal 
     year involved during which no such declaration was in effect.
       ``(C) Aggregate limitation on exclusions and additional 
     block grant payments.--The aggregate amount of expenditures 
     excluded under this paragraph and additional payments made 
     under section 1903B(c)(3)(E) for the period described in 
     subparagraph (A) shall not exceed $5,000,000,000.
       ``(D) Review.--If the Secretary exercises the authority 
     under this paragraph with respect to a State for a fiscal 
     year or portion of a fiscal year, the Secretary shall, not 
     later than 6 months after the declaration described in 
     subparagraph (A)(i) ceases to be in effect, conduct an audit 
     of the State's medical assistance expenditures for 1903A 
     enrollees during the year or portion of a year to ensure that 
     all of the expenditures so excluded were made for the purpose 
     of ensuring that the health care needs of 1903A enrollees in 
     areas affected by a public health emergency are met.

[[Page S4340]]

       ``(c)  Target Total Medical Assistance Expenditures.--
       ``(1) Calculation.--In this section, the term `target total 
     medical assistance expenditures' means, for a State for a 
     fiscal year, the sum of the products, for each of the 1903A 
     enrollee categories (as defined in subsection (e)(2)), of--
       ``(A) the target per capita medical assistance expenditures 
     (as defined in paragraph (2)) for the enrollee category, 
     State, and fiscal year; and
       ``(B) the number of 1903A enrollees for such enrollee 
     category, State, and fiscal year, as determined under 
     subsection (e)(4).
       ``(2) Target per capita medical assistance expenditures.--
     In this subsection, the term `target per capita medical 
     assistance expenditures' means, for a 1903A enrollee category 
     and State--
       ``(A) for fiscal year 2020, an amount equal to--
       ``(i) the provisional FY19 target per capita amount for 
     such enrollee category (as calculated under subsection 
     (d)(5)) for the State; increased by
       ``(ii) the applicable annual inflation factor (as defined 
     in paragraph (3)) for fiscal year 2020; and
       ``(B) for each succeeding fiscal year, an amount equal to--
       ``(i) the target per capita medical assistance expenditures 
     (under subparagraph (A) or this subparagraph) for the 1903A 
     enrollee category and State for the preceding fiscal year; 
     increased by
       ``(ii) the applicable annual inflation factor for that 
     succeeding fiscal year.
       ``(3) Applicable annual inflation factor.--In paragraph 
     (2), the term `applicable annual inflation factor' means--
       ``(A) for fiscal years before 2025--
       ``(i) for each of the 1903A enrollee categories described 
     in subparagraphs (C), (D), and (E) of subsection (e)(2), the 
     percentage increase in the medical care component of the 
     consumer price index for all urban consumers (U.S. city 
     average) from September of the previous fiscal year to 
     September of the fiscal year involved; and
       ``(ii) for each of the 1903A enrollee categories described 
     in subparagraphs (A) and (B) of subsection (e)(2), the 
     percentage increase described in clause (i) plus 1 percentage 
     point; and
       ``(B) for fiscal years after 2024, for all 1903A enrollee 
     categories, the percentage increase in the consumer price 
     index for all urban consumers (U.S. city average) from 
     September of the previous fiscal year to September of the 
     fiscal year involved.
       ``(4) Adjustments to state expenditures targets to promote 
     program equity across states.--
       ``(A) In general.--Beginning with fiscal year 2020, the 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category, State, and fiscal year, as determined 
     under paragraph (2), shall be adjusted (subject to 
     subparagraph (C)(i)) in accordance with this paragraph.
       ``(B) Adjustment based on level of per capita spending for 
     1903a enrollee categories.--Subject to subparagraph (C), with 
     respect to a State, fiscal year, and 1903A enrollee category, 
     if the State's per capita categorical medical assistance 
     expenditures (as defined in subparagraph (D)) for the State 
     and category in the preceding fiscal year--
       ``(i) exceed the mean per capita categorical medical 
     assistance expenditures for the category for all States for 
     such preceding year by not less than 25 percent, the State's 
     target per capita medical assistance expenditures for such 
     category for the fiscal year involved shall be reduced by a 
     percentage that shall be determined by the Secretary but 
     which shall not be less than 0.5 percent or greater than 2 
     percent; or
       ``(ii) are less than the mean per capita categorical 
     medical assistance expenditures for the category for all 
     States for such preceding year by not less than 25 percent, 
     the State's target per capita medical assistance expenditures 
     for such category for the fiscal year involved shall be 
     increased by a percentage that shall be determined by the 
     Secretary but which shall not be less than 0.5 percent or 
     greater than 2 percent.
       ``(C) Rules of application.--
       ``(i) Budget neutrality requirement.--In determining the 
     appropriate percentages by which to adjust States' target per 
     capita medical assistance expenditures for a category and 
     fiscal year under this paragraph, the Secretary shall make 
     such adjustments in a manner that does not result in a net 
     increase in Federal payments under this section for such 
     fiscal year, and if the Secretary cannot adjust such 
     expenditures in such a manner there shall be no adjustment 
     under this paragraph for such fiscal year.
       ``(ii) Assumption regarding state expenditures.--For 
     purposes of clause (i), in the case of a State that has its 
     target per capita medical assistance expenditures for a 1903A 
     enrollee category and fiscal year increased under this 
     paragraph, the Secretary shall assume that the categorical 
     medical assistance expenditures (as defined in subparagraph 
     (D)(ii)) for such State, category, and fiscal year will equal 
     such increased target medical assistance expenditures.
       ``(iii) Nonapplication to low-density states.--This 
     paragraph shall not apply to any State that has a population 
     density of less than 15 individuals per square mile, based on 
     the most recent data available from the Bureau of the Census.
       ``(iv) Disregard of adjustment.--Any adjustment under this 
     paragraph to target medical assistance expenditures for a 
     State, 1903A enrollee category, and fiscal year shall be 
     disregarded when determining the target medical assistance 
     expenditures for such State and category for a succeeding 
     year under paragraph (2).
       ``(v) Application for fiscal years 2020 and 2021.--In 
     fiscal years 2020 and 2021, the Secretary shall apply this 
     paragraph by deeming all categories of 1903A enrollees to be 
     a single category.
       ``(D) Per capita categorical medical assistance 
     expenditures.--
       ``(i) In general.--In this paragraph, the term `per capita 
     categorical medical assistance expenditures' means, with 
     respect to a State, 1903A enrollee category, and fiscal year, 
     an amount equal to--

       ``(I) the categorical medical expenditures (as defined in 
     clause (ii)) for the State, category, and year; divided by
       ``(II) the number of 1903A enrollees for the State, 
     category, and year.

       ``(ii) Categorical medical assistance expenditures.--The 
     term `categorical medical assistance expenditures' means, 
     with respect to a State, 1903A enrollee category, and fiscal 
     year, an amount equal to the total medical assistance 
     expenditures (as defined in paragraph (2)) for the State and 
     fiscal year that are attributable to 1903A enrollees in the 
     category, excluding any excluded expenditures (as defined in 
     paragraph (3)) for the State and fiscal year that are 
     attributable to 1903A enrollees in the category.
       ``(d) Calculation of FY19 Provisional Target Amount for 
     Each 1903A Enrollee Category.--Subject to subsection (g), the 
     following shall apply:
       ``(1) Calculation of base amounts for per capita base 
     period.--For each State the Secretary shall calculate (and 
     provide notice to the State not later than April 1, 2018, of) 
     the following:
       ``(A) The amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     for the State's per capita base period.
       ``(B) The number of 1903A enrollees for the State in the 
     State's per capita base period (as determined under 
     subsection (e)(4)).
       ``(C) The average per capita medical assistance 
     expenditures for the State for the State's per capita base 
     period equal to--
       ``(i) the amount calculated under subparagraph (A); divided 
     by
       ``(ii) the number calculated under subparagraph (B).
       ``(2) Fiscal year 2019 average per capita amount based on 
     inflating the per capita base period amount to fiscal year 
     2019 by cpi-medical.--The Secretary shall calculate a fiscal 
     year 2019 average per capita amount for each State equal to--
       ``(A) the average per capita medical assistance 
     expenditures for the State for the State's per capita base 
     period (calculated under paragraph (1)(C)); increased by
       ``(B) the percentage increase in the medical care component 
     of the consumer price index for all urban consumers (U.S. 
     city average) from the last month of the State's per capita 
     base period to September of fiscal year 2019.
       ``(3) Aggregate and average expenditures per capita for 
     fiscal year 2019.--The Secretary shall calculate for each 
     State the following:
       ``(A) The amount of the adjusted total medical assistance 
     expenditures (as defined in subsection (b)(1)) for the State 
     for fiscal year 2019. 
       ``(B) The number of 1903A enrollees for the State in fiscal 
     year 2019 (as determined under subsection (e)(4)).
       ``(4) Per capita expenditures for fiscal year 2019 for each 
     1903a enrollee category.--The Secretary shall calculate (and 
     provide notice to each State not later than January 1, 2020, 
     of) the following:
       ``(A)(i) For each 1903A enrollee category, the amount of 
     the adjusted total medical assistance expenditures (as 
     defined in subsection (b)(1)) for the State for fiscal year 
     2019 for individuals in the enrollee category, calculated by 
     excluding from medical assistance expenditures those 
     expenditures attributable to expenditures described in clause 
     (iii) or non-DSH supplemental expenditures (as defined in 
     clause (ii)).
       ``(ii) In this paragraph, the term `non-DSH supplemental 
     expenditure' means a payment to a provider under the State 
     plan (or under a waiver of the plan) that--
       ``(I) is not made under section 1923;
       ``(II) is not made with respect to a specific item or 
     service for an individual;
       ``(III) is in addition to any payments made to the provider 
     under the plan (or waiver) for any such item or service; and
       ``(IV) complies with the limits for additional payments to 
     providers under the plan (or waiver) imposed pursuant to 
     section 1902(a)(30)(A), including the regulations specifying 
     upper payment limits under the State plan in part 447 of 
     title 42, Code of Federal Regulations (or any successor 
     regulations).
       ``(iii) An expenditure described in this clause is an 
     expenditure that meets the criteria specified in subclauses 
     (I), (II), and (III) of clause (ii) and is authorized under 
     section 1115 for the purposes of funding a delivery system 
     reform pool, uncompensated care pool, a designated State 
     health program, or any other similar expenditure (as defined 
     by the Secretary).
       ``(B) For each 1903A enrollee category, the number of 1903A 
     enrollees for the State in fiscal year 2019 in the enrollee 
     category (as determined under subsection (e)(4)).

[[Page S4341]]

       ``(C) For the State's per capita base period, the State's 
     non-DSH supplemental and pool payment percentage is equal to 
     the ratio (expressed as a percentage) of--
       ``(i) the total amount of non-DSH supplemental expenditures 
     (as defined in subparagraph (A)(ii) and adjusted under 
     subparagraph (E)) and payments described in subparagraph 
     (A)(iii) (and adjusted under subparagraph (E)) for the State 
     for the period; to
       ``(ii) the amount described in subsection (b)(1)(A) for the 
     State for the State's per capita base period.
       ``(D) For each 1903A enrollee category an average medical 
     assistance expenditures per capita for the State for fiscal 
     year 2019 for the enrollee category equal to--
       ``(i) the amount calculated under subparagraph (A) for the 
     State, increased by the non-DSH supplemental and pool payment 
     percentage for the State (as calculated under subparagraph 
     (C)); divided by
       ``(ii) the number calculated under subparagraph (B) for the 
     State for the enrollee category.
       ``(E) For purposes of subparagraph (C)(i), in calculating 
     the total amount of non-DSH supplemental expenditures and 
     payments described in subparagraph (A)(iii) for a State for 
     the per capita base period, the total amount of such 
     expenditures and the total amount of such payments for the 
     State and base period shall each be divided by 2.
       ``(5) Provisional fy19 per capita target amount for each 
     1903a enrollee category.--Subject to subsection (f)(2), the 
     Secretary shall calculate for each State a provisional FY19 
     per capita target amount for each 1903A enrollee category 
     equal to the average medical assistance expenditures per 
     capita for the State for fiscal year 2019 (as calculated 
     under paragraph (4)(D)) for such enrollee category multiplied 
     by the ratio of--
       ``(A) the product of--
       ``(i) the fiscal year 2019 average per capita amount for 
     the State, as calculated under paragraph (2); and
       ``(ii) the number of 1903A enrollees for the State in 
     fiscal year 2019, as calculated under paragraph (3)(B); to
       ``(B) the amount of the adjusted total medical assistance 
     expenditures for the State for fiscal year 2019, as 
     calculated under paragraph (3)(A).
       ``(e) 1903A Enrollee; 1903A Enrollee Category.--Subject to 
     subsection (g), for purposes of this section, the following 
     shall apply:
       ``(1) 1903A enrollee.--The term `1903A enrollee' means, 
     with respect to a State and a month and subject to subsection 
     (i)(1)(B), any Medicaid enrollee (as defined in paragraph 
     (3)) for the month, other than such an enrollee who for such 
     month is in any of the following categories of excluded 
     individuals:
       ``(A) CHIP.--An individual who is provided, under this 
     title in the manner described in section 2101(a)(2), child 
     health assistance under title XXI.
       ``(B) IHS.--An individual who receives any medical 
     assistance under this title for services for which payment is 
     made under the third sentence of section 1905(b).
       ``(C) Breast and cervical cancer services eligible 
     individual.--An individual who is eligible for medical 
     assistance under this title only on the basis of section 
     1902(a)(10)(A)(ii)(XVIII).
       ``(D) Partial-benefit enrollees.--An individual who--
       ``(i) is an alien who is eligible for medical assistance 
     under this title only on the basis of section 1903(v)(2);
       ``(ii) is eligible for medical assistance under this title 
     only on the basis of subclause (XII) or (XXI) of section 
     1902(a)(10)(A)(ii) (or on the basis of a waiver that provides 
     only comparable benefits);
       ``(iii) is a dual eligible individual (as defined in 
     section 1915(h)(2)(B)) and is eligible for medical assistance 
     under this title (or under a waiver) only for some or all of 
     medicare cost-sharing (as defined in section 1905(p)(3)); or
       ``(iv) is eligible for medical assistance under this title 
     and for whom the State is providing a payment or subsidy to 
     an employer for coverage of the individual under a group 
     health plan pursuant to section 1906 or section 1906A (or 
     pursuant to a waiver that provides only comparable benefits).
       ``(E) Blind and disabled children.--An individual who--
       ``(i) is a child under 19 years of age; and
       ``(ii) is eligible for medical assistance under this title 
     on the basis of being blind or disabled.
       ``(2) 1903A enrollee category.--The term `1903A enrollee 
     category' means each of the following:
       ``(A) Elderly.--A category of 1903A enrollees who are 65 
     years of age or older.
       ``(B) Blind and disabled.--A category of 1903A enrollees 
     (not described in the previous subparagraph) who--
       ``(i) are 19 years of age or older; and
       ``(ii) are eligible for medical assistance under this title 
     on the basis of being blind or disabled.
       ``(C) Children.--A category of 1903A enrollees (not 
     described in a previous subparagraph) who are children under 
     19 years of age.
       ``(D) Expansion enrollees.--A category of 1903A enrollees 
     (not described in a previous subparagraph) who are eligible 
     for medical assistance under this title only on the basis of 
     clause (i)(VIII), (ii)(XX), or (ii)(XXIII) of section 
     1902(a)(10)(A).
       ``(E) Other nonelderly, nondisabled, non-expansion 
     adults.--A category of 1903A enrollees who are not described 
     in any previous subparagraph.
       ``(3) Medicaid enrollee.--The term `Medicaid enrollee' 
     means, with respect to a State for a month, an individual who 
     is eligible for medical assistance for items or services 
     under this title and enrolled under the State plan (or a 
     waiver of such plan) under this title for the month.
       ``(4) Determination of number of 1903a enrollees.--The 
     number of 1903A enrollees for a State and fiscal year or the 
     State's per capita base period, and, if applicable, for a 
     1903A enrollee category, is the average monthly number of 
     Medicaid enrollees for such State and fiscal year or base 
     period (and, if applicable, in such category) that are 
     reported through the CMS-64 report under (and subject to 
     audit under) subsection (h).
       ``(f) Special Payment Rules.--
       ``(1) Application in case of research and demonstration 
     projects and other waivers.--In the case of a State with a 
     waiver of the State plan approved under section 1115, section 
     1915, or another provision of this title, this section shall 
     apply to medical assistance expenditures and medical 
     assistance payments under the waiver, in the same manner as 
     if such expenditures and payments had been made under a State 
     plan under this title and the limitations on expenditures 
     under this section shall supersede any other payment 
     limitations or provisions (including limitations based on a 
     per capita limitation) otherwise applicable under such a 
     waiver.
       ``(2) Treatment of states expanding coverage after july 1, 
     2016.--In the case of a State that did not provide for 
     medical assistance for the 1903A enrollee category described 
     in subsection (e)(2)(D) as of July 1, 2016, but which 
     subsequently provides for such assistance for such category, 
     the provisional FY19 per capita target amount for such 
     enrollee category under subsection (d)(5) shall be equal to 
     the provisional FY19 per capita target amount for the 1903A 
     enrollee category described in subsection (e)(2)(E).
       ``(3) In case of state failure to report necessary data.--
     If a State for any quarter in a fiscal year (beginning with 
     fiscal year 2019) fails to satisfactorily submit data on 
     expenditures and enrollees in accordance with subsection 
     (h)(1), for such fiscal year and any succeeding fiscal year 
     for which such data are not satisfactorily submitted--
       ``(A) the Secretary shall calculate and apply subsections 
     (a) through (e) with respect to the State as if all 1903A 
     enrollee categories for which such expenditure and enrollee 
     data were not satisfactorily submitted were a single 1903A 
     enrollee category; and
       ``(B) the growth factor otherwise applied under subsection 
     (c)(2)(B) shall be decreased by 1 percentage point.
       ``(g) Recalculation of Certain Amounts for Data Errors.--
     The amounts and percentage calculated under paragraphs (1) 
     and (4)(C) of subsection (d) for a State for the State's per 
     capita base period, and the amounts of the adjusted total 
     medical assistance expenditures calculated under subsection 
     (b) and the number of Medicaid enrollees and 1903A enrollees 
     determined under subsection (e)(4) for a State for the 
     State's per capita base period, fiscal year 2019, and any 
     subsequent fiscal year, may be adjusted by the Secretary 
     based upon an appeal (filed by the State in such a form, 
     manner, and time, and containing such information relating to 
     data errors that support such appeal, as the Secretary 
     specifies) that the Secretary determines to be valid, except 
     that any adjustment by the Secretary under this subsection 
     for a State may not result in an increase of the target total 
     medical assistance expenditures exceeding 2 percent.
       ``(h) Required Reporting and Auditing; Transitional 
     Increase in Federal Matching Percentage for Certain 
     Administrative Expenses.--
       ``(1) Auditing of cms-64 data.--The Secretary shall conduct 
     for each State an audit of the number of individuals and 
     expenditures reported through the CMS-64 report for the 
     State's per capita base period, fiscal year 2019, and each 
     subsequent fiscal year, which audit may be conducted on a 
     representative sample (as determined by the Secretary).
       ``(2) Auditing of state spending.--The Inspector General of 
     the Department of Health and Human Services shall conduct an 
     audit (which shall be conducted using random sampling, as 
     determined by the Inspector General) of each State's spending 
     under this section not less than once every 3 years.
       ``(3) Temporary increase in federal matching percentage to 
     support improved data reporting systems for fiscal years 2018 
     and 2019.--In the case of any State that selects as its per 
     capita base period the most recent 8 consecutive quarter 
     period for which the data necessary to make the 
     determinations required under this section is available, for 
     amounts expended during calendar quarters beginning on or 
     after October 1, 2017, and before October 1, 2019--
       ``(A) the Federal matching percentage applied under section 
     1903(a)(3)(A)(i) shall be increased by 10 percentage points 
     to 100 percent; and
       ``(B) the Federal matching percentage applied under section 
     1903(a)(3)(B) shall be increased by 25 percentage points to 
     100 percent.
       ``(4) HHS report on adoption of t-msis data.--Not later 
     than January 1, 2025, the Secretary shall submit to Congress 
     a report making recommendations as to whether data from the 
     Transformed Medicaid Statistical

[[Page S4342]]

     Information System would be preferable to CMS-64 report data 
     for purposes of making the determinations necessary under 
     this section.''.
       (b) Ensuring Access to Home and Community Based Services.--
     Section 1915 of the Social Security Act (42 U.S.C. 1396n) is 
     amended by adding at the end the following new subsection:
       ``(l) Incentive Payments for Home and Community-based 
     Services.--
       ``(1) In general.--The Secretary shall establish a 
     demonstration project (referred to in this subsection as the 
     `demonstration project') under which eligible States may make 
     HCBS payment adjustments for the purpose of continuing to 
     provide and improving the quality of home and community-based 
     services provided under a waiver under subsection (c) or (d) 
     or a State plan amendment under subsection (i).
       ``(2) Selection of eligible states.--
       ``(A) Application.--A State seeking to participate in the 
     demonstration project shall submit to the Secretary, at such 
     time and in such manner as the Secretary shall require, an 
     application that includes--
       ``(i) an assurance that any HCBS payment adjustment made by 
     the State under this subsection will comply with the health 
     and welfare and financial accountability safeguards taken by 
     the State under subsection (c)(2)(A); and
       ``(ii) such other information and assurances as the 
     Secretary shall require.
       ``(B) Selection.--The Secretary shall select States to 
     participate in the demonstration project on a competitive 
     basis except that, in making selections under this paragraph, 
     the Secretary shall give priority to any State that is one of 
     the 15 States in the United States with the lowest population 
     density, as determined by the Secretary based on data from 
     the Bureau of the Census.
       ``(3) Term of demonstration project.--The demonstration 
     project shall be conducted for the 4-year period beginning on 
     January 1, 2020, and ending on December 31, 2023.
       ``(4) State allotments and increased fmap for payment 
     adjustments.--
       ``(A) In general.--
       ``(i) Annual allotment.--Subject to clause (ii), for each 
     year of the demonstration project, the Secretary shall allot 
     an amount to each State that is an eligible State for the 
     year.
       ``(ii) Limitation on federal spending.--The aggregate 
     amount that may be allotted to eligible States under clause 
     (i) for all years of the demonstration project shall not 
     exceed $8,000,000,000.
       ``(B) FMAP applicable to hcbs payment adjustments.--For 
     each year of the demonstration project, notwithstanding 
     section 1905(b) but subject to the limitations described in 
     subparagraph (C), the Federal medical assistance percentage 
     applicable with respect to expenditures by an eligible State 
     that are attributable to HCBS payment adjustments shall be 
     equal to (and shall in no case exceed) 100 percent.
       ``(C) Individual provider and allotment limitations.--
     Payment under section 1903(a) shall not be made to an 
     eligible State for expenditures for a year that are 
     attributable to an HCBS payment adjustment--
       ``(i) that is paid to a single provider and exceeds a 
     percentage which shall be established by the Secretary of the 
     payment otherwise made to the provider; or
       ``(ii) to the extent that the aggregate amount of HCBS 
     payment adjustments made by the State in the year exceeds the 
     amount allotted to the State for the year under clause (i).
       ``(5) Reporting and evaluation.--
       ``(A) In general.--As a condition of receiving the 
     increased Federal medical assistance percentage described in 
     paragraph (4)(B), each eligible State shall collect and 
     report information, as determined necessary by the Secretary, 
     for the purposes of providing Federal oversight and 
     evaluating the State's compliance with the health and welfare 
     and financial accountability safeguards taken by the State 
     under subsection (c)(2)(A).
       ``(B) Forms.--Expenditures by eligible States on HCBS 
     payment adjustments shall be separately reported on the CMS-
     64 Form and in T-MSIS.
       ``(6) Definitions.--In this subsection:
       ``(A) Eligible state.--The term `eligible State' means a 
     State that--
       ``(i) is one of the 50 States or the District of Columbia;
       ``(ii) has in effect--

       ``(I) a waiver under subsection (c) or (d); or
       ``(II) a State plan amendment under subsection (i);

       ``(iii) submits an application under paragraph (2)(A); and
       ``(iv) is selected by the Secretary to participate in the 
     demonstration project.
       ``(B) HCBS payment adjustment.--The term `HCBS payment 
     adjustment' means a payment adjustment made by an eligible 
     State to the amount of payment otherwise provided under a 
     waiver under subsection (c) or (d) or a State plan amendment 
     under subsection (i) for a home and community-based service 
     which is provided to a 1903A enrollee (as defined in section 
     1903A(e)(1)) who is in the enrollee category described in 
     subparagraph (A) or (B) of section 1903A(e)(2).''.

     SEC. 128. FLEXIBLE BLOCK GRANT OPTION FOR STATES.

       Title XIX of the Social Security Act, as previously 
     amended, is further amended by inserting after section 1903A 
     the following new section:

     ``SEC. 1903B. MEDICAID FLEXIBILITY PROGRAM.

       ``(a) In General.--Beginning with fiscal year 2020, any 
     State (as defined in subsection (e)) that has an application 
     approved by the Secretary under subsection (b) may conduct a 
     Medicaid Flexibility Program to provide targeted health 
     assistance to program enrollees.
       ``(b) State Application.--
       ``(1) In general.--To be eligible to conduct a Medicaid 
     Flexibility Program, a State shall submit an application to 
     the Secretary that meets the requirements of this subsection.
       ``(2) Contents of application.--An application under this 
     subsection shall include the following:
       ``(A) A description of the proposed Medicaid Flexibility 
     Program and how the State will satisfy the requirements 
     described in subsection (d).
       ``(B) The proposed conditions for eligibility of program 
     enrollees.
       ``(C) The applicable program enrollee category (as defined 
     in subsection (e)(1)).
       ``(D) A description of the types, amount, duration, and 
     scope of services which will be offered as targeted health 
     assistance under the program, including a description of the 
     proposed package of services which will be provided to 
     program enrollees to whom the State would otherwise be 
     required to make medical assistance available under section 
     1902(a)(10)(A)(i).
       ``(E) A description of how the State will notify 
     individuals currently enrolled in the State plan for medical 
     assistance under this title of the transition to such 
     program.
       ``(F) Statements certifying that the State agrees to--
       ``(i) submit regular enrollment data with respect to the 
     program to the Centers for Medicare & Medicaid Services at 
     such time and in such manner as the Secretary may require;
       ``(ii) submit timely and accurate data to the Transformed 
     Medicaid Statistical Information System (T-MSIS);
       ``(iii) report annually to the Secretary on adult health 
     quality measures implemented under the program and 
     information on the quality of health care furnished to 
     program enrollees under the program as part of the annual 
     report required under section 1139B(d)(1);
       ``(iv) submit such additional data and information not 
     described in any of the preceding clauses of this 
     subparagraph but which the Secretary determines is necessary 
     for monitoring, evaluation, or program integrity purposes, 
     including--

       ``(I) survey data, such as the data from Consumer 
     Assessment of Healthcare Providers and Systems (CAHPS) 
     surveys;
       ``(II) birth certificate data; and
       ``(III) clinical patient data for quality measurements 
     which may not be present in a claim, such as laboratory data, 
     body mass index, and blood pressure; and

       ``(v) on an annual basis, conduct a report evaluating the 
     program and make such report available to the public.
       ``(G) An information technology systems plan demonstrating 
     that the State has the capability to support the 
     technological administration of the program and comply with 
     reporting requirements under this section.
       ``(H) A statement of the goals of the proposed program, 
     which shall include--
       ``(i) goals related to quality, access, rate of growth 
     targets, consumer satisfaction, and outcomes;
       ``(ii) a plan for monitoring and evaluating the program to 
     determine whether such goals are being met; and
       ``(iii) a proposed process for the State, in consultation 
     with the Centers for Medicare & Medicaid Services, to take 
     remedial action to make progress on unmet goals.
       ``(I) Such other information as the Secretary may require.
       ``(3) State notice and comment period.--
       ``(A) In general.--Before submitting an application under 
     this subsection, a State shall make the application publicly 
     available for a 30 day notice and comment period.
       ``(B) Notice and comment process.--During the notice and 
     comment period described in subparagraph (A), the State shall 
     provide opportunities for a meaningful level of public input, 
     which shall include public hearings on the proposed Medicaid 
     Flexibility Program.
       ``(4) Federal notice and comment period.--The Secretary 
     shall not approve of any application to conduct a Medicaid 
     Flexibility Program without making such application publicly 
     available for a 30 day notice and comment period.
       ``(5) Timeline for submission.--
       ``(A) In general.--A State may submit an application under 
     this subsection to conduct a Medicaid Flexibility Program 
     that would begin in the next fiscal year at any time, subject 
     to subparagraph (B).
       ``(B) Deadlines.--Each year beginning with 2019, the 
     Secretary shall specify a deadline for submitting an 
     application under this subsection to conduct a Medicaid 
     Flexibility Program that would begin in the next fiscal year, 
     but such deadline shall not be earlier than 60 days after the 
     date that the Secretary publishes the amounts of State block 
     grants as required under subsection (c)(4).
       ``(c) Financing.--
       ``(1) In general.--For each fiscal year during which a 
     State is conducting a Medicaid Flexibility Program, the State 
     shall receive, instead of amounts otherwise payable to the 
     State under this title for medical assistance

[[Page S4343]]

     for program enrollees, the amount specified in paragraph 
     (3)(A).
       ``(2) Amount of block grant funds.--
       ``(A) In general.--The block grant amount under this 
     paragraph for a State and year shall be equal to the sum of 
     the amounts determined under subparagraph (B) for each 1903A 
     enrollee category within the applicable program enrollee 
     category for the State and year.
       ``(B) Enrollee category amounts.--
       ``(i) For initial year.--Subject to subparagraph (C), for 
     the first fiscal year in which a 1903A enrollee category is 
     included in the applicable program enrollee category for a 
     Medicaid Flexibility Program conducted by the State, the 
     amount determined under this subparagraph for the State, 
     year, and category shall be equal to the Federal average 
     medical assistance matching percentage (as defined in section 
     1903A(a)(4)) for the State and year multiplied by the product 
     of--

       ``(I) the target per capita medical assistance expenditures 
     (as defined in section 1903A(c)(2)) for the State, year, and 
     category; and
       ``(II) the number of 1903A enrollees in such category for 
     the State for the second fiscal year preceding such first 
     fiscal year, increased by the percentage increase in State 
     population from such second preceding fiscal year to such 
     first fiscal year, based on the best available estimates of 
     the Bureau of the Census.

       ``(ii) For any subsequent year.--For any fiscal year that 
     is not the first fiscal year in which a 1903A enrollee 
     category is included in the applicable program enrollee 
     category for a Medicaid Flexibility Program conducted by the 
     State, the block grant amount under this paragraph for the 
     State, year, and category shall be equal to the amount 
     determined for the State and category for the most recent 
     previous fiscal year in which the State conducted a Medicaid 
     Flexibility Program that included such category, except that 
     such amount shall be increased by the percentage increase in 
     the consumer price index for all urban consumers (U.S. city 
     average) from April of the second fiscal year preceding the 
     fiscal year involved to April of the fiscal year preceding 
     the fiscal year involved.
       ``(C) Cap on total population of 1903a enrollees for 
     purposes of block grant calculation.--
       ``(i) In general.--In calculating the amount of a block 
     grant for the first year in which a 1903A enrollee category 
     is included in the applicable program enrollee category for a 
     Medicaid Flexibility Program conducted by the State under 
     subparagraph (B)(i), the total number of 1903A enrollees in 
     such 1903A enrollee category for the State and year shall not 
     exceed the adjusted number of base period enrollees for the 
     State (as defined in clause (ii)).
       ``(ii) Adjusted number of base period enrollees.--The term 
     `adjusted number of base period enrollees' means, with 
     respect to a State and 1903A enrollee category, the number of 
     1903A enrollees in the enrollee category for the State for 
     the State's per capita base period (as determined under 
     section 1903A(e)(4)), increased by the percentage increase, 
     if any, in the total State population from the last April in 
     the State's per capita base period to April of the fiscal 
     year preceding the fiscal year involved (determined using the 
     best available data from the Bureau of the Census) plus 3 
     percentage points.
       ``(3) Federal payment and state maintenance of effort.--
       ``(A) Federal payment.--Subject to subparagraphs (D) and 
     (E), the Secretary shall pay to each State conducting a 
     Medicaid Flexibility Program under this section for a fiscal 
     year, from its block grant amount under paragraph (2) for 
     such year, an amount for each quarter of such year equal to 
     the Federal average medical assistance percentage (as defined 
     in section 1903A(a)(4)) of the total amount expended under 
     the program during such quarter as targeted health 
     assistance, and the State is responsible for the balance of 
     the funds to carry out such program.
       ``(B) State maintenance of effort expenditures.--For each 
     year during which a State is conducting a Medicaid 
     Flexibility Program, the State shall make expenditures for 
     targeted health assistance under the program in an amount 
     equal to the product of--
       ``(i) the block grant amount determined for the State and 
     year under paragraph (2); and
       ``(ii) the enhanced FMAP described in the first sentence of 
     section 2105(b) for the State and year.
       ``(C) Reduction in block grant amount for states failing to 
     meet moe requirement.--
       ``(i) In general.--In the case of a State conducting a 
     Medicaid Flexibility Program that makes expenditures for 
     targeted health assistance under the program for a fiscal 
     year in an amount that is less than the required amount for 
     the fiscal year under subparagraph (B), the amount of the 
     block grant determined for the State under paragraph (2) for 
     the succeeding fiscal year shall be reduced by the amount by 
     which such expenditures are less than such required amount.
       ``(ii) Disregard of reduction.--For purposes of determining 
     the amount of a State block grant under paragraph (2), any 
     reduction made under this subparagraph to a State's block 
     grant amount in a previous fiscal year shall be disregarded.
       ``(iii) Application to states that terminate program.--In 
     the case of a State described in clause (i) that terminates 
     the State Medicaid Flexibility Program under subsection 
     (d)(2)(B) and such termination is effective with the end of 
     the fiscal year in which the State fails to make the required 
     amount of expenditures under subparagraph (B), the reduction 
     amount determined for the State and succeeding fiscal year 
     under clause (i) shall be treated as an overpayment under 
     this title.
       ``(D) Reduction for noncompliance.--If the Secretary 
     determines that a State conducting a Medicaid Flexibility 
     Program is not complying with the requirements of this 
     section, the Secretary may withhold payments, reduce 
     payments, or recover previous payments to the State under 
     this section as the Secretary deems appropriate.
       ``(E) Additional federal payments during public health 
     emergency.--
       ``(i) In general.--In the case of a State and fiscal year 
     or portion of a fiscal year for which the Secretary has 
     excluded expenditures under section 1903A(b)(6), if the State 
     has uncompensated targeted health assistance expenditures for 
     the year or portion of a year, the Secretary may make an 
     additional payment to such State equal to the Federal average 
     medical assistance percentage (as defined in section 
     1903A(a)(4)) for the year or portion of a year of the amount 
     of such uncompensated targeted health assistance 
     expenditures, except that the amount of such payment shall 
     not exceed the amount determined for the State and year or 
     portion of a year under clause (ii).
       ``(ii) Maximum amount of additional payment.--The amount 
     determined for a State and fiscal year or portion of a fiscal 
     year under this subparagraph shall not exceed the Federal 
     average medical assistance percentage (as defined in section 
     1903A(a)(4)) for such year or portion of a year of the amount 
     by which--

       ``(I) the amount of State expenditures for targeted health 
     assistance for program enrollees in areas of the State which 
     are subject to a declaration described in section 
     1903A(b)(6)(A)(i) for the year or portion of a year; exceeds
       ``(II) the amount of such expenditures for such enrollees 
     in such areas during the most recent fiscal year involved (or 
     portion of a fiscal year of equal length to the portion of a 
     fiscal year involved) during which no such declaration was in 
     effect.

       ``(iii) Uncompensated targeted health assistance.--In this 
     subparagraph, the term `uncompensated targeted health 
     assistance expenditures' means, with respect to a State and 
     fiscal year or portion of a fiscal year, an amount equal to 
     the amount (if any) by which--

       ``(I) the total amount expended by the State under the 
     program for targeted health assistance for the year or 
     portion of a year; exceeds
       ``(II) the amount equal to the amount of the block grant 
     (reduced, in the case of a portion of a year, to the same 
     proportion of the full block grant amount that the portion of 
     the year bears to the whole year) divided by the Federal 
     average medical assistance percentage for the year or portion 
     of a year.

       ``(iv) Review.--If the Secretary makes a payment to a State 
     for a fiscal year or portion of a fiscal year, the Secretary 
     shall, not later than 6 months after the declaration 
     described in section 1903A(b)(6)(A)(i) ceases to be in 
     effect, conduct an audit of the State's targeted health 
     assistance expenditures for program enrollees during the year 
     or portion of a year to ensure that all of the expenditures 
     for which the additional payment was made were made for the 
     purpose of ensuring that the health care needs of program 
     enrollees in areas affected by a public health emergency are 
     met.
       ``(4) Determination and publication of block grant 
     amount.--Beginning in 2019 and each year thereafter, the 
     Secretary shall determine for each State, regardless of 
     whether the State is conducting a Medicaid Flexibility 
     Program or has submitted an application to conduct such a 
     program, the amount of the block grant for the State under 
     paragraph (2) which would apply for the upcoming fiscal year 
     if the State were to conduct such a program in such fiscal 
     year, and shall publish such determinations not later than 
     June 1 of each year.
       ``(d) Program Requirements.--
       ``(1) In general.--No payment shall be made under this 
     section to a State conducting a Medicaid Flexibility Program 
     unless such program meets the requirements of this 
     subsection.
       ``(2) Term of program.--
       ``(A) In general.--A State Medicaid Flexibility Program 
     approved under subsection (b)--
       ``(i) shall be conducted for not less than 1 program 
     period;
       ``(ii) at the option of the State, may be continued for 
     succeeding program periods without resubmitting an 
     application under subsection (b), provided that--

       ``(I) the State provides notice to the Secretary of its 
     decision to continue the program; and
       ``(II) no significant changes are made to the program; and

       ``(iii) shall be subject to termination only by the State, 
     which may terminate the program by making an election under 
     subparagraph (B).
       ``(B) Election to terminate program.--
       ``(i) In general.--Subject to clause (ii), a State 
     conducting a Medicaid Flexibility Program may elect to 
     terminate the program effective with the first day after the 
     end of the

[[Page S4344]]

     program period in which the State makes the election.
       ``(ii) Transition plan requirement.--A State may not elect 
     to terminate a Medicaid Flexibility Program unless the State 
     has in place an appropriate transition plan approved by the 
     Secretary.
       ``(iii) Effect of termination.--If a State elects to 
     terminate a Medicaid Flexibility Program, the per capita cap 
     limitations under section 1903A shall apply effective with 
     the day described in clause (i), and such limitations shall 
     be applied as if the State had never conducted a Medicaid 
     Flexibility Program.
       ``(3) Provision of targeted health assistance.--
       ``(A) In general.--A State Medicaid Flexibility Program 
     shall provide targeted health assistance to program enrollees 
     and such assistance shall be instead of medical assistance 
     which would otherwise be provided to the enrollees under this 
     title.
       ``(B) Conditions for eligibility.--
       ``(i) In general.--A State conducting a Medicaid 
     Flexibility Program shall establish conditions for 
     eligibility of program enrollees, which shall be instead of 
     other conditions for eligibility under this title, except 
     that the program must provide for eligibility for program 
     enrollees to whom the State would otherwise be required to 
     make medical assistance available under section 
     1902(a)(10)(A)(i).
       ``(ii) MAGI.--Any determination of income necessary to 
     establish the eligibility of a program enrollee for purposes 
     of a State Medicaid Flexibility Program shall be made using 
     modified adjusted gross income in accordance with section 
     1902(e)(14).
       ``(4) Benefits and services.--
       ``(A) Required services.--In the case of program enrollees 
     to whom the State would otherwise be required to make medical 
     assistance available under section 1902(a)(10)(A)(i), a State 
     conducting a Medicaid Flexibility Program shall provide as 
     targeted health assistance the following types of services:
       ``(i) Inpatient and outpatient hospital services.
       ``(ii) Laboratory and X-ray services.
       ``(iii) Nursing facility services for individuals aged 21 
     and older.
       ``(iv) Physician services.
       ``(v) Home health care services (including home nursing 
     services, medical supplies, equipment, and appliances).
       ``(vi) Rural health clinic services (as defined in section 
     1905(l)(1)).
       ``(vii) Federally-qualified health center services (as 
     defined in section 1905(l)(2)).
       ``(viii) Family planning services and supplies.
       ``(ix) Nurse midwife services.
       ``(x) Certified pediatric and family nurse practitioner 
     services.
       ``(xi) Freestanding birth center services (as defined in 
     section 1905(l)(3)).
       ``(xii) Emergency medical transportation.
       ``(xiii) Non-cosmetic dental services.
       ``(xiv) Pregnancy-related services, including postpartum 
     services for the 12-week period beginning on the last day of 
     a pregnancy.
       ``(B) Optional benefits.--A State may, at its option, 
     provide services in addition to the services described in 
     subparagraph (A) as targeted health assistance under a 
     Medicaid Flexibility Program.
       ``(C) Benefit packages.--
       ``(i) In general.--The targeted health assistance provided 
     by a State to any group of program enrollees under a Medicaid 
     Flexibility Program shall have an aggregate actuarial value 
     that is equal to at least 95 percent of the aggregate 
     actuarial value of the benchmark coverage described in 
     subsection (b)(1) of section 1937 or benchmark-equivalent 
     coverage described in subsection (b)(2) of such section, as 
     such subsections were in effect prior to the enactment of the 
     Patient Protection and Affordable Care Act.
       ``(ii) Amount, duration, and scope of benefits.--Subject to 
     clause (i), the State shall determine the amount, duration, 
     and scope with respect to services provided as targeted 
     health assistance under a Medicaid Flexibility Program, 
     including with respect to services that are required to be 
     provided to certain program enrollees under subparagraph (A) 
     except as otherwise provided under such subparagraph.
       ``(iii) Mental health and substance use disorder coverage 
     and parity.--The targeted health assistance provided by a 
     State to program enrollees under a Medicaid Flexibility 
     Program shall include mental health services and substance 
     use disorder services and the financial requirements and 
     treatment limitations applicable to such services under the 
     program shall comply with the requirements of section 2726 of 
     the Public Health Service Act in the same manner as such 
     requirements apply to a group health plan.
       ``(iv) Prescription drugs.--If the targeted health 
     assistance provided by a State to program enrollees under a 
     Medicaid Flexibility Program includes assistance for covered 
     outpatient drugs, such drugs shall be subject to a rebate 
     agreement that complies with the requirements of section 
     1927, and any requirements applicable to medical assistance 
     for covered outpatient drugs under a State plan (including 
     the requirement that the State provide information to a 
     manufacturer) shall apply in the same manner to targeted 
     health assistance for covered outpatient drugs under a 
     Medicaid Flexibility Program.
       ``(D) Cost sharing.--A State conducting a Medicaid 
     Flexibility Program may impose premiums, deductibles, cost-
     sharing, or other similar charges, except that the total 
     annual aggregate amount of all such charges imposed with 
     respect to all program enrollees in a family shall not exceed 
     5 percent of the family's income for the year involved.
       ``(5) Administration of program.--Each State conducting a 
     Medicaid Flexibility Program shall do the following:
       ``(A) Single agency.--Designate a single State agency 
     responsible for administering the program.
       ``(B) Enrollment simplification and coordination with state 
     health insurance exchanges.--Provide for simplified 
     enrollment processes (such as online enrollment and 
     reenrollment and electronic verification) and coordination 
     with State health insurance exchanges.
       ``(C) Beneficiary protections.--Establish a fair process 
     (which the State shall describe in the application required 
     under subsection (b)) for individuals to appeal adverse 
     eligibility determinations with respect to the program.
       ``(6) Application of rest of title xix.--
       ``(A) In general.--To the extent that a provision of this 
     section is inconsistent with another provision of this title, 
     the provision of this section shall apply.
       ``(B) Application of section 1903a.--With respect to a 
     State that is conducting a Medicaid Flexibility Program, 
     section 1903A shall be applied as if program enrollees were 
     not 1903A enrollees for each program period during which the 
     State conducts the program.
       ``(C) Waivers and state plan amendments.--
       ``(i) In general.--In the case of a State conducting a 
     Medicaid Flexibility Program that has in effect a waiver or 
     State plan amendment, such waiver or amendment shall not 
     apply with respect to the program, targeted health assistance 
     provided under the program, or program enrollees.
       ``(ii) Replication of waiver or amendment.--In designing a 
     Medicaid Flexibility Program, a State may mirror provisions 
     of a waiver or State plan amendment described in clause (i) 
     in the program to the extent that such provisions are 
     otherwise consistent with the requirements of this section.
       ``(iii) Effect of termination.--In the case of a State 
     described in clause (i) that terminates its program under 
     subsection (d)(2)(B), any waiver or amendment which was 
     limited pursuant to subparagraph (A) shall cease to be so 
     limited effective with the effective date of such 
     termination.
       ``(D) Nonapplication of provisions.--With respect to the 
     design and implementation of Medicaid Flexibility Programs 
     conducted under this section, paragraphs (1), (10)(B), (17), 
     and (23) of section 1902(a), as well as any other provision 
     of this title (except for this section and as otherwise 
     provided by this section) that the Secretary deems 
     appropriate, shall not apply.
       ``(e) Definitions.--For purposes of this section:
       ``(1) Applicable program enrollee category.--The term 
     `applicable program enrollee category' means, with respect to 
     a State Medicaid Flexibility Program for a program period, 
     any of the following as specified by the State for the period 
     in its application under subsection (b):
       ``(A) 2 enrollee categories.--Both of the 1903A enrollee 
     categories described in subparagraphs (D) and (E) of section 
     1903A(e)(2).
       ``(B) Expansion enrollees.--The 1903A enrollee category 
     described in subparagraph (D) of section 1903A(e)(2).
       ``(C) Nonelderly, nondisabled, nonexpansion adults.--The 
     1903A enrollee category described in subparagraph (E) of 
     section 1903A(e)(2).
       ``(2) Medicaid flexibility program.--The term `Medicaid 
     Flexibility Program' means a State program for providing 
     targeted health assistance to program enrollees funded by a 
     block grant under this section.
       ``(3) Program enrollee.--
       ``(A) In general.--The term `program enrollee' means, with 
     respect to a State that is conducting a Medicaid Flexibility 
     Program for a program period, an individual who is a 1903A 
     enrollee (as defined in section 1903A(e)(1)) who is in the 
     applicable program enrollee category specified by the State 
     for the period.
       ``(B) Rule of construction.--For purposes of section 
     1903A(e)(3), eligibility and enrollment of an individual 
     under a Medicaid Flexibility Program shall be deemed to be 
     eligibility and enrollment under a State plan (or waiver of 
     such plan) under this title.
       ``(4) Program period.--The term `program period' means, 
     with respect to a State Medicaid Flexibility Program, a 
     period of 5 consecutive fiscal years that begins with 
     either--
       ``(A) the first fiscal year in which the State conducts the 
     program; or
       ``(B) the next fiscal year in which the State conducts such 
     a program that begins after the end of a previous program 
     period.
       ``(5) State.--The term `State' means one of the 50 States 
     or the District of Columbia.
       ``(6) Targeted health assistance.--The term `targeted 
     health assistance' means assistance for health-care-related 
     items and medical services for program enrollees.''.

     SEC. 129. MEDICAID AND CHIP QUALITY PERFORMANCE BONUS 
                   PAYMENTS.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b), 
     as previously amended, is further amended by adding at the 
     end the following new subsection:

[[Page S4345]]

       ``(bb) Quality Performance Bonus Payments.--
       ``(1) Increased federal share.--With respect to each of 
     fiscal years 2023 through 2026, in the case of one of the 50 
     States or the District of Columbia (each referred to in this 
     subsection as a `State') that--
       ``(A) equals or exceeds the qualifying amount (as 
     established by the Secretary) of lower than expected 
     aggregate medical assistance expenditures (as defined in 
     paragraph (4)) for that fiscal year; and
       ``(B) submits to the Secretary, in accordance with such 
     manner and format as specified by the Secretary and for the 
     performance period (as defined by the Secretary) for such 
     fiscal year--
       ``(i) information on the applicable quality measures 
     identified under paragraph (3) with respect to each category 
     of Medicaid eligible individuals under the State plan or a 
     waiver of such plan; and
       ``(ii) a plan for spending a portion of additional funds 
     resulting from application of this subsection on quality 
     improvement within the State plan under this title or under a 
     waiver of such plan,

     the Federal matching percentage otherwise applied under 
     subsection (a)(7) for such fiscal year shall be increased by 
     such percentage (as determined by the Secretary) so that the 
     aggregate amount of the resulting increase pursuant to this 
     subsection for the State and fiscal year does not exceed the 
     State allotment established under paragraph (2) for the State 
     and fiscal year.
       ``(2) Allotment determination.--The Secretary shall 
     establish a formula for computing State allotments under this 
     paragraph for each fiscal year described in paragraph (1) 
     such that--
       ``(A) such an allotment to a State is determined based on 
     the performance, including improvement, of such State under 
     this title and title XXI with respect to the quality measures 
     submitted under paragraph (3) by such State for the 
     performance period (as defined by the Secretary) for such 
     fiscal year; and
       ``(B) the total of the allotments under this paragraph for 
     all States for the period of the fiscal years described in 
     paragraph (1) is equal to $8,000,000,000.
       ``(3) Quality measures required for bonus payments.--For 
     purposes of this subsection, the Secretary shall, pursuant to 
     rulemaking and after consultation with State agencies 
     administering State plans under this title, identify and 
     publish (and update as necessary) peer-reviewed quality 
     measures (which shall include health care and long-term care 
     outcome measures and may include the quality measures that 
     are overseen or developed by the National Committee for 
     Quality Assurance or the Agency for Healthcare Research and 
     Quality or that are identified under section 1139A or 1139B) 
     that are quantifiable, objective measures that take into 
     account the clinically appropriate measures of quality for 
     different types of patient populations receiving benefits or 
     services under this title or title XXI.
       ``(4) Lower than expected aggregate medical assistance 
     expenditures.--In this subsection, the term `lower than 
     expected aggregate medical assistance expenditures' means, 
     with respect to a State the amount (if any) by which--
       ``(A) the amount of the adjusted total medical assistance 
     expenditures for the State and fiscal year determined in 
     section 1903A(b)(1) without regard to the 1903A enrollee 
     category described in section 1903A(e)(2)(E); is less than
       ``(B) the amount of the target total medical assistance 
     expenditures for the State and fiscal year determined in 
     section 1903A(c) without regard to the 1903A enrollee 
     category described in section 1903A(e)(2)(E).''.

     SEC. 130. OPTIONAL ASSISTANCE FOR CERTAIN INPATIENT 
                   PSYCHIATRIC SERVICES.

       (a) State Option.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (a)--
       (A) in paragraph (16)--
       (i) by striking ``and, (B)'' and inserting ``(B)''; and
       (ii) by inserting before the semicolon at the end the 
     following: ``, and (C) subject to subsection (h)(4), 
     qualified inpatient psychiatric hospital services (as defined 
     in subsection (h)(3)) for individuals who are over 21 years 
     of age and under 65 years of age''; and
       (B) in the subdivision (B) that follows paragraph (29), by 
     inserting ``(other than services described in subparagraph 
     (C) of paragraph (16) for individuals described in such 
     subparagraph)'' after ``patient in an institution for mental 
     diseases''; and
       (2) in subsection (h), by adding at the end the following 
     new paragraphs:
       ``(3) For purposes of subsection (a)(16)(C), the term 
     `qualified inpatient psychiatric hospital services' means, 
     with respect to individuals described in such subsection, 
     services described in subparagraph (B) of paragraph (1) that 
     are not otherwise covered under subsection (a)(16)(A) and are 
     furnished--
       ``(A) in an institution (or distinct part thereof) which is 
     a psychiatric hospital (as defined in section 1861(f)); and
       ``(B) with respect to such an individual, for a period not 
     to exceed 30 consecutive days in any month and not to exceed 
     90 days in any calendar year.
       ``(4) As a condition for a State including qualified 
     inpatient psychiatric hospital services as medical assistance 
     under subsection (a)(16)(C), the State must (during the 
     period in which it furnishes medical assistance under this 
     title for services and individuals described in such 
     subsection)--
       ``(A) maintain at least the number of licensed beds at 
     psychiatric hospitals owned, operated, or contracted for by 
     the State that were being maintained as of the date of the 
     enactment of this paragraph or, if higher, as of the date the 
     State applies to the Secretary to include medical assistance 
     under such subsection; and
       ``(B) maintain on an annual basis a level of funding 
     expended by the State (and political subdivisions thereof) 
     other than under this title from non-Federal funds for 
     inpatient services in an institution described in paragraph 
     (3)(A), and for active psychiatric care and treatment 
     provided on an outpatient basis, that is not less than the 
     level of such funding for such services and care as of the 
     date of the enactment of this paragraph or, if higher, as of 
     the date the State applies to the Secretary to include 
     medical assistance under such subsection.''.
       (b) Special Matching Rate.--Section 1905(b) of the Social 
     Security Act (42 U.S.C. 1395d(b)) is amended by adding at the 
     end the following: ``Notwithstanding the previous provisions 
     of this subsection, the Federal medical assistance percentage 
     shall be 50 percent with respect to medical assistance for 
     services and individuals described in subsection 
     (a)(16)(C).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to qualified inpatient psychiatric hospital 
     services furnished on or after October 1, 2018.

     SEC. 131. ENHANCED FMAP FOR MEDICAL ASSISTANCE TO ELIGIBLE 
                   INDIANS.

       Section 1905(b) of the Social Security Act (42 U.S.C. 
     1396d(b)) is amended, in the third sentence, by inserting 
     ``and with respect to amounts expended by a State as medical 
     assistance for services provided by any other provider under 
     the State plan to an individual who is a member of an Indian 
     tribe who is eligible for assistance under the State plan'' 
     before the period.

     SEC. 132. SMALL BUSINESS HEALTH PLANS.

       (a) Tax Treatment of Small Business Health Plans.--A small 
     business health plan (as defined in section 801(a) of the 
     Employee Retirement Income Security Act of 1974) shall be 
     treated--
       (1) as a group health plan (as defined in section 2791 of 
     the Public Health Service Act (42 U.S.C. 300gg-91)) for 
     purposes of applying title XXVII of the Public Health Service 
     Act (42 U.S.C. 300gg et seq.) and title XXII of such Act (42 
     U.S.C. 300bb-1);
       (2) as a group health plan (as defined in section 
     5000(b)(1) of the Internal Revenue Code of 1986) for purposes 
     of applying sections 4980B and 5000 and chapter 100 of the 
     Internal Revenue Code of 1986; and
       (3) as a group health plan (as defined in section 733(a)(1) 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1191b(a)(1))) for purposes of applying parts 6 and 7 
     of title I of the Employee Retirement Income Security Act of 
     1974 (29 U.S.C. 1161 et seq.).
       (b) Rules.--Subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1021 et 
     seq.) is amended by adding at the end the following new part:

      ``PART 8--RULES GOVERNING SMALL BUSINESS RISK SHARING POOLS

     ``SEC. 801. SMALL BUSINESS HEALTH PLANS.

       ``(a) In General.--For purposes of this part, the term 
     `small business health plan' means a fully insured group 
     health plan, offered by a health insurance issuer in the 
     large group market, whose sponsor is described in subsection 
     (b).
       ``(b) Sponsor.--The sponsor of a group health plan is 
     described in this subsection if such sponsor--
       ``(1) is a qualified sponsor and receives certification by 
     the Secretary;
       ``(2) is organized and maintained in good faith, with a 
     constitution or bylaws specifically stating its purpose and 
     providing for periodic meetings on at least an annual basis;
       ``(3) is established as a permanent entity;
       ``(4) is established for a purpose other than providing 
     health benefits to its members, such as an organization 
     established as a bona fide trade association, franchise, or 
     section 7705 organization; and
       ``(5) does not condition membership on the basis of a 
     minimum group size.

     ``SEC. 802. FILING FEE AND CERTIFICATION OF SMALL BUSINESS 
                   HEALTH PLANS.

       ``(a) Filing Fee.--A small business health plan shall pay 
     to the Secretary at the time of filing an application for 
     certification under subsection (b) a filing fee in the amount 
     of $5,000, which shall be available to the Secretary for the 
     sole purpose of administering the certification procedures 
     applicable with respect to small business health plans.
       ``(b) Certification.--
       ``(1) In general.--Not later than 6 months after the date 
     of enactment of this part, the Secretary shall prescribe by 
     interim final rule a procedure under which the Secretary--
       ``(A) will certify a qualified sponsor of a small business 
     health plan, upon receipt of an application that includes the 
     information described in paragraph (2);
       ``(B) may provide for continued certification of small 
     business health plans under this part;
       ``(C) shall provide for the revocation of a certification 
     if the applicable authority finds that the small business 
     health plan involved

[[Page S4346]]

     fails to comply with the requirements of this part;
       ``(D) shall conduct oversight of certified plan sponsors, 
     including periodic review, and consistent with section 504, 
     applying the requirements of sections 518, 519, and 520; and
       ``(E) will consult with a State with respect to a small 
     business health plan domiciled in such State regarding the 
     Secretary's authority under this part and other enforcement 
     authority under sections 502 and 504.
       ``(2) Information to be included in application for 
     certification.--An application for certification under this 
     part meets the requirements of this section only if it 
     includes, in a manner and form which shall be prescribed by 
     the applicable authority by regulation, at least the 
     following information:
       ``(A) Identifying information.
       ``(B) States in which the plan intends to do business.
       ``(C) Bonding requirements.
       ``(D) Plan documents.
       ``(E) Agreements with service providers.
       ``(3) Requirements for certified plan sponsors.--Not later 
     than 6 months after the date of enactment of this part, the 
     Secretary shall prescribe by interim final rule requirements 
     for certified plan sponsors that include requirements 
     regarding--
       ``(A) structure and requirements for boards of trustees or 
     plan administrators;
       ``(B) notification of material changes; and
       ``(C) notification for voluntary termination.
       ``(c) Filing Notice of Certification With States.--A 
     certification granted under this part to a small business 
     health plan shall not be effective unless written notice of 
     such certification is filed by the plan sponsor with the 
     applicable State authority of each State in which the small 
     business health plan operates.
       ``(d) Expedited and Deemed Certification.--
       ``(1) In general.--If the Secretary fails to act on a 
     complete application for certification under this section 
     within 90 days of receipt of such complete application, the 
     applying small business health plan sponsor shall be deemed 
     certified until such time as the Secretary may deny for cause 
     the application for certification.
       ``(2) Penalty.--The Secretary may assess a penalty against 
     the board of trustees, plan administrator, and plan sponsor 
     (jointly and severally) of a small business health plan 
     sponsor that is deemed certified under paragraph (1) of up to 
     $500,000 in the event the Secretary determines that the 
     application for certification of such small business health 
     plan sponsor was willfully or with gross negligence 
     incomplete or inaccurate.

     ``SEC. 803. PARTICIPATION AND COVERAGE REQUIREMENTS.

       ``(a) Covered Employers and Individuals.--The requirements 
     of this subsection are met with respect to a small business 
     health plan if, under the terms of the plan--
       ``(1) each participating employer must be--
       ``(A) a member of the sponsor;
       ``(B) the sponsor; or
       ``(C) an affiliated member of the sponsor, except that, in 
     the case of a sponsor which is a professional association or 
     other individual-based association, if at least one of the 
     officers, directors, or employees of an employer, or at least 
     one of the individuals who are partners in an employer and 
     who actively participates in the business, is a member or 
     such an affiliated member of the sponsor, participating 
     employers may also include such employer; and
       ``(2) all individuals commencing coverage under the plan 
     after certification under this part must be--
       ``(A) active or retired owners (including self-employed 
     individuals with or without employees), officers, directors, 
     or employees of, or partners in, participating employers; or
       ``(B) the dependents of individuals described in 
     subparagraph (A).
       ``(b) Participating Employers.--In applying requirements 
     relating to coverage renewal, a participating employer shall 
     not be deemed to be a plan sponsor.
       ``(c) Prohibition of Discrimination Against Employers and 
     Employees Eligible to Participate.--The requirements of this 
     subsection are met with respect to a small business health 
     plan if--
       ``(1) under the terms of the plan, no participating 
     employer may provide health insurance coverage in the 
     individual market for any employee not covered under the 
     plan, if such exclusion of the employee from coverage under 
     the plan is based on a health status-related factor with 
     respect to the employee and such employee would, but for such 
     exclusion on such basis, be eligible for coverage under the 
     plan; and
       ``(2) information regarding all coverage options available 
     under the plan is made readily available to any employer 
     eligible to participate.

     ``SEC. 804. DEFINITIONS; RENEWAL.

       ``For purposes of this part:
       ``(1) Affiliated member.--The term `affiliated member' 
     means, in connection with a sponsor--
       ``(A) a person who is otherwise eligible to be a member of 
     the sponsor but who elects an affiliated status with the 
     sponsor, or
       ``(B) in the case of a sponsor with members which consist 
     of associations, a person who is a member or employee of any 
     such association and elects an affiliated status with the 
     sponsor.
       ``(2) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of title XXVII of the Public Health Service Act 
     for the State involved with respect to such issuer.
       ``(3) Franchisor; franchisee.--The terms `franchisor' and 
     `franchisee' have the meanings given such terms for purposes 
     of sections 436.2(a) through 436.2(c) of title 16, Code of 
     Federal Regulations (including any such amendments to such 
     regulation after the date of enactment of this part) and, for 
     purposes of this part, franchisor or franchisee employers 
     participating in such a group health plan shall not be 
     treated as the employer, co-employer, or joint employer of 
     the employees of another participating franchisor or 
     franchisee employer for any purpose.
       ``(4) Health plan terms.--The terms `group health plan', 
     `health insurance coverage', and `health insurance issuer' 
     have the meanings given such terms in section 733.
       ``(5) Individual market.--
       ``(A) In general.--The term `individual market' means the 
     market for health insurance coverage offered to individuals 
     other than in connection with a group health plan.
       ``(B) Treatment of very small groups.--
       ``(i) In general.--Subject to clause (ii), such term 
     includes coverage offered in connection with a group health 
     plan that has fewer than 2 participants as current employees 
     or participants described in section 732(d)(3) on the first 
     day of the plan year.
       ``(ii) State exception.--Clause (i) shall not apply in the 
     case of health insurance coverage offered in a State if such 
     State regulates the coverage described in such clause in the 
     same manner and to the same extent as coverage in the small 
     group market (as defined in section 2791(e)(5) of the Public 
     Health Service Act) is regulated by such State.
       ``(6) Participating employer.--The term `participating 
     employer' means, in connection with a small business health 
     plan, any employer, if any individual who is an employee of 
     such employer, a partner in such employer, or a self-employed 
     individual who is such employer with or without employees (or 
     any dependent, as defined under the terms of the plan, of 
     such individual) is or was covered under such plan in 
     connection with the status of such individual as such an 
     employee, partner, or self-employed individual in relation to 
     the plan.
       ``(7) Section 7705 organization.--The term `section 7705 
     organization' means an organization providing services for a 
     customer pursuant to a contract meeting the conditions of 
     subparagraphs (A), (B), (C), (D), and (E) (but not (F)) of 
     section 7705(e)(2) of the Internal Revenue Code of 1986, 
     including an entity that is part of a section 7705 
     organization control group . For purposes of this part, any 
     reference to `member' shall include a customer of a section 
     7705 organization except with respect to references to a 
     `member' or `members' in paragraph (1).''.
       (c) Preemption Rules.--Section 514 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1144) is 
     amended by adding at the end the following:
       ``(f) The provisions of this title shall supersede any and 
     all State laws insofar as they may now or hereafter preclude 
     a health insurance issuer from offering health insurance 
     coverage in connection with a small business health plan 
     which is certified under part 8.''.
       (d) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C. 
     102(16)(B)) is amended by adding at the end the following new 
     sentence: ``Such term also includes a person serving as the 
     sponsor of a small business health plan under part 8.''.
       (e) Savings Clause.--Section 731(c) of such Act is amended 
     by inserting ``or part 8'' after ``this part''.
       (f) Effective Date.--The amendments made by this section 
     shall take effect 1 year after the date of the enactment of 
     this Act. The Secretary of Labor shall first issue all 
     regulations necessary to carry out the amendments made by 
     this section within 6 months after the date of the enactment 
     of this Act.

                                TITLE II

     SEC. 201. THE PREVENTION AND PUBLIC HEALTH FUND.

       Subsection (b) of section 4002 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 300u-11) is amended--
       (1) in paragraph (3), by striking ``each of fiscal years 
     2018 and 2019'' and inserting ``fiscal year 2018''; and
       (2) by striking paragraphs (4) through (8).

     SEC. 202. COMMUNITY HEALTH CENTER PROGRAM.

       Effective as if included in the enactment of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10, 129 Stat. 87), paragraph (1) of section 221(a) of such 
     Act is amended by inserting ``, and an additional 
     $422,000,000 for fiscal year 2017'' after ``2017''.

     SEC. 203. CHANGE IN PERMISSIBLE AGE VARIATION IN HEALTH 
                   INSURANCE PREMIUM RATES.

       Section 2701(a)(1)(A)(iii) of the Public Health Service Act 
     (42 U.S.C. 300gg(a)(1)(A)(iii)) is amended by inserting after 
     ``(consistent with section 2707(c))'' the following: ``or, 
     for plan years beginning on or after January 1, 2019, 5 to 1 
     for adults (consistent with section 2707(c)) or such other

[[Page S4347]]

     ratio for adults (consistent with section 2707(c)) as the 
     State may determine''.

     SEC. 204. WAIVERS FOR STATE INNOVATION.

       (a) In General.--Section 1332 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18052) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) in subparagraph (B)--

       (I) by amending clause (i) to read as follows:

       ``(i) a description of how the State plan meeting the 
     requirements of a waiver under this section would, with 
     respect to health insurance coverage within the State--

       ``(I) take the place of the requirements described in 
     paragraph (2) that are waived; and
       ``(II) provide for alternative means of, and requirements 
     for, increasing access to comprehensive coverage, reducing 
     average premiums, providing consumers the freedom to purchase 
     the health insurance of their choice, and increasing 
     enrollment in private health insurance; and''; and
       (II) in clause (ii), by striking ``that is budget neutral 
     for the Federal Government'' and inserting ``, demonstrating 
     that the State plan does not increase the Federal deficit''; 
     and

       (ii) in subparagraph (C), by striking ``the law'' and 
     inserting ``a law or has in effect a certification'';
       (B) in paragraph (3)--
       (i) in the first sentence, by inserting ``or would qualify 
     for a reduction in'' after ``would not qualify for'';
       (ii) by adding after the second sentence the following: ``A 
     State may request that all of, or any portion of, such 
     aggregate amount of such credits or reductions be paid to the 
     State as described in the first sentence.'';
       (iii) in the paragraph heading, by striking ``Pass through 
     of funding'' and inserting ``Funding'';
       (iv) by striking ``With respect'' and inserting the 
     following:
       ``(A) Pass through of funding.--With respect''; and
       (v) by adding at the end the following:
       ``(B) Additional funding.--There is authorized to be 
     appropriated, and is appropriated, to the Secretary of Health 
     and Human Services, out of monies in the Treasury not 
     otherwise obligated, $2,000,000,000 for fiscal year 2017, to 
     remain available until the end of fiscal year 2019, to 
     provide grants to States for purposes of submitting an 
     application for a waiver granted under this section and 
     implementing the State plan under such waiver.
       ``(C) Authority to use market-based health care grant 
     allotment.--If the State has an application for an allotment 
     under section 2105(i) of the Social Security Act for the plan 
     year, the State may use the funds available under the State's 
     allotment for the plan year to carry out the State plan under 
     this section, so long as such use is consistent with the 
     requirements of paragraphs (1) and (7) of section 2105(i) of 
     such Act (other than paragraph (1)(B) of such section). Any 
     funds used to carry out a State plan under this subparagraph 
     shall not be considered in determining whether the State plan 
     increases the Federal deficit.''; and
       (C) in paragraph (4), by adding at the end the following:
       ``(D) Expedited process.--The Secretary shall establish an 
     expedited application and approval process that may be used 
     if the Secretary determines that such expedited process is 
     necessary to respond to an urgent or emergency situation with 
     respect to health insurance coverage within a State.'';
       (2) in subsection (b)--
       (A) in paragraph (1)--
       (i) in the matter preceding subparagraph (A)--

       (I) by striking ``may'' and inserting ``shall''; and
       (II) by striking ``only if'' and inserting ``unless''; and

       (ii) by striking ``plan--'' and all that follows through 
     the period at the end of subparagraph (D) and inserting 
     ``application is missing a required element under subsection 
     (a)(1) or that the State plan will increase the Federal 
     deficit, not taking into account any amounts received through 
     a grant under subsection (a)(3)(B).'';
       (B) in paragraph (2)--
       (i) in the paragraph heading, by inserting ``or certify'' 
     after ``law'';
       (ii) in subparagraph (A), by inserting before the period 
     ``, and a certification described in this paragraph is a 
     document, signed by the Governor, and the State insurance 
     commissioner, of the State, that provides authority for State 
     actions under a waiver under this section, including the 
     implementation of the State plan under subsection 
     (a)(1)(B)''; and
       (iii) in subparagraph (B)--

       (I) in the subparagraph heading, by striking ``of opt 
     out''; and
       (II) by striking `` may repeal a law'' and all that follows 
     through the period at the end and inserting the following: 
     ``may terminate the authority provided under the waiver with 
     respect to the State by--

       ``(i) repealing a law described in subparagraph (A); or
       ``(ii) terminating a certification described in 
     subparagraph (A), through a certification for such 
     termination signed by the Governor, and the State insurance 
     commissioner, of the State.'';
       (3) in subsection (d)(2)(B), by striking ``and the reasons 
     therefore'' and inserting ``and the reasons therefore, and 
     provide the data on which such determination was made''; and
       (4) in subsection (e), by striking ``No waiver'' and all 
     that follows through the period at the end and inserting the 
     following: ``A waiver under this section--
       ``(1) shall be in effect for a period of 8 years unless the 
     State requests a shorter duration;
       ``(2) may be renewed for unlimited additional 8-year 
     periods upon application by the State; and
       ``(3) may not be cancelled by the Secretary before the 
     expiration of the 8-year period (including any renewal period 
     under paragraph (2)).''.
       (b) Applicability.--Section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) shall apply as 
     follows:
       (1) In the case of a State for which a waiver under such 
     section was granted prior to the date of enactment of this 
     Act, such section 1332, as in effect on the day before the 
     date of enactment of this Act shall apply to the waiver and 
     State plan.
       (2) In the case of a State that submitted an application 
     for a waiver under such section prior to the date of 
     enactment of this Act, and which application the Secretary of 
     Health and Human Services has not approved prior to such 
     date, the State may elect to have such section 1332, as in 
     effect on the day before the date of enactment of this Act, 
     or such section 1332, as amended by subsection (a), apply to 
     such application and State plan.
       (3) In the case of a State that submits an application for 
     a waiver under such section on or after the date of enactment 
     of this Act, such section 1332, as amended by subsection (a), 
     shall apply to such application and State plan.

     SEC. 205. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH 
                   INSURANCE IN THE INDIVIDUAL MARKET THE OPTION 
                   TO PURCHASE A LOWER PREMIUM CATASTROPHIC PLAN.

       (a) In General.--Section 1302(e) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(e)) is amended by 
     adding at the end the following:
       ``(4) Consumer freedom.--For plan years beginning on or 
     after January 1, 2019, paragraph (1)(A) shall not apply with 
     respect to any plan offered in the State.''.
       (b) Risk Pools.--Section 1312(c) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18032(c)) is amended--
       (1) in paragraph (1), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''; and
       (2) in paragraph (2), by inserting ``and including, with 
     respect to plan years beginning on or after January 1, 2019, 
     enrollees in catastrophic plans described in section 
     1302(e)'' after ``Exchange''.

     SEC. 206. APPLICATION OF ENFORCEMENT PENALTIES.

       (a) In General.--Section 2723 of the Public Health Service 
     Act (42 U.S.C. 300gg-22) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by inserting ``and of section 1303 of 
     the Patient Protection and Affordable Care Act'' after ``this 
     part''; and
       (B) in paragraph (2), by inserting ``or in such section 
     1303'' after ``this part''; and
       (2) in subsection (b)--
       (A) in paragraphs (1) and (2)(A), by inserting ``or section 
     1303 of the Patient Protection and Affordable Care Act'' 
     after ``this part'' each place such term appears;
       (B) in paragraph (2)(C)(ii), by inserting ``and section 
     1303 of the Patient Protection and Affordable Care Act'' 
     after ``this part''.
       (b) Effect of Waiver.--A State waiver pursuant to section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052) shall not affect the authority of the Secretary 
     to impose penalties under section 2723 of the Public Health 
     Service Act (42 U.S.C. 300gg-22).

     SEC. 207. FUNDING FOR COST-SHARING PAYMENTS.

       There is appropriated to the Secretary of Health and Human 
     Services, out of any money in the Treasury not otherwise 
     appropriated, such sums as may be necessary for payments for 
     cost-sharing reductions authorized by the Patient Protection 
     and Affordable Care Act (including adjustments to any prior 
     obligations for such payments) for the period beginning on 
     the date of enactment of this Act and ending on December 31, 
     2019. Notwithstanding any other provision of this Act, 
     payments and other actions for adjustments to any obligations 
     incurred for plan years 2018 and 2019 may be made through 
     December 31, 2020.

     SEC. 208. REPEAL OF COST-SHARING SUBSIDY PROGRAM.

       (a) In General.--Section 1402 of the Patient Protection and 
     Affordable Care Act is repealed.
       (b) Effective Date.--The repeal made by subsection (a) 
     shall apply to cost-sharing reductions (and payments to 
     issuers for such reductions) for plan years beginning after 
     December 31, 2019.

                          ____________________