[Congressional Record Volume 163, Number 179 (Friday, November 3, 2017)]
[House]
[Pages H8449-H8475]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  0915
 COMMUNITY HEALTH AND MEDICAL PROFESSIONALS IMPROVE OUR NATION ACT OF 
                                  2017

  Mr. WALDEN. Mr. Speaker, pursuant to House Resolution 601, I call up 
the bill (H.R. 3922) to extend funding for certain public health 
programs, and for other purposes, and ask for its immediate 
consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Mr. Byrne). Pursuant to House Resolution 
601, in lieu of the amendment in the nature of a substitute recommended 
by the Committee on Energy and Commerce printed in the bill, the 
amendment printed in part A of House Report 115-382, modified by the 
amendment printed in part B of the report, is adopted, and the bill, as 
amended, is considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 3922

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Continuing Community Health 
     And Medical Professional Programs to Improve Our Nation, 
     Increase National Gains, and Help Ensure Access for Little 
     Ones, Toddlers, and Hopeful Youth by Keeping Insurance 
     Delivery Stable Act of 2017'' or the ``CHAMPIONING HEALTHY 
     KIDS Act''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

                        DIVISION A--CHAMPION ACT

Sec. 100. Short title.

              TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS

Sec. 101. Extension for community health centers, the National Health 
              Service Corps, and teaching health centers that operate 
              GME programs.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Extension for family-to-family health information centers.
Sec. 104. Youth empowerment program; personal responsibility education.

                           TITLE II--OFFSETS

Sec. 201. Providing for qualified health plan grace period requirements 
              for issuer receipt of advance payments of cost-sharing 
              reductions and premium tax credits that are more 
              consistent with State law grace period requirements.
Sec. 202. Prevention and Public Health Fund.

                      DIVISION B--HEALTHY KIDS ACT

Sec. 300. Short title.

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

Sec. 301. Five-year funding extension of the Children's Health 
              Insurance Program.
Sec. 302. Extension of certain programs and demonstration projects.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension and reduction of additional Federal financial 
              participation for CHIP.
Sec. 305. Modifying reductions in Medicaid DSH allotments.
Sec. 306. Puerto Rico and the Virgin Islands Medicaid payments.

                           TITLE II--OFFSETS

Sec. 401. Medicaid third party liability provisions.
Sec. 402. Treatment of lottery winnings and other lump-sum income for 
              purposes of income eligibility under Medicaid.
Sec. 403. Adjustments to Medicare Part B and Part D premium subsidies 
              for higher income individuals.

                        DIVISION A--CHAMPION ACT

     SEC. 100. SHORT TITLE.

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

              TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS

     SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE 
                   NATIONAL HEALTH SERVICE CORPS, AND TEACHING 
                   HEALTH CENTERS THAT OPERATE GME PROGRAMS.

       (a) Community Health Centers Funding.--Section 
     10503(b)(1)(E) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 254b-2(b)(1)(E)) is amended by striking 
     ``2017'' and inserting ``2019''.
       (b) Other Community Health Centers Provisions.--Section 330 
     of the Public Health Service Act (42 U.S.C. 254b) is 
     amended--
       (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
     inserting ``use disorder'';
       (2) in subsection (b)(2)(A), by striking ``abuse'' and 
     inserting ``use disorder'';
       (3) in subsection (c)--
       (A) in paragraph (1), by striking subparagraphs (B) through 
     (D);
       (B) by striking ``(1) In general'' and all that follows 
     through ``The Secretary'' and inserting the following:
       ``(1) Centers.--The Secretary''; and
       (C) in paragraph (1), as amended, by redesignating clauses 
     (i) through (v) as subparagraphs (A) through (E) and moving 
     the margin of each of such redesignated subparagraph 2 ems to 
     the left;
       (4) by striking subsection (d) and inserting the following:
       ``(d) Improving Quality of Care.--
       ``(1) Supplemental awards.--The Secretary may award 
     supplemental grant funds to health centers funded under this 
     section to implement evidence-based models for increasing 
     access to high-quality primary care services, which may 
     include models related to--
       ``(A) improving the delivery of care for individuals with 
     multiple chronic conditions;
       ``(B) workforce configuration;
       ``(C) reducing the cost of care;
       ``(D) enhancing care coordination;
       ``(E) expanding the use of telehealth and technology-
     enabled collaborative learning and capacity building models;
       ``(F) care integration, including integration of behavioral 
     health, mental health, or substance use disorder services; 
     and
       ``(G) addressing emerging public health or substance use 
     disorder issues to meet the

[[Page H8450]]

     health needs of the population served by the health center.
       ``(2) Sustainability.--In making supplemental awards under 
     this subsection, the Secretary may consider whether the 
     health center involved has submitted a plan for continuing 
     the activities funded under this subsection after 
     supplemental funding is expended.
       ``(3) Special consideration.--The Secretary may give 
     special consideration to applications for supplemental 
     funding under this subsection that seek to address 
     significant barriers to access to care in areas with a 
     greater shortage of health care providers and health services 
     relative to the national average.'';
       (5) in subsection (e)(1)--
       (A) in subparagraph (B)--
       (i) by striking ``2 years'' and inserting ``1 year''; and
       (ii) by adding at the end the following: ``The Secretary 
     shall not make a grant under this paragraph unless the 
     applicant provides assurances to the Secretary that within 
     120 days of receiving grant funding for the operation of the 
     health center, the applicant will submit, for approval by the 
     Secretary, an implementation plan to meet the requirements of 
     subsection (k)(3). The Secretary may extend such 120-day 
     period for achieving compliance upon a demonstration of good 
     cause by the health center.''; and
       (B) in subparagraph (C)--
       (i) in the subparagraph heading, by striking ``and plans'';
       (ii) by striking ``or plan (as described in subparagraphs 
     (B) and (C) of subsection (c)(1))'';
       (iii) by striking ``or plan, including the purchase'' and 
     inserting the following: ``including--
       ``(i) the purchase'';
       (iv) by inserting ``, which may include data and 
     information systems'' after ``of equipment'';
       (v) by striking the period at the end and inserting a 
     semicolon; and
       (vi) by adding at the end the following:
       ``(ii) the provision of training and technical assistance; 
     and
       ``(iii) other activities that--

       ``(I) reduce costs associated with the provision of health 
     services;
       ``(II) improve access to, and availability of, health 
     services provided to individuals served by the centers;
       ``(III) enhance the quality and coordination of health 
     services; or
       ``(IV) improve the health status of communities.'';

       (6) in subsection (e)(5)(B)--
       (A) in the heading of subparagraph (B), by striking ``and 
     plans''; and
       (B) by striking ``and subparagraphs (B) and (C) of 
     subsection (c)(1) to a health center or to a network or 
     plan'' and inserting ``to a health center or to a network'';
       (7) in subsection (e), by adding at the end the following:
       ``(6) New access points and expanded services.--
       ``(A) Approval of new access points.--
       ``(i) In general.--The Secretary may approve applications 
     for grants under subparagraph (A) or (B) of paragraph (1) to 
     establish new delivery sites.
       ``(ii) Special consideration.--In carrying out clause (i), 
     the Secretary may give special consideration to applicants 
     that have demonstrated the new delivery site will be located 
     within a sparsely populated area, or an area which has a 
     level of unmet need that is higher relative to other 
     applicants.
       ``(iii) Consideration of applications.--In carrying out 
     clause (i), the Secretary shall approve applications for 
     grants in such a manner that the ratio of the medically 
     underserved populations in rural areas which may be expected 
     to use the services provided by the applicants involved to 
     the medically underserved populations in urban areas which 
     may be expected to use the services provided by the 
     applicants is not less than two to three or greater than 
     three to two.
       ``(iv) Service area overlap.--If in carrying out clause (i) 
     the applicant proposes to serve an area that is currently 
     served by another health center funded under this section, 
     the Secretary may consider whether the award of funding to an 
     additional health center in the area can be justified based 
     on the unmet need for additional services within the 
     catchment area.
       ``(B) Approval of expanded service applications.--
       ``(i) In general.--The Secretary may approve applications 
     for grants under subparagraph (A) or (B) of paragraph (1) to 
     expand the capacity of the applicant to provide required 
     primary health services described in subsection (b)(1) or 
     additional health services described in subsection (b)(2).
       ``(ii) Priority expansion projects.--In carrying out clause 
     (i), the Secretary may give special consideration to expanded 
     service applications that seek to address emerging public 
     health or behavioral health, mental health, or substance 
     abuse issues through increasing the availability of 
     additional health services described in subsection (b)(2) in 
     an area in which there are significant barriers to accessing 
     care.
       ``(iii) Consideration of applications.--In carrying out 
     clause (i), the Secretary shall approve applications for 
     grants in such a manner that the ratio of the medically 
     underserved populations in rural areas which may be expected 
     to use the services provided by the applicants involved to 
     the medically underserved populations in urban areas which 
     may be expected to use the services provided by such 
     applicants is not less than two to three or greater than 
     three to two.'';
       (8) in subsection (h)--
       (A) in paragraph (1), by striking ``and children and youth 
     at risk of homelessness'' and inserting ``, children and 
     youth at risk of homelessness, homeless veterans, and 
     veterans at risk of homelessness''; and
       (B) in paragraph (5)--
       (i) by striking subparagraph (B);
       (ii) by redesignating subparagraph (C) as subparagraph (B); 
     and
       (iii) in subparagraph (B) (as so redesignated)--

       (I) in the subparagraph heading, by striking ``abuse'' and 
     inserting ``use disorder''; and
       (II) by striking ``abuse'' and inserting ``use disorder'';

       (9) in subsection (k)--
       (A) in paragraph (2)--
       (i) in the paragraph heading, by inserting ``unmet'' before 
     ``need'';
       (ii) in the matter preceding subparagraph (A), by inserting 
     ``or subsection (e)(6)'' after ``subsection (e)(1)'';
       (iii) in subparagraph (A), by inserting ``unmet'' before 
     ``need for health services'';
       (iv) in subparagraph (B), by striking ``and'' at the end;
       (v) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (vi) by adding after subparagraph (C) the following:
       ``(D) in the case of an application for a grant pursuant to 
     subsection (e)(6), a demonstration that the applicant has 
     consulted with appropriate State and local government 
     agencies, and health care providers regarding the need for 
     the health services to be provided at the proposed delivery 
     site.'';
       (B) in paragraph (3)--
       (i) in the matter preceding subparagraph (A), by inserting 
     ``or subsection (e)(6)'' after ``subsection (e)(1)(B)'';
       (ii) in subparagraph (B), by striking ``in the catchment 
     area of the center'' and inserting ``, including other health 
     care providers that provide care within the catchment area, 
     local hospitals, and specialty providers in the catchment 
     area of the center, to provide access to services not 
     available through the health center and to reduce the non-
     urgent use of hospital emergency departments'';
       (iii) in subparagraph (H)(ii), by inserting ``who shall be 
     directly employed by the center'' after ``approves the 
     selection of a director for the center'';
       (iv) in subparagraph (L), by striking ``and'' at the end;
       (v) in subparagraph (M), by striking the period and 
     inserting ``; and''; and
       (vi) by inserting after subparagraph (M), the following:
       ``(N) the center has written policies and procedures in 
     place to ensure the appropriate use of Federal funds in 
     compliance with applicable Federal statutes, regulations, and 
     the terms and conditions of the Federal award.''; and
       (C) by striking paragraph (4);
       (10) in subsection (l), by adding at the end the following: 
     ``Funds expended to carry out activities under this 
     subsection and operational support activities under 
     subsection (m) shall not exceed 3 percent of the amount 
     appropriated for this section for the fiscal year 
     involved.'';
       (11) in subsection (q)(4), by adding at the end the 
     following: ``A waiver provided by the Secretary under this 
     paragraph may not remain in effect for more than 1 year and 
     may not be extended after such period. An entity may not 
     receive more than one waiver under this paragraph in 
     consecutive years.'';
       (12) in subsection (r)(3)--
       (A) by striking ``appropriate committees of Congress a 
     report concerning the distribution of funds under this 
     section'' and inserting the following: ``Committee on Health, 
     Education, Labor, and Pensions of the Senate, and the 
     Committee on Energy and Commerce of the House of 
     Representatives, a report including, at a minimum--
       ``(A) the distribution of funds for carrying out this 
     section'';
       (B) by striking ``populations. Such report shall include an 
     assessment'' and inserting the following: ``populations;
       ``(B) an assessment'';
       (C) by striking ``and the rationale for any substantial 
     changes in the distribution of funds.'' and inserting a 
     semicolon; and
       (D) by adding at the end the following:
       ``(C) the distribution of awards and funding for new or 
     expanded services in each of rural areas and urban areas;
       ``(D) the distribution of awards and funding for 
     establishing new access points, and the number of new access 
     points created;
       ``(E) the amount of unexpended funding for loan guarantees 
     and loan guarantee authority under title XVI;
       ``(F) the rationale for any substantial changes in the 
     distribution of funds;
       ``(G) the rate of closures for health centers and access 
     points;
       ``(H) the number and reason for any grants awarded pursuant 
     to subsection (e)(1)(B); and
       ``(I) the number and reason for any waivers provided 
     pursuant to subsection (q)(4).'';
       (13) in subsection (r), by adding at the end the following 
     new paragraph:
       ``(5) Funding for participation of health centers in all of 
     us research program.--In addition to any amounts made 
     available pursuant to paragraph (1) of this subsection, 
     section 402A of this Act, or section 10503 of the Patient 
     Protection and Affordable Care

[[Page H8451]]

     Act, there is authorized to be appropriated, and there is 
     appropriated, out of any monies in the Treasury not otherwise 
     appropriated, to the Secretary $25,000,000 for fiscal year 
     2018 to support the participation of health centers in the 
     All of Us Research Program under the Precision Medicine 
     Initiative under section 498E of this Act.''; and
       (14) by striking subsection (s).
       (c) National Health Service Corps.--Section 10503(b)(2)(E) 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     254b-2(b)(2)(E)) is amended by striking ``2017'' and 
     inserting ``2019''.
       (d) Teaching Health Centers That Operate Graduate Medical 
     Education Programs.--
       (1) Payments.--Subsection (a) of section 340H of the Public 
     Health Service Act (42 U.S.C. 256h) is amended to read as 
     follows:
       ``(a) Payments.--
       ``(1) In general.--Subject to subsection (h)(2), the 
     Secretary shall make payments under this section for direct 
     expenses and indirect expenses to qualified teaching health 
     centers that are listed as sponsoring institutions by the 
     relevant accrediting body for, as appropriate--
       ``(A) maintenance of existing approved graduate medical 
     residency training programs;
       ``(B) expansion of existing approved graduate medical 
     residency training programs; and
       ``(C) establishment of new approved graduate medical 
     residency training programs.
       ``(2) Priority.--In making payments pursuant to paragraph 
     (1)(C), the Secretary shall give priority to qualified 
     teaching health centers that--
       ``(A) serve a health professional shortage area with a 
     designation in effect under section 332 or a medically 
     underserved community (as defined in section 799B); or
       ``(B) are located in a rural area (as defined in section 
     1886(d)(2)(D) of the Social Security Act).''.
       (2) Funding.--Subsection (g) of section 340H of the Public 
     Health Service Act (42 U.S.C. 256h) is amended--
       (A) by striking ``To carry out'' and inserting the 
     following:
       ``(1) In general.--To carry out'';
       (B) by striking ``and $15,000,000 for the first quarter of 
     fiscal year 2018'' and inserting ``and $126,500,000 for each 
     of fiscal years 2018 and 2019, to remain available until 
     expended''; and
       (C) by adding at the end the following:
       ``(2) Administrative expenses.--Of the amount made 
     available to carry out this section for any fiscal year, the 
     Secretary may not use more than 5 percent of such amount for 
     the expenses of administering this section.''.
       (3) Annual reporting.--Subsection (h)(1) of section 340H of 
     the Public Health Service Act (42 U.S.C. 256h) is amended--
       (A) by redesignating subparagraph (D) as subparagraph (H); 
     and
       (B) by inserting after subparagraph (C) the following:
       ``(D) The number of patients treated by residents described 
     in paragraph (4).
       ``(E) The number of visits by patients treated by residents 
     described in paragraph (4).
       ``(F) Of the number of residents described in paragraph (4) 
     who completed their residency training at the end of such 
     residency academic year, the number and percentage of such 
     residents entering primary care practice (meaning any of the 
     areas of practice listed in the definition of a primary care 
     residency program in section 749A).
       ``(G) Of the number of residents described in paragraph (4) 
     who completed their residency training at the end of such 
     residency academic year, the number and percentage of such 
     residents who entered practice at a health care facility--
       ``(i) primarily serving a health professional shortage area 
     with a designation in effect under section 332 or a medically 
     underserved community (as defined in section 799B); or
       ``(ii) located in a rural area (as defined in section 
     1886(d)(2)(D) of the Social Security Act).''.
       (4) Report on training costs.--Not later than March 31, 
     2019, the Secretary of Health and Human Services shall submit 
     to the Congress a report on the direct graduate expenses of 
     approved graduate medical residency training programs, and 
     the indirect expenses associated with the additional costs of 
     teaching residents, of qualified teaching health centers (as 
     such terms are used or defined in section 340H of the Public 
     Health Service Act (42 U.S.C. 256h)).
       (5) Definition.--Subsection (j) of section 340H of the 
     Public Health Service Act (42 U.S.C. 256h) is amended--
       (A) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively; and
       (B) by inserting after paragraph (1) the following:
       ``(2) New approved graduate medical residency training 
     program.--The term `new approved graduate medical residency 
     training program' means an approved graduate medical 
     residency training program for which the sponsoring qualified 
     teaching health center has not received a payment under this 
     section for a previous fiscal year (other than pursuant to 
     subsection (a)(1)(C)).''.
       (6) Technical correction.--Subsection (f) of section 340H 
     (42 U.S.C. 256h) is amended by striking ``hospital'' each 
     place it appears and inserting ``teaching health center''.
       (7) Payments for previous fiscal years.--The provisions of 
     section 340H of the Public Health Service Act (42 U.S.C. 
     256h), as in effect on the day before the date of enactment 
     of this Act, shall continue to apply with respect to payments 
     under such section for fiscal years before fiscal year 2018.
       (e) Application.--Amounts appropriated pursuant to this 
     section for fiscal year 2018 or 2019 are subject to the 
     requirements contained in Public Law 115-31 for funds for 
     programs authorized under sections 330 through 340 of the 
     Public Health Service Act (42 U.S.C. 254b-256).
       (f) Conforming Amendments.--Section 3014(h) of title 18, 
     United States Code, is amended--
       (1) in paragraph (1), by striking ``, as amended by section 
     221 of the Medicare Access and CHIP Reauthorization Act of 
     2015,''; and
       (2) in paragraph (4), by inserting ``and section 101(e) of 
     the Community Health And Medical Professionals Improve Our 
     Nation Act of 2017'' after ``section 221(c) of the Medicare 
     Access and CHIP Reauthorization Act of 2015''.

     SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

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

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

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

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

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

     ``SEC. 510. YOUTH EMPOWERMENT PROGRAM.

       ``(a) In General.--
       ``(1) Allotments to states.--For the purpose described in 
     subsection (b), the Secretary shall, for each of fiscal years 
     2018 and 2019, allot to each State which has transmitted an 
     application for the fiscal year under section 505(a) an 
     amount equal to the product of--
       ``(A) the amount appropriated pursuant to subsection (e)(1) 
     for the fiscal year, minus the amount reserved under 
     subsection (e)(2) for the fiscal year; and
       ``(B) the proportion that the number of low-income children 
     in the State bears to the total of such numbers of children 
     for all the States.
       ``(2) Other allotments.--
       ``(A) Other entities.--For the purpose described in 
     subsection (b), the Secretary shall, for each of fiscal years 
     2018 and 2019, for any State which has not transmitted an 
     application for the fiscal year under section 505(a), allot 
     to one or more entities in the State the amount that would 
     have been allotted to the State under paragraph (1) if the 
     State had submitted such an application.
       ``(B) Process.--The Secretary shall select the recipients 
     of allotments under subparagraph (A) by means of a 
     competitive grant process under which--
       ``(i) not later than 30 days after the deadline for the 
     State involved to submit an application for the fiscal year 
     under section 505(a), the Secretary publishes a notice 
     soliciting grant applications; and
       ``(ii) not later than 120 days after such deadline, all 
     such applications must be submitted.
       ``(b) Purpose.--
       ``(1) In general.--Except for research under paragraph (5) 
     and information collection and reporting under paragraph (6), 
     the purpose of an allotment under subsection (a) to a State 
     (or to another entity in the State pursuant to subsection 
     (a)(2)) is to enable the State or other entity to implement 
     education exclusively on sexual risk avoidance (meaning 
     voluntarily refraining from sexual activity).
       ``(2) Required components.--Education on sexual risk 
     avoidance pursuant to an allotment under this section shall--
       ``(A) ensure that the unambiguous and primary emphasis and 
     context for each topic

[[Page H8452]]

     described in paragraph (3) is a message to youth that 
     normalizes the optimal health behavior of avoiding nonmarital 
     sexual activity;
       ``(B) be medically accurate and complete;
       ``(C) be age-appropriate; and
       ``(D) be based on adolescent learning and developmental 
     theories for the age group receiving the education.
       ``(3) Topics.--Education on sexual risk avoidance pursuant 
     to an allotment under this section shall address each of the 
     following topics:
       ``(A) The holistic individual and societal benefits 
     associated with personal responsibility, self-regulation, 
     goal setting, healthy decisionmaking, and a focus on the 
     future.
       ``(B) The advantage of refraining from nonmarital sexual 
     activity in order to improve the future prospects and 
     physical and emotional health of youth.
       ``(C) The increased likelihood of avoiding poverty when 
     youth attain self-sufficiency and emotional maturity before 
     engaging in sexual activity.
       ``(D) The foundational components of healthy relationships 
     and their impact on the formation of healthy marriages and 
     safe and stable families.
       ``(E) How other youth risk behaviors, such as drug and 
     alcohol usage, increase the risk for teen sex.
       ``(F) How to resist and avoid, and receive help regarding, 
     sexual coercion and dating violence, recognizing that even 
     with consent teen sex remains a youth risk behavior.
       ``(4) Contraception.--Education on sexual risk avoidance 
     pursuant to an allotment under this section shall ensure 
     that--
       ``(A) any information provided on contraception is 
     medically accurate and ensures that students understand that 
     contraception offers physical risk reduction, but not risk 
     elimination; and
       ``(B) the education does not include demonstrations, 
     simulations, or distribution of contraceptive devices.
       ``(5) Research.--
       ``(A) In general.--A State or other entity receiving an 
     allotment pursuant to subsection (a) may use up to 20 percent 
     of such allotment to build the evidence base for sexual risk 
     avoidance education by conducting or supporting research.
       ``(B) Requirements.--Any research conducted or supported 
     pursuant to subparagraph (A) shall be--
       ``(i) rigorous;
       ``(ii) evidence-based; and
       ``(iii) designed and conducted by independent researchers 
     who have experience in conducting and publishing research in 
     peer-reviewed outlets.
       ``(6) Information collection and reporting.--A State or 
     other entity receiving an allotment pursuant to subsection 
     (a) shall, as specified by the Secretary--
       ``(A) collect information on the programs and activities 
     funded through the allotment; and
       ``(B) submit reports to the Secretary on the data from such 
     programs and activities.
       ``(c) National Evaluation.--
       ``(1) In general.--The Secretary shall--
       ``(A) in consultation with appropriate State and local 
     agencies, conduct one or more rigorous evaluations of the 
     education funded through this section and associated data; 
     and
       ``(B) submit a report to the Congress on the results of 
     such evaluations, together with a summary of the information 
     collected pursuant to subsection (b)(6).
       ``(2) Consultation.--In conducting the evaluations required 
     by paragraph (1), including the establishment of evaluation 
     methodologies, the Secretary shall consult with relevant 
     stakeholders.
       ``(d) Applicability of Certain Provisions.--
       ``(1) Sections 503, 507, and 508 apply to allotments under 
     subsection (a) to the same extent and in the same manner as 
     such sections apply to allotments under section 502(c).
       ``(2) Sections 505 and 506 apply to allotments under 
     subsection (a) to the extent determined by the Secretary to 
     be appropriate.
       ``(e) Funding.--
       ``(1) In general.--To carry out this section, there is 
     appropriated, out of any money in the Treasury not otherwise 
     appropriated, $75,000,000 for each of fiscal years 2018 and 
     2019.
       ``(2) Reservation.--The Secretary shall reserve, for each 
     of fiscal years 2018 and 2019, not more than 20 percent of 
     the amount appropriated pursuant to paragraph (1) for 
     administering the program under this section, including the 
     conducting of national evaluations and the provision of 
     technical assistance to the recipients of allotments.''.
       (2) Effective date.--The amendment made by this subsection 
     takes effect on October 1, 2017.
       (b) Personal Responsibility Education.--
       (1) In general.--Section 513 of the Social Security Act (42 
     U.S.C. 713) is amended--
       (A) in subsection (a)(1)(A), by striking ``2017'' and 
     inserting ``2019''; and
       (B) in subsection (a)(4)--
       (i) in subparagraph (A), by striking ``2017'' each place it 
     appears and inserting ``2019''; and
       (ii) in subparagraph (B)--

       (I) in the subparagraph heading, by striking ``3-year 
     grants'' and inserting ``Competitive prep grants''; and
       (II) in clause (i), by striking ``solicit applications to 
     award 3-year grants in each of fiscal years 2012 through 
     2017'' and inserting ``continue through fiscal year 2019 
     grants awarded for any of fiscal years 2015 through 2017'';

       (C) in subsection (c)(1), by inserting after ``youth with 
     HIV/AIDS,'' the following: ``victims of human trafficking,''; 
     and
       (D) in subsection (f), by striking ``2017'' and inserting 
     ``2019''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on October 1, 2017.

                           TITLE II--OFFSETS

     SEC. 201. PROVIDING FOR QUALIFIED HEALTH PLAN GRACE PERIOD 
                   REQUIREMENTS FOR ISSUER RECEIPT OF ADVANCE 
                   PAYMENTS OF COST-SHARING REDUCTIONS AND PREMIUM 
                   TAX CREDITS THAT ARE MORE CONSISTENT WITH STATE 
                   LAW GRACE PERIOD REQUIREMENTS.

       (a) In General.--Section 1412(c) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18082(c)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (B)(iv)(II), by striking ``a 3-month 
     grace period'' and inserting ``a grace period specified in 
     subparagraph (C)''; and
       (B) by adding at the end the following new subparagraphs:
       ``(C) Grace period specified.--For purposes of subparagraph 
     (B)(iv)(II), the grace period specified in this subparagraph 
     is--
       ``(i) for plan years beginning before January 1, 2018, a 3-
     month grace period; and
       ``(ii) for plan years beginning on or after January 1, 
     2018--

       ``(I) in the case of an Exchange operating in a State that 
     has a State law grace period in place, such State law grace 
     period; and
       ``(II) in the case of an Exchange operating in a State that 
     does not have a State law grace period in place, a 1-month 
     grace period.

       ``(D) State law grace period.--For purposes of subparagraph 
     (C), the term `State law grace period' means, with respect to 
     a State, a grace period for nonpayment of premiums before 
     discontinuing coverage that is applicable under the State law 
     to health insurance coverage offered in the individual market 
     of the State.''; and
       (2) in paragraph (3), by adding at the end the following 
     new sentence: ``The requirements of paragraph (2)(B)(iv) 
     apply to an issuer of a qualified health plan receiving an 
     advanced payment under this paragraph in the same manner and 
     to the same extent that such requirements apply to an issuer 
     of a qualified health plan receiving an advanced payment 
     under paragraph (2)(A).''.
       (b) Report on Aligning Grace Periods for Medicaid, 
     Medicare, and Exchange Plans.--Not later than two years after 
     the date of full implementation of subsection (a), the 
     Comptroller General of the United States shall submit to 
     Congress a report on--
       (1) the effects on consumers of aligning grace periods 
     applied under the Medicaid program under title XIX of the 
     Social Security Act, under the Medicare program under parts C 
     and D of title XVIII of such Act, and under qualified health 
     plans offered on an Exchange established under title I of the 
     Patient Protection and Affordable Care Act, including the 
     extent to which such an alignment of grace periods may help 
     to avoid enrollment status confusion for individuals under 
     such Medicaid program, Medicare program, and qualified health 
     plans; and
       (2) the extent to which such an alignment of grace periods 
     may reduce fraud, waste, and abuse under the Medicaid 
     program.

     SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.

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

                      DIVISION B--HEALTHY KIDS ACT

     SEC. 300. SHORT TITLE.

       This division may be cited as the ``Helping Ensure Access 
     for Little Ones, Toddlers, and Hopeful Youth by Keeping 
     Insurance Delivery Stable Act of 2017'' or the ``HEALTHY KIDS 
     Act''.

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

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

       (a) Appropriation; Total Allotment.--Section 2104(a) of the 
     Social Security Act (42 U.S.C. 1397dd(a)) is amended--
       (1) in paragraph (19), by striking ``and'';
       (2) in paragraph (20), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following new paragraphs:
       ``(21) for fiscal year 2018, $21,500,000,000;
       ``(22) for fiscal year 2019, $22,600,000,000;
       ``(23) for fiscal year 2020, $23,700,000,000;
       ``(24) for fiscal year 2021, $24,800,000,000; and
       ``(25) for fiscal year 2022, for purposes of making 2 semi-
     annual allotments--
       ``(A) $2,850,000,000 for the period beginning on October 1, 
     2021, and ending on March 31, 2022; and
       ``(B) $2,850,000,000 for the period beginning on April 1, 
     2022, and ending on September 30, 2022.''.

[[Page H8453]]

       (b) Allotments.--
       (1) In general.--Section 2104(m) of the Social Security Act 
     (42 U.S.C. 1397dd(m)) is amended--
       (A) in paragraph (2)--
       (i) in the heading, by striking ``through 2016'' and 
     inserting ``through 2022''; and
       (ii) in subparagraph (B)--

       (I) in the matter preceding clause (i), by striking 
     ``(19)'' and inserting ``(24)'';
       (II) in clause (ii), in the matter preceding subclause (I), 
     by inserting ``(other than fiscal year 2022)'' after ``even-
     numbered fiscal year''; and
       (III) in clause (ii)(I), by inserting ``(or, in the case of 
     fiscal year 2018, under paragraph (4))'' after ``clause 
     (i)'';

       (B) in paragraph (5)--
       (i) by striking ``or (4)'' and inserting ``(4), or (10)''; 
     and
       (ii) by striking ``or 2017'' and inserting ``, 2017, or 
     2022'';
       (C) in paragraph (7)--
       (i) in subparagraph (A), by striking ``2017'' and inserting 
     ``2022'';
       (ii) in subparagraph (B), in the matter preceding clause 
     (i), by inserting ``(or, in the case of fiscal year 2018, by 
     not later than the date that is 60 days after the date of the 
     enactment of the HEALTHY KIDS Act)'' after ``before the 
     August 31 preceding the beginning of the fiscal year''; and
       (iii) in the matter following subparagraph (B), by striking 
     ``or fiscal year 2016'' and inserting ``fiscal year 2016, 
     fiscal year 2018, fiscal year 2020, or fiscal year 2022'';
       (D) in paragraph (9)--
       (i) in the heading, by striking ``fiscal years 2015 and 
     2017'' and inserting ``certain fiscal years'';
       (ii) by striking ``or (4)'' and inserting ``, (4), or 
     (10)''; and
       (iii) by striking ``or fiscal year 2017'' and inserting ``, 
     2017, or 2022''; and
       (E) by adding at the end the following new paragraph:
       ``(10) For fiscal year 2022.--
       ``(A) First half.--Subject to paragraphs (5) and (7), from 
     the amount made available under subparagraph (A) of paragraph 
     (25) of subsection (a) for the semi-annual period described 
     in such subparagraph, increased by the amount of the 
     appropriation for such period under section 301(b)(3) of the 
     HEALTHY KIDS Act, the Secretary shall compute a State 
     allotment for each State (including the District of Columbia 
     and each commonwealth and territory) for such semi-annual 
     period in an amount equal to the first half ratio (described 
     in subparagraph (D)) of the amount described in subparagraph 
     (C).
       ``(B) Second half.--Subject to paragraphs (5) and (7), from 
     the amount made available under subparagraph (B) of paragraph 
     (25) of subsection (a) for the semi-annual period described 
     in such subparagraph, the Secretary shall compute a State 
     allotment for each State (including the District of Columbia 
     and each commonwealth and territory) for such semi-annual 
     period in an amount equal to the amount made available under 
     such subparagraph, multiplied by the ratio of--
       ``(i) the amount of the allotment to such State under 
     subparagraph (A); to
       ``(ii) the total of the amount of all of the allotments 
     made available under such subparagraph.
       ``(C) Full year amount based on growth factor updated 
     amount.--The amount described in this subparagraph for a 
     State is equal to the sum of--
       ``(i) the amount of the State allotment for fiscal year 
     2021 determined under paragraph (2)(B)(i); and
       ``(ii) the amount of any payments made to the State under 
     subsection (n) for fiscal year 2021,
     multiplied by the allotment increase factor under paragraph 
     (6) for fiscal year 2022.
       ``(D) First half ratio.--The first half ratio described in 
     this subparagraph is the ratio of--
       ``(i) the sum of--

       ``(I) the amount made available under subsection 
     (a)(25)(A); and
       ``(II) the amount of the appropriation for such period 
     under section 301(b)(3) of the HEALTHY KIDS Act; to

       ``(ii) the sum of--

       ``(I) the amount described in clause (i); and
       ``(II) the amount made available under subsection 
     (a)(25)(B).''.

       (2) Technical amendment.--Section 2104(m)(2)(A) of such Act 
     (42 U.S.C. 1397dd(m)(2)(A)) is amended by striking ``the 
     allotment increase factor under paragraph (5)'' each place it 
     appears and inserting ``the allotment increase factor under 
     paragraph (6)''.
       (3) One-time appropriation for fiscal year 2022.--There is 
     appropriated to the Secretary of Health and Human Services, 
     out of any money in the Treasury not otherwise appropriated, 
     $20,200,000,000 to accompany the allotment made for the 
     period beginning on October 1, 2021, and ending on March 31, 
     2022, under paragraph (25)(A) of section 2104(a) of the 
     Social Security Act (42 U.S.C. 1397dd(a)) (as added by 
     subsection (a)(3)), to remain available until expended. Such 
     amount shall be used to provide allotments to States under 
     paragraph (10) of section 2104(m) of such Act (as added by 
     subsection (b)(1)(E)) for the first 6 months of fiscal year 
     2022 in the same manner as allotments are provided under 
     subsection (a)(25)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(25)(A).
       (c) Extension of the Child Enrollment Contingency Fund.--
     Section 2104(n) of the Social Security Act (42 U.S.C. 
     1397dd(n)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A)(ii)--
       (i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016'' 
     and inserting ``2010 through 2014, 2016, and 2018 through 
     2021''; and
       (ii) by striking ``fiscal year 2015 and fiscal year 2017'' 
     and inserting ``fiscal years 2015, 2017, and 2022''; and
       (B) in subparagraph (B)--
       (i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016'' 
     and inserting ``2010 through 2014, 2016, and 2018 through 
     2021''; and
       (ii) by striking ``fiscal year 2015 and fiscal year 2017'' 
     and inserting ``fiscal years 2015, 2017, and 2022''; and
       (2) in paragraph (3)(A), in the matter preceding clause 
     (i), by striking ``or a semi-annual allotment period for 
     fiscal year 2015 or 2017'' and inserting ``or in any of 
     fiscal years 2018 through 2021 (or a semi-annual allotment 
     period for fiscal year 2015, 2017, or 2022)''.
       (d) Extension of Qualifying States Option.--Section 
     2105(g)(4) of the Social Security Act (42 U.S.C. 
     1397ee(g)(4)) is amended--
       (1) in the heading, by striking ``through 2017'' and 
     inserting ``through 2022''; and
       (2) in subparagraph (A), by striking ``2017'' and inserting 
     ``2022''.
       (e) Extension of Express Lane Eligibility Option.--Section 
     1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
     1396a(e)(13)(I)) is amended by striking ``2017'' and 
     inserting ``2022''.
       (f) Assurance of Affordability Standard for Children and 
     Families.--
       (1) In general.--Section 2105(d)(3) of the Social Security 
     Act (42 U.S.C. 1397ee(d)(3)) is amended--
       (A) in the paragraph heading, by striking ``until october 
     1, 2019'' and inserting ``through september 30, 2022''; and
       (B) in subparagraph (A), in the matter preceding clause 
     (i)--
       (i) by striking ``2019'' and inserting ``2022''; and
       (ii) by striking ``The preceding sentence shall not be 
     construed as preventing a State during such period'' and 
     inserting ``During the period that begins on October 1, 2019, 
     and ends on September 30, 2022, the preceding sentence shall 
     only apply with respect to children in families whose income 
     does not exceed 300 percent of the poverty line (as defined 
     in section 2110(c)(5)) applicable to a family of the size 
     involved. The preceding sentences shall not be construed as 
     preventing a State during any such periods''.
       (2) Conforming amendments.--Section 1902(gg)(2) of the 
     Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
       (A) in the paragraph heading, by striking ``until october 
     1, 2019'' and inserting ``through september 30, 2022''; and
       (B) by striking ``September 30, 2019,'' and inserting 
     ``September 30, 2022 (but during the period that begins on 
     October 1, 2019, and ends on September 30, 2022, only with 
     respect to children in families whose income does not exceed 
     300 percent of the poverty line (as defined in section 
     2110(c)(5)) applicable to a family of the size involved)''.
       (g) CHIP Look-alike Plans.--
       (1) Blending risk pools.--Section 2107 of the Social 
     Security Act (42 U.S.C. 1397gg) is amended by adding at the 
     end the following:
       ``(g) Use of Blended Risk Pools.--
       ``(1) In general.--Nothing in this title (or any other 
     provision of Federal law) shall be construed as preventing a 
     State from considering children enrolled in a qualified CHIP 
     look-alike program and children enrolled in a State child 
     health plan under this title (or a waiver of such plan) as 
     members of a single risk pool.
       ``(2) Qualified chip look-alike program.--In this 
     subsection, the term `qualified CHIP look-alike program' 
     means a State program--
       ``(A) under which children who are under the age of 19 and 
     are not eligible to receive medical assistance under title 
     XIX or child health assistance under this title may purchase 
     coverage through the State that provides benefits that are at 
     least identical to the benefits provided under the State 
     child health plan under this title (or a waiver of such 
     plan); and
       ``(B) that is funded exclusively through non-Federal funds, 
     including funds received by the State in the form of premiums 
     for the purchase of such coverage.''.
       (2) Coverage rule.--
       (A) In general.--Section 5000A(f)(1) of the Internal 
     Revenue Code of 1986 is amended in subparagraph (A)(iii), by 
     inserting ``or under a qualified CHIP look-alike program (as 
     defined in section 2107(g) of the Social Security Act)'' 
     before the comma at the end.
       (B) Effective date.--The amendment made by subparagraph (A) 
     shall apply with respect to taxable years beginning after 
     December 31, 2017.

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

       (a) Childhood Obesity Demonstration Project.--Section 
     1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
     9a(e)(8)) is amended--
       (1) by striking ``and $10,000,000'' and inserting ``, 
     $10,000,000''; and
       (2) by inserting after ``2017'' the following: ``, and 
     $25,000,000 for the period of fiscal years 2018 through 
     2022''.
       (b) Pediatric Quality Measures Program.--Section 1139A(i) 
     of the Social Security Act (42 U.S.C. 1320b-9a(i)) is 
     amended--
       (1) by striking ``Out of any'' and inserting the following:
       ``(1) In general.--Out of any'';

[[Page H8454]]

       (2) by striking ``there is appropriated for each'' and 
     inserting ``there is appropriated--
       ``(A) for each'';
       (3) by striking ``, and there is appropriated for the 
     period'' and inserting ``;
       ``(B) for the period'';
       (4) by striking ``. Funds appropriated under this 
     subsection shall remain available until expended.'' and 
     inserting ``; and''; and
       (5) by adding at the end the following:
       ``(C) for the period of fiscal years 2018 through 2022, 
     $75,000,000 for the purpose of carrying out this section 
     (other than subsections (e), (f), and (g)).
       ``(2) Availability.--Funds appropriated under this 
     subsection shall remain available until expended.''.

     SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.

       (a) In General.--Section 2113 of the Social Security Act 
     (42 U.S.C. 1397mm) is amended--
       (1) in subsection (a)(1), by striking ``2017'' and 
     inserting ``2022''; and
       (2) in subsection (g)--
       (A) by striking ``and $40,000,000'' and inserting ``, 
     $40,000,000''; and
       (B) by inserting after ``2017'' the following: ``, and 
     $100,000,000 for the period of fiscal years 2018 through 
     2022''.
       (b) Making Organizations That Use Parent Mentors Eligible 
     to Receive Grants.--Section 2113(f) of the Social Security 
     Act (42 U.S.C. 1397mm(f)) is amended--
       (1) in paragraph (1)(E), by striking ``or community-based 
     doula programs'' and inserting ``, community-based doula 
     programs, or parent mentors''; and
       (2) by adding at the end the following new paragraph:
       ``(5) Parent mentor.--The term `parent mentor' means an 
     individual who--
       ``(A) is a parent or guardian of at least one child who is 
     an eligible child under this title or title XIX; and
       ``(B) is trained to assist families with children who have 
     no health insurance coverage with respect to improving the 
     social determinants of the health of such children, including 
     by providing--
       ``(i) education about health insurance coverage, including, 
     with respect to obtaining such coverage, eligibility criteria 
     and application and renewal processes;
       ``(ii) assistance with completing and submitting 
     applications for health insurance coverage;
       ``(iii) a liaison between families and representatives of 
     State plans under title XIX or State child health plans under 
     this title;
       ``(iv) guidance on identifying medical and dental homes and 
     community pharmacies for children; and
       ``(v) assistance and referrals to successfully address 
     social determinants of children's health, including poverty, 
     food insufficiency, and housing.''.
       (c) Exclusion From Modified Adjusted Gross Income.--Section 
     1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is 
     amended--
       (1) in the first paragraph (14), relating to income 
     determined using modified adjusted gross income, by adding at 
     the end the following new subparagraph:
       ``(J) Exclusion of parent mentor compensation from income 
     determination.--Any nominal amount received by an individual 
     as compensation, including a stipend, for participation as a 
     parent mentor (as defined in paragraph (5) of section 
     2113(f)) in an activity or program funded through a grant 
     under such section shall be disregarded for purposes of 
     determining the income eligibility of such individual for 
     medical assistance under the State plan or any waiver of such 
     plan.''; and
       (2) by striking ``(14) Exclusion'' and inserting ``(15) 
     Exclusion''.

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

       Section 2105(b) of the Social Security Act (42 U.S.C. 
     1397ee(b)) is amended in the second sentence by inserting 
     ``and during the period that begins on October 1, 2019, and 
     ends on September 30, 2020, the enhanced FMAP determined for 
     a State for a fiscal year (or for any portion of a fiscal 
     year occurring during such period) shall be increased by 11.5 
     percentage points'' after ``23 percentage points,''.

     SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.

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

       ``(I) $4,000,000,000 for fiscal year 2020; and
       ``(II) $8,000,000,000 for each of fiscal years 2021 through 
     2025.''.

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

       (a) Increased Cap.--Section 1108(g) of the Social Security 
     Act (42 U.S.C. 1308(g)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A), by inserting ``(or, with respect 
     to fiscal years 2018 and 2019, increased by such percentage 
     increase plus one percentage point)'' after ``beginning of 
     the fiscal year''; and
       (B) in subparagraph (B), by inserting ``(or, with respect 
     to fiscal years 2018 and 2019, increased by such percentage 
     increase plus one percentage point)'' after ``percentage 
     increase referred to in subparagraph (A)'';
       (2) in paragraph (5)--
       (A) in subparagraph (A), by striking ``subparagraph (B)'' 
     and inserting ``subparagraphs (B), (C), (D), (E), and (F)''; 
     and
       (B) by adding at the end the following new subparagraphs:
       ``(C) The amount of the increase otherwise provided under 
     subparagraph (A) for Puerto Rico shall be further increased 
     by $880,000,000.
       ``(D)(i) For the period beginning October 1, 2017, and 
     ending December 31, 2019, the amount of the increase 
     otherwise provided under subparagraph (A) for Puerto Rico 
     shall be further increased by $120,000,000 if the Financial 
     Oversight and Management Board for Puerto Rico established 
     under section 101 of the Puerto Rico Oversight, Management, 
     and Economic Stability Act (48 U.S.C. 2121) certifies by a 
     majority vote that Puerto Rico has taken reasonable and 
     appropriate steps during such period to--
       ``(I) reduce fraud, waste, and abuse under the program 
     under title XIX;
       ``(II) implement strategies to reduce unnecessary, 
     inefficient, or excessive spending under title XIX;
       ``(III) improve the use and availability of Medicaid data 
     for program operation and oversight; and
       ``(IV) improve the quality of care and patient experience 
     for individuals enrolled under the program under title XIX.
       ``(ii) As a condition of any additional increase pursuant 
     to clause (i), not later than October 1, 2018, Puerto Rico 
     shall submit to the Financial Oversight and Management Board 
     for Puerto Rico a report regarding steps taken to achieve 
     each of the goals described in subclauses (I) through (IV) of 
     clause (i).
       ``(E) Payments under section 1903(a)(8) for a quarter of a 
     fiscal year shall not be taken into account in applying 
     subsection (f) (as increased in accordance with this 
     paragraph and paragraphs (1), (2), (3), and (4)) to Puerto 
     Rico or the Virgin Islands for such fiscal year.
       ``(F)(i) For the period beginning October 1, 2017, and 
     ending December 31, 2019, the amount of the increase 
     otherwise provided under subparagraph (A) for the Virgin 
     Islands shall be further increased by an amount equal to the 
     per capita equivalent of the total amount of the increase 
     provided for Puerto Rico under subparagraphs (C) and (D) for 
     such period.
       ``(ii) For purposes of clause (i), the term `per capita 
     equivalent' means the ratio of--
       ``(I) the population of the Virgin Islands, as determined 
     by the most recent census estimate released by the Bureau of 
     the Census before September 4, 2017; to
       ``(II) the population of Puerto Rico, as so determined.''.
       (b) Federal Match for Medical Personnel and Fraud 
     Reduction.--Section 1903(a) of the Social Security Act (42 
     U.S.C. 1396b(a)) is amended--
       (1) in paragraph (2)(A), by inserting ``subject to 
     paragraph (8),'' before ``an amount'';
       (2) in paragraph (6)--
       (A) in subparagraph (B), by inserting ``subject to 
     paragraph (8),'' before ``75 per centum''; and
       (B) by striking at the end ``plus'';
       (3) in paragraph (7), by striking at the end the period and 
     inserting ``; plus'' ; and
       (4) by adding at the end the following new paragraph:
       ``(8) for quarters during the period beginning January 1, 
     2018, and ending December 31, 2019, paragraphs (2)(A) and (6) 
     shall apply with respect to Puerto Rico and the Virgin 
     Islands as if--
       ``(A) the reference to `75 per centum' in paragraph (2)(A) 
     were a reference to `90 per centum'; and
       ``(B) the reference to `75 per centum' in paragraph (6)(B) 
     were a reference to `90 per centum'.''.

                           TITLE II--OFFSETS

     SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS.

       (a) Medicaid Third Party Liability.--
       (1) Delay of bipartisan budget act of 2013 third party 
     liability provisions.--
       (A) In general.--Section 202(c) of the Bipartisan Budget 
     Act of 2013 (Public Law 113-67; 127 Stat. 1177; 42 U.S.C. 
     1396a note), as amended by section 211 of the Protecting 
     Access to Medicare Act of 2014 (Public Law 113-93; 128 Stat. 
     1047; 42 U.S.C. 1396a note) and section 220 of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10), is amended by striking ``2017'' and inserting ``2019''.
       (B) Effective date; treatment.--The amendment made by 
     subparagraph (A) shall take effect on September 30, 2017, and 
     shall apply with respect to any open claims, including claims 
     generated or filed, after such date.
       (2) Clarification of definitions applicable to third party 
     liability.--
       (A) In general.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a) is amended by adding at the end the 
     following new subsection:
       ``(nn) Responsible Third Party and Health Insurer 
     Definitions.--For purposes of subsection (a)(25) and section 
     1903(d)(2)(B):
       ``(1) Responsible third party.--The term `responsible third 
     party' means a health insurer, a pharmacy benefit manager to 
     the extent the pharmacy benefit manager provides information 
     under this title for the purpose of coordinating benefits, an 
     accountable care organization under section 1899, or any 
     other party that is, by statute, contract, or agreement, 
     legally responsible for payment of a

[[Page H8455]]

     claim for a health care item or service. Such term does not 
     include a party if payment by such party has been made or can 
     reasonably be expected to be made under a workmen's 
     compensation law or plan of the United States or a State, or 
     under an automobile or liability insurance policy or plan 
     (including a self-insured plan), or under no fault insurance.
       ``(2) Health insurer.--The term `health insurer' means a 
     group health plan, as defined in section 607(1) of the 
     Employee Retirement Income Security Act of 1974, a self-
     insured plan, a fully-insured plan, a service benefit plan, a 
     medicaid managed care plan under section 1903(m) or 1932, and 
     any other health plan determined appropriate by the 
     Secretary.''.
       (B) Conforming amendments.--Section 1902(a)(25) of the 
     Social Security Act (42 U.S.C. 1396a(a)(25)) is amended--
       (i) in subparagraph (A), in the matter preceding clause 
     (i), by striking ``third parties'' and all that follows 
     through ``item or service)'' and inserting ``responsible 
     third parties'';
       (ii) in subparagraph (G), by striking ``health insurer'' 
     and all that follows through ``item or service)'' and 
     inserting ``responsible third party'';
       (iii) in subparagraph (I), in the matter preceding clause 
     (i), by striking ``health insurers'' and all that follows 
     through ``item or service'' and inserting ``responsible third 
     parties''; and
       (iv) by inserting ``responsible'' before ``third'' each 
     place it appears in subparagraphs (A)(i), (A)(ii), (C), (D), 
     and (H).
       (3) Removal of special treatment of certain types of care 
     and payments under medicaid third party liability rules.--
     Section 1902(a)(25) of the Social Security Act (42 U.S.C. 
     1396a(a)(25)), as amended by section 202(c) of the Bipartisan 
     Budget Act of 2013 (after application of paragraph (1)), is 
     amended--
       (A) in subparagraph (E)--
       (i) in the matter preceding clause (i), by striking 
     ``prenatal or preventive'' and all that follows through 
     ``State plan'' and inserting ``items and services provided 
     under the program required under the State plan pursuant to 
     paragraph (62)''; and
       (ii) in clause (i)--

       (I) by striking ``such service'' and inserting ``such items 
     and services''; and
       (II) by striking each place it appears ``such services'' 
     and inserting ``such items and services'' each such place; 
     and

       (B) by striking subparagraph (F).
       (4) Clarification of role of health insurers with respect 
     to third party liability.--
       (A) In general.--Section 1902(a)(25) of the Social Security 
     Act (42 U.S.C. 1396a(a)(25)), as amended by paragraph (3), is 
     further amended by inserting after subparagraph (E) the 
     following new subparagraph:
       ``(F) that--
       ``(i) in the case of a State that provides medical 
     assistance under this title through a contract with a health 
     insurer, such contract shall specify any responsibility of 
     such health insurer (or other entity) with respect to 
     recovery of payment from responsible third parties pursuant 
     to the delegation or transfer by the State to such insurer 
     (or other entity) of a right described in subparagraph 
     (I)(ii); and
       ``(ii) in the case of a State that under a contract 
     described in clause (i) delegates or transfers to a health 
     insurer (or other entity) a right described in such clause, 
     the State shall provide assurances to the Secretary that the 
     State laws referred to in subparagraph (I), with respect to 
     each responsibility of such health insurer (or other entity) 
     specified under such clause, confer to such health insurer 
     (or other entity) the authority of the State with respect to 
     the requirements specified in clauses (i) through (iv) of 
     such subparagraph (I);''.
       (B) Treatment of collected amounts.--Section 1903(d)(2)(B) 
     of the Social Security Act (42 U.S.C. 1396b(d)(2)(B)) is 
     amended by adding at the end the following: ``For purposes of 
     this subparagraph, reimbursements made by a responsible third 
     party to health insurers (as defined in section 1902(nn)) 
     pursuant to section 1902(a)(25)(F)(ii) shall be treated in 
     the same manner as reimbursements made to a State under the 
     previous sentence.''.
       (5) Increasing state flexibility with respect to third 
     party liability.--Section 1902(a)(25)(I) of the Social 
     Security Act (42 U.S.C. 1396a(a)(25)(I)) is amended--
       (A) in clause (i), by striking ``medical assistance under 
     the State plan'' and inserting ``medical assistance under a 
     State plan (or under a waiver of the plan)'';
       (B) by striking clause (ii) and inserting the following new 
     clause:
       ``(ii) accept--

       ``(I) any State's right of recovery and the assignment to 
     any State of any right of an individual or other entity to 
     payment from the party for an item or service for which 
     payment has been made under the respective State's plan (or 
     under a waiver of the plan); and
       ``(II) as a valid authorization of the responsible third 
     party for the furnishing of an item or service to an 
     individual eligible to receive medical assistance under this 
     title, an authorization made on behalf of such individual 
     under the State plan (or under a waiver of such plan) for the 
     furnishing of such item or service to such individual;'';

       (C) in clause (iii)--
       (i) by striking ``respond to'' and inserting ``not later 
     than 60 days after receiving''; and
       (ii) by striking ``; and'' at the end and inserting ``, 
     respond to such inquiry; and''; and
       (D) in clause (iv), by inserting ``a failure to obtain a 
     prior authorization,'' after ``claim form,''.
       (6) State incentive to pursue third party liability for 
     newly eligibles.--Section 1903(d)(2)(B) of the Social 
     Security Act (42 U.S.C. 1396b(d)(2)(B)), as amended by 
     paragraph (4)(B), is further amended by adding at the end the 
     following: ``In the case of expenditures for medical 
     assistance provided during 2017 and subsequent years for 
     individuals described in subclause (VIII) of section 
     1902(a)(10)(A)(i), in determining the amount, if any, of 
     overpayment under this subparagraph with respect to such 
     medical assistance, the Secretary shall apply the Federal 
     medical assistance percentage for the State under section 
     1905(b), notwithstanding the application of section 
     1905(y).''.
       (b) Compliance With Third Party Insurance Reporting.--
     Section 1905 of the Social Security Act (42 U.S.C. 1396d) is 
     amended by adding at the end the following new subsection:
       ``(ee) Notwithstanding subsection (b), for any year 
     beginning after 2019, if a State fails to comply with the 
     requirements of section 1902(a)(25) with respect to each 
     calendar quarter in such year, the Secretary may reduce the 
     Federal medical assistance percentage by 0.1 percentage point 
     for calendar quarters in each subsequent year in which the 
     State fails to so comply.''.
       (c) Application to CHIP.--
       (1) In general.--Section 2107(e)(1) of the Social Security 
     Act (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (B) through (R) as 
     subparagraphs (C) through (S), respectively; and
       (B) by inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) Section 1902(a)(25) (relating to third party 
     liability).''.
       (2) Mandatory reporting.--Section 1902(a)(25)(I)(i) of the 
     Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)), as 
     amended by subsection (a)(5), is further amended--
       (A) by striking ``(and, at State option, child'' and 
     inserting ``and child''; and
       (B) by striking ``title XXI)'' and inserting ``title XXI''.
       (d) Training on Third Party Liability.--Section 1936 of the 
     Social Security Act (42 U.S.C. 1396u-6) is amended--
       (1) in subsection (b)(4), by striking ``and quality of 
     care'' and inserting ``, quality of care, and the liability 
     of responsible third parties (as defined in section 
     1902(nn))''; and
       (2) by adding at the end the following new subsection:
       ``(f) Third Party Liability Training.--With respect to 
     education or training activities carried out pursuant to 
     subsection (b)(4) with respect to the liability of 
     responsible third parties (as defined in section 1902(nn) for 
     payment for items and services furnished under State plans 
     (or under waivers of such plans)) under this title, the 
     Secretary shall--
       ``(1) publish (and update on an annual basis) on the public 
     Internet website of the Centers for Medicare & Medicaid 
     Services a dedicated Internet page containing best practices 
     to be used in assessing such liability;
       ``(2) monitor efforts to assess such liability and analyze 
     the challenges posed by that assessment;
       ``(3) distribute to State agencies administering the State 
     plan under this title information related to such efforts and 
     challenges; and
       ``(4) provide guidance to such State agencies with respect 
     to State oversight of efforts under a medicaid managed care 
     plan under section 1903(m) or 1932 to assess such 
     liability.''.
       (e) Development of Model Uniform Fields for States To 
     Report Third Party Information.--Not later than January 1, 
     2019, the Secretary of Health and Human Services shall, in 
     consultation with the States, develop and make available to 
     the States a model uniform reporting set of reporting fields 
     and accompanying guidance documentation that States shall use 
     for purposes of--
       (1) reporting information to the Secretary within the 
     Transformed Medicaid Statistical Information System (T-MSIS) 
     (or a successor system); and
       (2) collecting information that identifies responsible 
     third parties (as defined in subsection (nn) of section 1902 
     of the Social Security Act (42 U.S.C. 1396a), as added by 
     subsection (a)(2)(A)) and other relevant information for 
     ascertaining the legal responsibility of such third parties 
     to pay for care and services available under the State plan 
     (or under a waiver of the plan) under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) or under the State 
     child health plan under title XXI of such Act (42 U.S.C. 1397 
     et seq.).
       (f) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), this 
     section and the amendments made by this section (other than 
     as specified in the preceding provisions of this section) 
     shall take effect on October 1, 2019, and shall apply to 
     medical assistance or child health assistance provided on or 
     after such date.
       (2) Exception if state legislation required.--In the case 
     of a State plan for medical assistance under title XIX of the 
     Social Security Act (42 U.S.C. 1396 et seq.), or a State 
     child health plan for child health assistance under title XXI 
     of such Act (42 U.S.C. 1397aa et seq.), that the Secretary of

[[Page H8456]]

     Health and Human Services determines requires State 
     legislation (other than legislation appropriating funds) in 
     order for the plan to meet the additional requirement imposed 
     by the amendments made under this section, such plan shall 
     not be regarded as failing to comply with the requirements of 
     such title solely on the basis of its failure to meet this 
     additional requirement before the first day of the first 
     calendar quarter beginning after the close of the first 
     regular session of the State legislature that begins after 
     the date of the enactment of this Act. For purposes of the 
     previous sentence, in the case of a State that has a 2-year 
     legislative session, each year of such session shall be 
     deemed to be a separate regular session of the State 
     legislature.

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

       (a) In General.--Section 1902 of the Social Security Act 
     (42 U.S.C. 1396a) is amended--
       (1) in subsection (a)(17), by striking ``(e)(14), (e)(14)'' 
     and inserting ``(e)(14), (e)(15)''; and
       (2) in subsection (e)(14), as amended by section 303(c), by 
     adding at the end the following new subparagraph:
       ``(K) Treatment of certain lottery winnings and income 
     received as a lump sum.--
       ``(i) In general.--In the case of an individual who is the 
     recipient of qualified lottery winnings (pursuant to 
     lotteries occurring on or after January 1, 2018) or qualified 
     lump sum income (received on or after such date) and whose 
     eligibility for medical assistance is determined based on the 
     application of modified adjusted gross income under 
     subparagraph (A), a State shall, in determining such 
     eligibility, include such winnings or income (as applicable) 
     as income received--

       ``(I) in the month in which such winnings or income (as 
     applicable) is received if the amount of such winnings or 
     income is less than $80,000;
       ``(II) over a period of 2 months if the amount of such 
     winnings or income (as applicable) is greater than or equal 
     to $80,000 but less than $90,000;
       ``(III) over a period of 3 months if the amount of such 
     winnings or income (as applicable) is greater than or equal 
     to $90,000 but less than $100,000; and
       ``(IV) over a period of 3 months plus 1 additional month 
     for each increment of $10,000 of such winnings or income (as 
     applicable) received, not to exceed a period of 120 months 
     (for winnings or income of $1,260,000 or more), if the amount 
     of such winnings or income is greater than or equal to 
     $100,000.

       ``(ii) Counting in equal installments.--For purposes of 
     subclauses (II), (III), and (IV) of clause (i), winnings or 
     income to which such subclause applies shall be counted in 
     equal monthly installments over the period of months 
     specified under such subclause.
       ``(iii) Hardship exemption.--An individual whose income, by 
     application of clause (i), exceeds the applicable eligibility 
     threshold established by the State, shall continue to be 
     eligible for medical assistance to the extent that the State 
     determines, under procedures established by the State (in 
     accordance with standards specified by the Secretary), that 
     the denial of eligibility of the individual would cause an 
     undue medical or financial hardship as determined on the 
     basis of criteria established by the Secretary.
       ``(iv) Notifications and assistance required in case of 
     loss of eligibility.--A State shall, with respect to an 
     individual who loses eligibility for medical assistance under 
     the State plan (or a waiver of such plan) by reason of clause 
     (i)--

       ``(I) before the date on which the individual loses such 
     eligibility, inform the individual--

       ``(aa) of the individual's opportunity to enroll in a 
     qualified health plan offered through an Exchange established 
     under title I of the Patient Protection and Affordable Care 
     Act during the special enrollment period specified in section 
     9801(f)(3) of the Internal Revenue Code of 1986 (relating to 
     loss of Medicaid or CHIP coverage); and
       ``(bb) of the date on which the individual would no longer 
     be considered ineligible by reason of clause (i) to receive 
     medical assistance under the State plan or under any waiver 
     of such plan and be eligible to reapply to receive such 
     medical assistance; and

       ``(II) provide technical assistance to the individual 
     seeking to enroll in such a qualified health plan.

       ``(v) Qualified lottery winnings defined.--In this 
     subparagraph, the term `qualified lottery winnings' means 
     winnings from a sweepstakes, lottery, or pool described in 
     paragraph (3) of section 4402 of the Internal Revenue Code of 
     1986 or a lottery operated by a multistate or 
     multijurisdictional lottery association, including amounts 
     awarded as a lump sum payment.
       ``(vi) Qualified lump sum income defined.--In this 
     subparagraph, the term `qualified lump sum income' means 
     income that is received as a lump sum from one of the 
     following sources:

       ``(I) Monetary winnings from gambling (as defined by the 
     Secretary and including gambling activities described in 
     section 1955(b)(4) of title 18, United States Code).
       ``(II) Damages received, whether by suit or agreement and 
     whether as lump sums or as periodic payments (other than 
     monthly payments), on account of causes of action other than 
     causes of action arising from personal physical injuries or 
     physical sickness.
       ``(III) Income received as liquid assets from the estate 
     (as defined in section 1917(b)(4)) of a deceased 
     individual.''.

       (b) Rules of Construction.--
       (1) Interception of lottery winnings allowed.--Nothing in 
     the amendment made by subsection (a)(2) shall be construed as 
     preventing a State from intercepting the State lottery 
     winnings awarded to an individual in the State to recover 
     amounts paid by the State under the State Medicaid plan under 
     title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) 
     for medical assistance furnished to the individual.
       (2) Applicability limited to eligibility of recipient of 
     lottery winnings or lump sum income.--Nothing in the 
     amendment made by subsection (a)(2) shall be construed, with 
     respect to a determination of household income for purposes 
     of a determination of eligibility for medical assistance 
     under the State plan under title XIX of the Social Security 
     Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) made 
     by applying modified adjusted gross income under subparagraph 
     (A) of section 1902(e)(14) of such Act (42 U.S.C. 
     1396a(e)(14)), as limiting the eligibility for such medical 
     assistance of any individual that is a member of the 
     household other than the individual who received qualified 
     lottery winnings or qualified lump-sum income (as defined in 
     subparagraph (K) of such section 1902(e)(14), as added by 
     subsection (a)(2) of this section).

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

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

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

       (b) Joint Returns.--Section 1839(i)(3)(C)(ii) of the Social 
     Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by 
     inserting before the period the following: ``except, with 
     respect to the dollar amounts applied in the last row of the 
     table under subclause (II) of such clause (and the second 
     dollar amount specified in the second to last row of such 
     table), clause (i) shall be applied by substituting dollar 
     amounts which are 175 percent of such dollar amounts for the 
     calendar year''.
       (c) Inflation Adjustment.--Section 1839(i) of the Social 
     Security Act (42 U.S.C. 1395r(i)) is amended--
       (1) in paragraph (5)--
       (A) in subparagraph (A), by striking ``In the case'' and 
     inserting ``Subject to subparagraph (C), in the case'';
       (B) in subparagraph (B), by striking ``subparagraph (A)'' 
     and inserting ``subparagraph (A) or (C)''; and
       (C) by adding at the end the following new subparagraph:
       ``(C) Treatment of adjustments for certain higher income 
     individuals.--
       ``(i) In general.--Subparagraph (A) shall not apply with 
     respect to each dollar amount in paragraph (3) of $500,000.
       ``(ii) Adjustment beginning 2027.--In the case of any 
     calendar year beginning after 2026, each dollar amount in 
     paragraph (3) of $500,000 shall be increased by an amount 
     equal to--

       ``(I) such dollar amount, multiplied by
       ``(II) the percentage (if any) by which the average of the 
     Consumer Price Index for all urban consumers (United States 
     city average) for the 12-month period ending with August of 
     the preceding calendar year exceeds such average for the 12-
     month period ending with August 2025.''; and
       (2) in paragraph (6)(B), by inserting ``(other than 
     $500,000)'' after ``the dollar amounts''.

  The SPEAKER pro tempore. The bill shall be debatable for 1 hour 
equally divided and controlled by the chair and ranking minority member 
of the Committee on Energy and Commerce.
  The gentleman from Oregon (Mr. Walden) and the gentleman from New 
Jersey (Mr. Pallone) each will control 30 minutes.
  The Chair recognizes the gentleman from Oregon.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, we are here today to consider a very, very important 
public health bill, H.R. 3922, the CHAMPIONING HEALTHY KIDS Act. This 
legislation funds a 5-year extension of the Children's Health Insurance 
Program, known as CHIP, along with a 2-year extension of community 
health centers and numerous other critically important public health 
programs.
  This bill will deliver quality healthcare and peace of mind to 
millions of Americans. The patients and families helped by this 
legislation are our neighbors and our friends. More than 8 million 
children receive CHIP-funded coverage, and more than 25 million 
patients are served by our community health centers and other important 
programs.
  This 5-year funding of CHIP marks one of the longest extensions of 
the program since it was created 20 years ago. The policy we are 
considering mirrors the bipartisan policy that has been introduced and 
voted out of our sister

[[Page H8457]]

committee in the United States Senate.
  Funding for these important programs expired September 30. The 
committee worked on a bipartisan basis well before this deadline to try 
and reach a bipartisan agreement on a range of policies to offset the 
costs of this very critically important funding extension.
  Three times, at the request of the Democrats, we delayed committee 
action--three times. We tried to find offsets that were agreeable as we 
have always been able to do before. Unfortunately, that was not the 
case this time. These delays meant Congress went past the deadline of 
September 30.
  While States still have rollover CHIP funds available and the next 
wave of community health center funds won't go out until next year, we 
cannot wait any longer. Patients cannot wait any longer. Patients need 
care, these critical programs need funding, and we must move forward.
  In my district alone, there are 12 federally qualified health center 
organizations, with 63 delivery sites. They leverage $41 million in 
Federal money in order to serve more than 240,000 patients in Oregon's 
Second District. These health centers--and I have visited many of 
them--are prevention and public health in action, often serving as the 
main provider of care for people for hundreds of miles around.
  We are also extending the National Health Service Corps and the 
Teaching Health Center Graduate Medical Education program. Now, Mr. 
Speaker, these are really important workforce programs that place 
qualified providers into some of the most underserved areas of our 
country.
  In addition to community health centers and the workforce programs, 
this bill extends the funding for the Special Diabetes Program and the 
Family-to-Family Health Information centers, the Personal 
Responsibility Program, and the Youth Empowerment Program. These 
locally based, patient-centered organizations provide comprehensive 
services to those most in need.
  Moreover, this legislation eliminates 2 years of the across-the-board 
cuts to Medicaid allotments called for under the Affordable Care Act, 
ObamaCare. We delay those cuts for disproportionate share hospitals for 
2 years. Medicaid DSH funding represents an important component of many 
State Medicaid programs and is particularly relied upon by many States 
to help provide additional resources to key safety net providers.
  Now, while this relief is only temporary and does not address the 
larger structural challenges under ObamaCare, it would give Congress 
time to explore what budget-neutral approaches there might be to 
allocate existing DSH dollars on a more equitable and fair basis. In my 
State alone of Oregon, hospitals have told me this relief in this bill, 
just for them, represents $6.8 million over the next 2 years that they 
can use to help low-income people get access to hospital care.
  Now, in paying for this package--and this is the area where we have 
the most disagreement with the Democrats--we have taken a fiscally 
responsible approach, like using existing funding streams for 
prevention and public health efforts, ensuring high-dollar lottery 
winners are removed from the Medicaid program so its limited resources 
can be prioritized for the most vulnerable, and stopping individuals on 
the Affordable Care Act's exchanges from gaming the system.
  The bill also asks Medicare's wealthiest 1 percent, people who are 
retired and making $40,000 a month--not a year, a month--to pay about 
$135 more for their Medicare just on parts B and D that is already 
subsidized by 75 percent, just a little more so we can fund children's 
health insurance for 5 years.
  While it was not ultimately possible, unfortunately, to reach 
consensus on some of the policies to offset the new funding in this 
bill, there is broad bipartisan agreement on the core policies 
contained in this legislation, and I believe there is bipartisan 
support for many of the reasonable and fiscally responsible offsets 
contained in H.R. 3922.
  Mr. Speaker, this is good legislation. This is long-overdue 
legislation. It reflects the good work done by your House Energy and 
Commerce Committee, and I urge my colleagues to put politics aside 
today and ensure these vital programs get the funding extensions they 
need. We are over the deadline. It is time to act.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today to speak in opposition to H.R. 3922, a 
partisan bill to reauthorize the Children's Health Insurance Program, 
or CHIP, as well as community health centers and other public health 
programs.
  It pains me to be here today, because this should not be a partisan 
bill. I have tried for months to negotiate with Republicans to develop 
a bipartisan compromise, but House Republicans chose to spend the first 
9 months of this year trying to repeal the Affordable Care Act. They 
failed, but now House Republicans are using the reauthorization of CHIP 
and community health centers as a way to once again sabotage the ACA.

  Make no mistake, Mr. Speaker: if Republicans can't repeal the ACA 
outright, they will cripple it any time they can.
  This time, Republicans are risking the healthcare of nearly 9 million 
children and the care of families all around the country that use 
community health centers. They are risking that care because this 
partisan bill has no chance of ever becoming law.
  By taking this route, Republicans are guaranteeing that CHIP and 
community health centers will not be reauthorized until the end of the 
year, and that is extremely unfortunate.
  Mr. Speaker, I strongly support CHIP, our community health centers, 
and all of our public health programs that are extended in this bill. 
These programs have traditionally been bipartisan, but the bill before 
us extends these programs by taking billions of dollars away from the 
Affordable Care Act and undermining Medicare.
  In short, this Republican bill offers a false choice. On one hand, it 
strips healthcare away from upwards of 680,000 Americans and guts the 
Prevention Fund, which pays for immunization and vaccines, lead 
poisoning prevention, opioid treatment, and many other important 
programs; on other hand, it reauthorizes these important programs. 
Democrats strongly support reauthorization of these programs, but we 
reject the way Republicans are paying for them.
  Mr. Speaker, there are so many other policies that save money, 
countless alternatives that Democrats have offered to Republicans for 
months. Yesterday I offered an alternative that would have provided a 
robust reauthorization and extension of these important programs, and 
it was paid for in a commonsense way.
  My alternative would have changed the timing of payments to Medicare 
Advantage Plans. This approach was recommended by both the GAO and the 
Office of the Inspector General, but Republicans rejected it in the 
Rules Committee. They wouldn't even allow it to come before the full 
House for a vote. And why is because they would rather use 
reauthorization of CHIP and community health centers as another way to 
sabotage the Affordable Care Act.
  I simply reject that approach and strongly urge a ``no'' vote.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, before I call on my next person to say 
something here, there are 17,000 children in Mr. Pallone's district and 
14 health centers that, if he votes ``no,'' he will be voting against.
  By the way, the offset he recommended, people who are watching this 
need to know, would violate statute and it would be a PAYGO violation. 
That is why it was not acceptable.
  See, this is the problem we faced. We delayed three times at their 
request only to be offered up a pay-for that violates statute and 
violates our PAYGO rules. We could not accept that. We have to operate 
within the law like everyone else in America.
  Mr. Speaker, I yield 4 minutes to the gentleman from Texas (Mr. 
Burgess).
  Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding the 
time, for the recognition.
  Let me just say, I want to thank members of the Health Subcommittee, 
both sides of the dais, who have worked hard on this legislation, and 
it is unfortunate that it was not brought to the floor of the House in 
the month of September.

[[Page H8458]]

  From a subcommittee perspective, we were ready. We had our 
legislative hearings in June. We were delayed one time when the whole 
House recessed after the shooting of the Members at the baseball 
practice, but we rescheduled for 2 weeks later, and we had a successful 
hearing. We had a good hearing; a lot of facts were laid out. We came 
up with commonsense legislation that was offset in a responsible way. 
The offsets are not draconian.
  We have before us a bill today that will, in fact, fund some of the 
Nation's most important public health programs. It does fund the State 
Children's Health Insurance for 5 years, one of the longest extensions 
for this program since its inception in 1996. It will ensure that 
children and families who rely on this program will continue to receive 
the access they need. It also includes, in a fiscally responsible way, 
to delay the harmful ObamaCare-mandated cuts to safety net hospitals, 
who also provide care to underserved patients.
  Now, think about that for a minute. We are accused of undermining 
ObamaCare, but here is a cut that ObamaCare mandates to your safety net 
hospitals across the country--not just in Texas, but across the 
country--and we are replacing that today in a fiscally responsible way.
  It provides funding for community health centers, an important key 
part of healthcare in communities across the country. It will help the 
Americans who rely on these vital health services.
  Not only does the bill provide assistance for underserved 
populations, but it does so without adding to the national debt. The 
Committee for a Responsible Federal Budget called this a responsible 
health package, noting that the $18 billion cost is fully offset, with 
savings beyond the 10-year budget window.
  Other groups have also been supportive: Texas Hospital Association, 
Texas Health Resources--for me back home--Children's Hospital, and a 
number of healthcare organizations.
  We have data from MACPAC, whose job it is to advise Congress on 
Medicaid and CHIP policy; and MACPAC has advised us that, under current 
law, there are no new Federal funds for State Children's Health 
Insurance for fiscal year 2018 and beyond. Unless Congress acts to 
renew funding, all States will experience a shortfall in CHIP funds for 
2018, which means, if someone is contemplating a ``no'' vote on this 
bill, if you are contemplating a ``no'' vote, you do need to be aware 
that if you live in the States of Arizona and Minnesota, you ran out of 
money in October of 2017; North Carolina, same situation. Oregon runs 
out next month. Vermont runs out next month. You need to think about 
your ``no'' vote before you apply it.

  Every single U.S. territory, with the exception of Puerto Rico, ran 
out of money in the month of October.
  So those are a few facts that people do need to bear in mind, if they 
vote ``no'' on this bill, what the actual implications of that are.
  Yesterday, during debate on the rule, I heard a lot of discussion 
about taking money out of the Prevention Fund. It doesn't take money 
out of the Prevention Fund, but it does provide discretion for some 
prevention and public health dollars. It takes it away from the 
executive branch and redirects these dollars to proven public health 
programs that enjoy broad bipartisan support in Congress, like 
community health centers.
  So we are fulfilling our Article I responsibility. We shouldn't just 
be giving everything to the administration to decide how to spend 
money, whether it be a Democratic or Republican administration. This is 
the right thing to do.
  I am proud of the work done by our subcommittee. I think our 
subcommittee staff has performed admirably on both sides of the dais.
  Mr. Speaker, I urge a ``yes'' vote on the bill. It is time to act, as 
our chairman has said.

                              {time}  0930

  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Eshoo).
  Ms. ESHOO. Mr. Speaker, I thank our distinguished ranking member.
  Mr. Speaker, I rise today to oppose this bill, the so-called 
CHAMPIONING HEALTHY KIDS Act. First of all, we are a month late and 
many dollars short. It was the majority that brought it up late. We 
didn't have anything to do with being late.
  Secondly, we are playing political games with the lives of 14 percent 
of the children in my congressional district who receive their health 
insurance through the Children's Health Insurance Program and the five 
federally qualified health centers in my congressional district. They 
provide medical, dental, and mental health services to almost 55,000 of 
my constituents every year.
  Reauthorizing these historically bipartisan programs is critical to 
the health and safety of not only my constituents but millions of 
others across our country.
  Today, the Republican majority is holding them hostage by insisting 
to fund these programs by means-testing Medicare beneficiaries, kicking 
individuals who purchase their health coverage on the marketplaces off 
their insurance, and gutting the Public Health Prevention Fund 
established in the Affordable Care Act.
  Remember, the Republicans have set their budget based on eliminating 
the Affordable Care Act. My State of California will run out of funding 
for CHIP sometime between now and December. This has never happened 
before in the history of this program.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the 
gentlewoman from California.
  Ms. ESHOO. Mr. Speaker, the community health centers in my district 
have told me about the difficult decisions they have to make because 
Congress has not reauthorized their funding, including layoffs of 
physicians and closing clinics' doors. We are playing with people's 
lives here.
  If we can't find the funding for these important bipartisan programs, 
then we don't deserve to be Members of Congress. I cannot support a 
bill that hurts people instead of helping them.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume to 
respond.
  Mr. Speaker, my friend, and she is my friend from California, 
obviously was not aware of the fact that it was her party, her leader, 
who asked us on three occasions to delay bringing this to the floor, 
including you could look at the CQ article from October 23 where Mr. 
Pallone says he hopes it doesn't come to the floor.
  This was a bipartisan agreement not to bring it until we could try to 
work these things out. We were all trying to figure out how to get this 
done.
  When it comes to Medicare, remember, we are talking about people 
making $40,000 a month paying $135 a month more. We can fully fund 
children's health insurance for millions of children.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from 
Washington (Mrs. McMorris Rodgers), the conference chairwoman.
  Mrs. McMORRIS RODGERS. Mr. Speaker, I thank the chairman for his 
tremendous leadership on the reauthorization of CHIP, including many 
vital public health programs.
  CHIP provides healthcare coverage for some 9 million children--more 
than a million in Washington State. We all need to remember how 
important this program is for the health of some of the most 
vulnerable.
  Some States, like mine, are expecting to run out of CHIP funding 
soon. It is crucial that we move forward now.
  This bill also reauthorizes the Teaching Health Center Graduate 
Medical Education program, providing funding for 2 years, with a robust 
increase. This not only preserves current programs like the Spokane 
Teaching Health Center, but it also provides funding for the creation 
of new programs in communities that need them.
  Mr. Speaker, this bill makes a real difference to those who need 
healthcare, and I encourage my colleagues to support it.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, it is the ultimate absurdity for my colleague, the 
chairman of the Energy and Commerce Committee, to suggest that somehow 
I control when a bill comes to the floor of the House of 
Representatives.
  The only reason that the Republicans ever delayed bringing this vote 
to the floor is because they know and I know that, if this bill is 
partisan, it will

[[Page H8459]]

never become law. It will go to the Senate, and it will sit there, and 
the only way that it is going to become law is if it is a bipartisan 
effort that actually accomplishes something and gets most people to 
support it.
  We could keep listening to the other side all day say: Oh, the 
Democrats delayed the vote. The Democrats delayed the vote.
  The vote shouldn't be held today. The vote should be delayed today 
because this is going nowhere. This bill is going nowhere. They know 
it. You want to keep saying it? You can say it all day for the next 
hour, but it is the ultimate of absurdity.
  Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Gene 
Green), who is the ranking member of our Health Subcommittee.
  Mr. GENE GREEN of Texas. Mr. Speaker, I thank my ranking member for 
yielding time to me.
  I rise to oppose H.R. 3922. I got elected to Congress to expand 
access for healthcare. I am not a doctor, I am not a nurse, but as 
Members of Congress, we can do as much damage as someone who isn't a 
doctor or nurse by legislation that we see today.
  And while I strongly support extending funding for the Children's 
Healthcare Insurance Program and federally qualified health centers, 
delaying cuts to disproportionate share hospital payments, advancing 
our other bipartisan healthcare programs, this legislation includes 
offsets that undermine access to cover these services.

  Again, my goal in Congress was to expand healthcare, and this bill 
restricts that access. Two-thirds of Medicaid dollars go to children. 
If you cut Medicaid, you are cutting those children's benefits. This 
bill cuts children from Medicaid, and it gives money to the children 
who are less poor on CHIP. We need both programs. We don't need one or 
the other.
  Both CHIP and FQHCs are bedrocks of our healthcare system, providing 
health insurance to almost 9 million lower-income children serving on 
the front lines by providing high-quality primary and preventative care 
to more than 25 million Americans.
  Congress let funding for these programs expire last month, the first 
time in our history, since the 1960s, that the FQHCs and the CHIP 
program were not bipartisan. That is the step this House is making 
today by doing this.
  It should be bipartisan because it has always been bipartisan. 
Unfortunately, instead of bipartisan negotiations looking for a 
compromise, the process was derailed. The bill cuts, again, Medicaid. 
Two-thirds are children, to help poor children, and limit their access.
  The Prevention Fund funds the Centers for Disease Control. We have 
any number of future illnesses that we need the CDC to have the ability 
to fight that, and here we are, cutting vaccinations in our 
communities. We are cutting infectious disease detection and 
prevention.
  Mr. Speaker, I urge my colleagues to vote ``no,'' and let's expand 
access and not restrict it.
  Mr. WALDEN. Mr. Speaker, I would point out there are about 50,000 
kids that Mr. Green may be voting against today in the Houston area if 
this goes down and we can't get this over to the Senate and work it out 
with them. Twice he has voted to cut the Prevention Fund and use it for 
other purposes.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from New Jersey 
(Mr. Lance).
  Mr. LANCE. Mr. Speaker, I rise in support of this legislation. This 
package is the product of our work on the Energy and Commerce Committee 
under the leadership of Chairman Walden. This legislation accomplishes 
the very important goals of reauthorizing the Children's Health 
Insurance Program, renewing funding for community health centers, and 
extending critical resources for Medicaid in Puerto Rico.
  One of the first votes I cast in Congress was for CHIP, creating a 
fiscally responsible health program that now serves 8.5 million 
children in the United States.
  I continue to support community health centers and the work they do 
in areas like Dover and Somerville, New Jersey, in the district I 
serve.
  We also cannot forget about the many families and children in Puerto 
Rico, who also benefit from the Medicaid program. That is why I have 
teamed up with Resident Commissioner Gonzalez-Colon, to make sure low-
cost Federal healthcare continues to be made available to our American 
children in Puerto Rico.
  Mr. Speaker, I urge passage of this legislation and for the United 
States Senate to act as soon as possible.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ to the gentleman from New 
York (Mr. Engel).
  Mr. ENGEL. Mr. Speaker, I am deeply saddened by the situation we are 
in today. Historically, CHIP and community health centers have been 
bipartisan priorities. We are talking about programs that provide 
healthcare for millions of American children and serve some of our 
country's most vulnerable citizens.
  Yet my Republican colleagues have inexplicably taken these programs 
hostage, tucking into this bill new attempts to undermine Medicare, 
sabotage the ACA, and strip hardworking Americans of their health 
insurance, not to mention they are trying to extort these harmful 
policy changes a month after they let CHIP and community health center 
funding expire. This is absolutely unconscionable because, make no 
mistake, these cuts will hurt the same Americans who depend on CHIP and 
community health centers.
  My Democratic colleagues and I care deeply about these programs. That 
is why we have sounded the alarm for months, not just yesterday, for 
months, and urged the majority to stop wasting time on ACA repeal and 
get to work on renewing these lifelines for American families.
  Mr. Speaker, I am disappointed that didn't happen, and I am 
disappointed by what is happening now. I urge my colleagues to vote 
``no.''
  Mr. WALDEN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Texas (Mr. Olson), a very important member of our committee.
  Mr. OLSON. Mr. Speaker, I thank the chairman for yielding time to me.
  Mr. Speaker, I rise today to strongly encourage my colleagues to 
support the HEALTHY KIDS Act. There are many reasons to support this 
bill, but, most importantly, it extends the Children's Health Insurance 
Program, CHIP, until 2022.
  CHIP ensures that children with incomes too low for Medicaid get 
basic health insurance. Close to 400,000 children in Texas rely on CHIP 
for access to quality healthcare services. We must act now.
  Earlier this year, Hurricane Harvey left a path of destruction across 
Texas. It put a major strain on our communities and resources that has 
resulted in moments of uncertainty.
  The bottom line is, we must act now. This bill responsibly provides 
children in need with the proper resources to live a healthy life 
without adding to our country's deficit.
  Mr. Speaker, again, I strongly urge my colleagues to act now. Vote 
for this bill.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Colorado (Ms. DeGette), the ranking member of our Oversight 
Subcommittee.
  Ms. DeGETTE. Mr. Speaker, as one of the authors of the original bill 
20 years ago, I rise to express deep disappointment that the House has 
not been able to reach a bipartisan agreement on how to fund the 
extension of CHIP.
  The September 30 deadline has long passed, and now 9 million children 
and families are waiting anxiously for us to figure this out. My home 
State of Colorado is likely to run out of CHIP funding in January, with 
termination notices going out to worried families in the next few 
weeks.
  Yet here we are with a partisan bill that asks us to pay for low-
income children's insurance on the backs of seniors and the most 
vulnerable.
  The bill also cuts the Affordable Care Act, which could result in 
668,000 people enrolled in ACA plans losing their health insurance. 
Nobody should have to lose coverage in order for others to keep it. 
This is a false choice, and it is out of step with what the American 
people have been calling on us to do. Only the 115th Congress could 
find a way to make the CHIP bill partisan.
  Irrespective of what happens today in this vote, I urge my colleagues 
to get together across the aisle, across the Capitol, find a way to 
reauthorize this important bill in a way that doesn't cut benefits for 
other people. Let's

[[Page H8460]]

truly give kids these benefits that they need, and let's move on with 
our business.
  Mr. WALDEN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from 
Florida (Mr. Bilirakis), an incredible advocate for children and 
healthcare in America.
  Mr. BILIRAKIS. Mr. Speaker, I am so proud to serve on this great 
committee under the chairman's leadership.
  Mr. Speaker, I rise in support of this important bill, which 
incorporates my bill, the Community CARE Act, which reauthorizes 
funding for community health centers for the next 2 years.
  Community health centers have a proven track record of providing 
high-quality, cost-efficient healthcare to approximately 25 million 
Americans, including 7 million children, and 300,000 veterans each 
year. There are over 100 million coordinated and integrated patient 
visits through the 1,400 community health centers across the country.

                              {time}  0945

  This bill will reauthorize CHIP for the next 5 years. This program is 
vital for the roughly 360,000 children on CHIP in Florida alone.
  Additionally, this bill provides clarity for CHIP buy-in programs, 
such as the one we have in Florida. This sets the rules of the road and 
will ensure that 12,000 children in Florida's CHIP buy-in program will 
continue to have access to CHIP.
  Mr. Speaker, let's get this done now for our children. I urge passage 
of this important piece of legislation.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Illinois (Ms. Schakowsky).
  Ms. SCHAKOWSKY. Mr. Speaker, the truth is that Republicans are 
holding the Children's Health Insurance Program, 9 million kids, and 
the Community Health Center program, 15 million people, hostage to 
wreak even more havoc on our healthcare system and make children and 
seniors sicker and undercut Medicare.
  Paying for children's health insurance on the backs of seniors is 
simply a disgrace. This bill would increase Medicare part D and part B 
income-related premiums, charging higher income seniors the entire 
cost. This is a structural attack on Medicare, and that is why the 
AARP, which supports the Children's Health Insurance Program, opposes 
this bill. Imposing a 100 percent premium is unfair because these 
seniors already pay more, and it will drive many out of Medicare 
altogether, undermining its solvency.
  To make matters worse, the Republican income threshold is not based 
on current income, but on a 2-year period. So, for example, seniors' 
income is volatile, and if you sold your home, you could get a massive 
premium penalty, even if you used the money you got from selling your 
home to buy in to assisted living and that money wasn't available.
  Income-related premiums are simply unnecessary. There are many other 
ways to pay for the CHIP program without using Medicare as an ATM. 
Democrats have offered reasonable alternatives, but Republicans opposed 
all of them.
  I urge my colleagues to oppose this legislation.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Before I call on my next colleague, I just want to point out that, in 
Ms. Schakowsky's district, all we are talking about here is seniors 
making $41,000 a month--a month--would pay an extra 135 bucks so we can 
fully fund children's health insurance, community health centers. All 
these programs in here are funded. We use the Prevention Fund, which is 
not allocated out in the out-years. It is just a pot of money you can 
use for prevention and wellness. We actually use that to fund this as 
well.
  This is why we have been unable to reach agreement with the 
Democrats. It is sad they have made this partisan.
  I yield 1 minute to the gentleman from California (Mr. Costa).
  Mr. COSTA. Mr. Speaker, I rise today to speak on behalf of the people 
of the San Joaquin Valley in favor of H.R. 3922.
  The people of the valley whom I represent in California did not send 
me here to put the lives of children at risk. I have made a commitment 
to improve access to healthcare for families that I have the honor to 
represent here in the House. I will continue to meet that commitment. 
The question is: Will Congress do the same and extend the Children's 
Health Insurance Program?
  My congressional district has perhaps the largest percentage of 
children who qualify for the Children's Health Insurance Program in the 
entire country. The coverage is vital to families throughout my 
district, but it is particularly important to communities like Gustine, 
Planada, Chowchilla, and Biola, where these healthcare clinics provide 
such important, valuable healthcare to these children and their 
families.
  Approximately 71 percent of the children in my district receive their 
medical coverage through the combination of the Children's Health 
Insurance Program and Medicaid. We cannot let this end.
  This bill is not perfect, to be sure, but these children cannot be 
put at risk with further delays in funding for the important programs 
that this bill extends. I urge my colleagues to support this 
legislation.
  Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Florida (Ms. Castor), the vice ranking member of our committee.
  Ms. CASTOR of Florida. Mr. Speaker, for decades now in America we 
have worked together to make sure that kids can see a doctor and get 
the care that they need. Working with pediatricians, families, and 
advocates back home, we have reached a historic point where almost all 
kids across the country have health insurance coverage.
  The Children's Health Insurance Program, or CHIP, or known in Florida 
as Florida KidCare, or Healthy Kids, has been an important piece of 
this historic coverage level. CHIP simply is vital for families, 
millions of hardworking families, so that their kids can get the 
checkups, the immunizations, sometimes the critical care that they need 
so they can be healthy and well.
  Now, I chair the bipartisan Children's Healthcare Caucus. We educate 
and advocate so that kids across America are healthy and well. So it is 
especially disappointing this year that my Republican colleagues failed 
to act before CHIP expired.
  See, they were consumed all year long with ripping health coverage 
away, decimating the Affordable Care Act, and radically changing health 
services provided under Medicaid. In doing so, they let our kids down; 
they let our families down. And then, at the 11th hour, after the 
program expired, they come up with a very partisan bill rather than the 
bipartisan bill that has been the historic backbone of Children's 
Health Insurance.
  Don't take it from me. A lot of the advocates across the country, 
like pediatricians, obstetricians, gynecologists, March of Dimes, say: 
Please don't fund CHIP based upon harmful cuts; don't have cuts 
negatively impact the health of women, children, and families. 
Pediatricians say: Don't jeopardize other important child health 
policies in the process.

  Let's go back to the drawing board as soon as possible, over the 
weekend, next week; bring it back to the floor next week, so that 
families and kids get the care that they need.
  This bill today, unfortunately, is simply a delay.
  Mr. WALDEN. Mr. Speaker, there they go again: delay, delay, delay; 
and vote against kids, vote against their hospitals, and vote against 
their doctors. That is why we couldn't get agreement.
  I yield 1\1/2\ minutes to the gentleman from Indiana (Mr. Bucshon).
  Mr. BUCSHON. Mr. Speaker, I rise today in strong support of the 
CHAMPIONING HEALTHY KIDS Act, which extends the State Children's Health 
Insurance Program, SCHIP, for another 5 years.
  In 1997, Congress created S-CHIP in partnership with the States to 
meet the healthcare needs of lower income kids. Last year, nearly 
100,000 Hoosier kids received health insurance thanks to this critical 
program. I am proud that this legislation will continue to protect 
vulnerable children in the Eighth District of Indiana.
  This bill also extends 2 years of funding for federally qualified 
health centers, family-to-family health information centers, and other 
important public health programs. This funding provides important 
healthcare services, resources, and information for families in the 
Eighth District and across America.

[[Page H8461]]

  I urge my colleagues to support passage of the CHAMPIONING HEALTHY 
KIDS Act.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from Vermont (Mr. Welch).
  Mr. WELCH. Mr. Speaker, speaking to my chairman, Chairman Walden, I 
accept your commitment and your leadership on insuring children, but I 
am speaking to you because I reject the argument that, in order to fund 
a health insurance program that all of us support, we have to 
compromise health programs that benefit many other people, including in 
Vermont. Let me just give an example.
  The prevention program in Vermont is really helping people stay well. 
We had $922,000 that was spent on immunization programs for our kids. 
We had $377,000 for lead poisoning prevention. Lead poisoning is 
brutal. We had $372,000 for heart disease prevention and control, and 
we had over $209,000 for diabetes and prevention control.
  So I acknowledge your commitment. I acknowledge the urgency with 
which your side and our side supports CHIP. But why is it that, if we 
support it, we don't pay for it? And instead of paying for it directly, 
coming up with ways to eliminate waste in the healthcare system, we 
take away our ability to immunize, to prevent lead poisoning, to reduce 
heart disease? That is my question. The answer for me would be that we 
go where the waste is.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. PALLONE. I yield the gentleman from Vermont an additional 30 
seconds.
  Mr. WELCH. The answer to me would be that our committee engages in 
addressing the waste in healthcare, including high prescription drug 
costs, rather than take it out of good programs.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  I appreciate the gentleman's sincerity. We work well together on lots 
of issues. He has also voted to use this Prevention Fund for other 
purposes in the past, as have I.
  We don't touch the Prevention Fund for 2018, and there is $400 
million left in 2019, and billions thereafter for the very important 
programs the gentleman has articulated. We don't use all the money. We 
leave money behind for these other purposes.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  The bottom line is, when you start cutting money from the Prevention 
Fund, you are cutting prevention programs for kids, adults, the 
disabled, and, most importantly, the opiates.
  CDC spends a significant amount of money from the Prevention Fund 
dealing with the opiate crisis, so don't tell me that somehow this is 
okay. You are taking money away from opiate prevention. You are taking 
money away from kids programs like lead poisoning and vaccines. It is 
unbelievable how much is actually going to be lost from the Prevention 
Fund because of this bill.
  I am not interested in what happened in the past. I want to know what 
is going to happen in the future. We have an opiate crisis. Don't take 
money away from the Prevention Fund that is used to deal with that 
crisis.
  I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, I do think it is important to note that my 
friend, and he is my friend from New Jersey, has twice voted to use 
this Prevention Fund for other purposes, including the 2012 middle 
class tax cut.
  I yield 1\1/2\ minutes to the gentleman from Texas (Mr. Barton).
  (Mr. BARTON asked and was given permission to revise and extend his 
remarks.)
  Mr. BARTON. Mr. Speaker, we have talked a lot today on the floor 
about the children's component of this bill, the S-CHIP. It is a good 
program. It covers about 45 percent of the low-income children in 
Texas. It is a very worthwhile program and needs to be reauthorized and 
funded.
  I also want to talk about the community health centers. In Ennis, 
Texas, there is the Nell Barton Hope Clinic Annex. Nell Barton was my 
mother.
  The Joe Barton Family Foundation purchased a building for the Hope 
Clinic, which is a federally funded health center that is primarily 
located in Waxahachie, Texas. Every day, several dozen low-income 
people go to the Nell Barton Hope Clinic. Over the course of the year, 
several thousand people go to the Hope Clinic in both Ennis and 
Waxahachie. This bill reauthorizes those health centers for 2 years.
  Now, my friends on the Democratic side, I am not sure what they are 
complaining about. This is a program that funds healthcare for children 
and for low-income people through the community health centers. It is 
fully offset, and funding is increasing, Mr. Speaker, not decreasing, 
but it is doing so in a way that it is offset. What is the big offset?
  I hope we vote for this bill when it comes up for a vote later today.

                              {time}  1000

  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I just wanted to talk about this use of the Prevention 
Fund. Democrats have never supported the type of drastic cuts to the 
Prevention Fund that is in this proposal today. In fact, when faced 
with such cuts, we voted ``no'' nine times. In the two cases where we 
voted in favor of using some of the Prevention Fund as an offset, 
neither cut placed the CDC programs and efforts at risk as this 
legislation does today.
  The Republican proposal would cut the Prevention Fund nearly in half 
and leave a $400 million hole in funding for prevention and health 
programs within the CDC's budget beginning in 2019. This cut would be 
devastating to local, State and Federal efforts to protect the Nation's 
health.
  Unlike my Republican counterparts, what they contend, this cut to 
these programs would not be made up in the annual appropriations 
process, as evidenced by the proposed cut of $198 million to the CDC in 
the House Republican fiscal year 2018 appropriations bill, and the 
decrease of $580 million in CDC funding since 2010 when adjusted for 
inflation.
  Again, you talk about opiates, you talk about children's health 
programs. These would be drastically cut because of what they are doing 
today to the Prevention Fund.
  Mr. Speaker, I reserve the balance of my time.
  Mr. WALDEN. Mr. Speaker, before I yield to the gentleman from 
Michigan, I would just point out that when Democrats joined Republicans 
in voting for the 2012 middle class tax cut, we used $6.3 billion out 
of the Prevention Fund they now say they never touched, yet they have.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Michigan 
(Mr. Walberg).
  Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 3922. I 
want to thank Chairman Walden and Dr. Burgess for their leadership in 
bringing this bill to the floor today.
  The CHAMPIONING HEALTHY KIDS Act reauthorizes and funds a number of 
programs important to my constituents, including the State Children's 
Health Insurance Program, community health centers, and the Teaching 
Health Center Graduate Medical Education program.
  H.R. 3922 will continue CHIP for 5 years, allowing this successful 
Federal-State partnership to provide health coverage for low-income 
children and pregnant women. It also extends funding to federally 
qualified health centers for 2 years, a key component of the healthcare 
safety net; and helps address our increasing health provider shortages 
by investing in the education and training of future health 
professionals.
  Of importance, this legislation is fully paid for with responsible 
policies, such as measures to allow States to disenroll lottery winners 
from Medicaid and prioritize the most vulnerable.
  I am proud of the good work that was done by the Energy and Commerce 
Committee to advance this legislation to the floor, and I encourage my 
colleagues to vote ``yes'' on the bill and to ensure the programs are 
available for the people who depend upon them.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Matsui).
  Ms. MATSUI. Mr. Speaker, I rise in opposition to H.R. 3922.
  Mr. Speaker, the uncertainty that we have created for our community 
health clinics and their patients is unacceptable. Each day it is a new 
threat. Most

[[Page H8462]]

of the year it has been TrumpCare's severe cuts to Medicaid, which 
health centers and their patients rely upon. Today it is a lack of 
extension of the critical grant funding. Tomorrow or the next week, we 
will be back to ripping Medicaid away to pay for the Republican's tax 
cuts.
  We have always extended CHIP and community health center funding on a 
bipartisan basis, but, unfortunately, the bill before us today is not 
bipartisan. The Prevention Fund, which would be slashed in this bill, 
funds programs that are critical to children and families who rely upon 
CHIP and community health centers. Many times these programs are even 
run out of our community health centers and could not exist without the 
Prevention Fund. These are things like childhood asthma prevention, 
vaccines, and lead abatement.
  It often takes someone going above and beyond a simple doctor's visit 
to provide families with the resources they need to stay healthy. We 
need to invest in these services. We cannot strip this funding from 
critical prevention programs that children and families rely on. We 
cannot allow programs like Medicare and Medicaid to be attacked and 
raided.
  Mr. Speaker, I urge my colleagues to vote ``no'' on H.R. 3922.
  Mr. WALDEN. Mr. Speaker, once again, my dear friend from California 
has twice voted to use these Prevention Funds for other things. By the 
way, when we use them for community health centers, they are doing this 
work on the ground, helping people with opioid addictions and other 
healthcare issues.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Georgia 
(Mr. Carter).
  Mr. CARTER of Georgia. Mr. Speaker, I thank the chairman for yielding 
and for his outstanding leadership on this very important committee.
  Mr. Speaker, I rise today to implore my colleagues to put politics 
aside for the sake of the 232,000 children in my State of Georgia and 
the 8.9 million children across our Nation who are counting on us to 
reauthorize CHIP. Twelve States will run out of CHIP funding before the 
end of this year. So the idea of waiting around another 2 months before 
acting on CHIP is simply unacceptable.
  Let's be clear why we are here today. Instead of having this 
discussion 2 months ago, we had to delay the Energy and Commerce 
Committee markup of the CHAMPIONING HEALTHY KIDS Act, the CHIP bill, 
because the other side of the aisle refused to even consider reasonable 
offsets to pay for the program.

  I ask my colleagues on the other side of the aisle: How was that 
objection related to fighting for the middle class?
  Even President Obama supported the change for high-income Medicare 
beneficiaries in his annual budget.
  How are we supposed to look parents in the eye back home and tell 
them that we choose politics instead of choosing to relieve their 
concerns about coverage?
  Mr. Speaker, let's do our job and let's reauthorize CHIP.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from California (Mr. McNerney).


 =========================== NOTE =========================== 

  
  November 3, 2017, on page H8462, the following appeared: 1\1/2\ 
minutes to gentleman California
  
  The online version has been corrected to read: 1\1/2\ minutes to 
the gentleman from California


 ========================= END NOTE ========================= 

  Mr. McNERNEY. Mr. Speaker, I rise in opposition to H.R. 3922.
  Mr. Speaker, it is critical that we authorize CHIP and community 
health centers, but slashing essential public health funding is not the 
right way to do it.
  Treatment of chronic diseases accounts for 75 percent of our Nation's 
healthcare spending, and many of these diseases can be prevented. 
Unfortunately, H.R. 3922 does not do that at all. This bill cuts in 
half the ACA Prevention and Public Health Fund that plays a critical 
role in preventing and treating chronic diseases, including keeping 
kids healthy.
  The massive cuts to this funding will be devastating to my Central 
Valley of California district. My district has the largest number of 
tuberculosis cases in California for children under 5 years old. 
Children in this age group are more likely to develop life-threatening 
forms of TB since their immune systems are less mature. Public 
officials in my district are relying on funding from the Prevention 
Fund to address TB outbreaks.
  It is troubling that Republicans are using CHIP reauthorization to 
take core public health services away from kids. It is also 
frustrating, but not surprising, that the Republicans are making 
another attempt to sabotage the Affordable Care Act. This legislation 
is robbing Paul to pay Peter, and I urge my colleagues to vote against 
it.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, sabotaging the Affordable Care Act; what we are doing is 
putting off planned cuts to our hospitals that take care of low-income 
people that those cuts called for under the Affordable Care Act. We are 
putting those off so they can serve these low-income people. That, in 
their language, is sabotaging the Affordable Care Act.
  On the issue of using the Prevention Fund, my friend from California 
who just spoke, has twice voted to use the Prevention Fund, including 
for tax cuts in 2012 and for the 21st Century Cures Act last year. Now 
we are using it for community health centers and children's health 
insurance programs. This is an appropriate use of a fund that gets 
replenished by law every year.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Puerto 
Rico (Miss Gonzalez-Colon), whose constituents and herself have 
suffered such damage, such destruction as a result of the hurricanes.
  Miss GONZALEZ-COLON of Puerto Rico. Mr. Speaker, I rise in strong 
support of H.R. 3922, the CHAMPIONING HEALTHY KIDS Act.
  I wanted to begin by first thanking Chairman Walden and Dr. Burgess 
for their leadership in moving forward this critically needed 
legislation. I am particularly thankful for those in the leadership and 
all of my colleagues in the Energy and Commerce Committee for including 
a $1 billion allocation to temporarily address Puerto Rico's impending 
ObamaCare-created medical cliff, while also providing another year of 
the disproportionate share hospital relief.
  To put things in perspective, when we arrived in this Congress during 
January of this year, more than 1 million Puerto Ricans were facing the 
imminent possibility of losing their healthcare coverage due to a 
funding shortfall resulting from ObamaCare's disparate application to 
the island.
  We moved quickly during the appropriations bill, and they allocated 
$295 million to improve that situation. In this bill, we are allocating 
$1 billion for Puerto Rico's Medicaid program. This is an important 
step, but we still need to secure a permanent and equitable solution to 
Puerto Rico's longstanding Medicaid inequalities, and that means 
changing the FMAP for the island.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from New York (Ms. Velazquez).
  Ms. VELAZQUEZ. Mr. Speaker, I want to thank the ranking member for 
yielding.
  Mr. Speaker, as Puerto Rico struggles to recover from the historic 
damage of Hurricane Maria, this legislation shortchanges the island's 
long-struggling healthcare system at exactly the time that Puerto Rico 
most needs our help.
  This legislation provides a measly sum of Puerto Rico's Medicaid 
system. Even before Hurricane Maria made landfall, Speaker Ryan had 
committed to help resolve Puerto Rico's looming Medicaid crisis, yet 
this bill provides just $1 billion. We have no assurance or guarantee 
that the next emergency supplemental will provide appropriate funds to 
address this problem.
  The fact is that our fellow citizens have been shortchanged by the 
disparity in Medicaid funding. This forced the government of Puerto 
Rico to borrow money to provide healthcare. So if you wonder where 
Puerto Rico's financial crisis stems from, you can look right here at 
the U.S. Congress. Yet the amount included in this bill is far from 
sufficient to address even this year's shortfall. For the Puerto Rican 
people who have already suffered so much, this funding level amounts to 
an insult.
  If ever there were a time to channel aid to the island's healthcare 
system and fix the systemic problems that we sought in the system 
underfunding, this is it.
  The SPEAKER pro tempore (Mr. Collins of Georgia). The time of the 
gentlewoman has expired.
  Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the 
gentlewoman from New York.

[[Page H8463]]

  

  Ms. VELAZQUEZ. Mr. Speaker, there are a litany of reasons to oppose 
this bill, but let's make it clear: one of them is that it will not do 
enough for the people of Puerto Rico. These are U.S. citizens. They 
have fought, shed blood, and died in every major conflict. Now they 
need our help, and this bill does not supply it. Reject this bill. Vote 
``no.''
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  How cynical what we just heard. How cynical.
  Ms. Velazquez has 43,000 children in CHIP, $2 billion in DSH cuts in 
her district, 43 health centers, and she is going to vote against $1 
billion for the citizens of Puerto Rico and the Virgin Islands because 
that is not enough.
  Yes, we need to do more, so her answer is vote ``no'' today and deny 
$1 billion.
  Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from South 
Carolina (Mr. Norman).
  Mr. NORMAN. Mr. Speaker, today I rise in support of H.R. 3922. 
Listening to my Democratic friends, it was said right by Chairman 
Walden. It is cynical, and it is amazing that they could vote against 
this bill.
  Not only does this bill reauthorize public health programs vital to 
Americans who need them most, but it does so in a fiscally responsible 
manner. Reauthorizing CHIP for a 5-year period was an important 
priority of children's healthcare providers in my district, but doing 
so while saving billions is an impressive feat.
  On top of that, providing funding for community health centers will 
drastically improve rural health in South Carolina's Fifth District. 
This bill is proof that the American people can trust their government 
to provide essential services to citizens who cannot provide for 
themselves, without saddling our children and grandchildren with debt.
  Mr. Speaker, I would like to commend my colleague, Chairman Walden, 
for his impressive efforts in striving toward a greater government.

                              {time}  1015

  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman 
from Massachusetts (Mr. Kennedy), who is a member of our committee.
  Mr. KENNEDY. Mr. Speaker, this moment is a bit hard to stomach. It is 
hard to stomach yet another attempt to sabotage the Affordable Care 
Act, in the words of our colleagues, while extolling the virtues of 
public health programs by cutting grace periods down to 30 days that 
will result in hundreds of thousands of people losing access to their 
insurance.
  It is hard to stomach a $1 trillion tax cut being proposed for 
wealthy adults at the same time that our Republican colleagues are 
telling us that we can't afford to care for sick kids. It is hard to 
stomach the indifference shown in this Chamber over the course of the 
past month as CHIP lapses and panic sets in amongst families whose 
lives depend on this program.
  It is hard to stomach an idea that the only way to give them care is 
to somehow take it away from somebody else, by gutting the Public 
Health Fund in the midst of an opioid epidemic or scapegoating patients 
who struggle to afford the monthly premiums and sometimes fall behind.
  Why is it always those patients who are asked to sacrifice?
  It is always those communities that are asked to do more with less.
  Why do we somehow create a false choice on this floor today that 
leads 9 million families to an impossible choice tomorrow?
  For those families, CHIP is not a privilege or a line item in the 
budget, it is a lifeline. They deserve the same decency and the same 
urgency that our Republican colleagues showed the wealthy in their tax 
plan yesterday.
  Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
  Wow. We are fully funding CHIP for 5 years. We are fully funding our 
community health centers for 2 years. We are taking care of programs 
for our citizens who have diabetes. And the pay-for that they are 
objecting to most is we are asking the wealthiest seniors in America, 
those making $40,000 a month, to pay $135 more for their Medicare so we 
can do this work that is so important.
  How ironic. How cynical. This is a pay-for that has been used before 
for other programs. President Obama himself suggested in a budget that, 
instead of the top earners, the $480,000 a year, a couple making over 
$800,000 a year pay a little more as we do here, take it all the way 
down to $80,000 a year.
  We didn't do that. We just said, if you are making $480,000 a year, 
roughly $40,000 a month, you will pay $135 more. They will not vote for 
that cut to fund children's healthcare. We will.
  That is what is going on here. This is where we could never get them 
off dead center to make this bipartisan. It is a tragedy this is not a 
bipartisan bill as it always has been. I, three times, delayed moving 
this forward, including crossing the deadline of September 30, to try 
to find common ground that would be bipartisan, and we could never get 
there because they would never yield in a way where we could find 
common ground.
  So we must go to the Senate from here and we must get our work done 
for the American people.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Michigan (Mrs. Dingell).


 =========================== NOTE =========================== 

  
  November 3, 2017, on page H8463, the following appeared: 1\1/2\ 
minutes to gentlewoman from
  
  The online version has been corrected to read: 1\1/2\ minutes to 
the gentlewoman from


 ========================= END NOTE ========================= 

  Mrs. DINGELL. Mr. Speaker, I rise in strong opposition to this 
legislation because it presents us with a choice that we should not 
have to make. I take a backseat to nobody in this institution in terms 
of fighting for children and families.
  But we live in the United States of America, the greatest Nation in 
the world. I reject the notion that we have to rob Peter to pay Paul 
or, in this instance, jeopardize the future of Medicare and steal $6 
billion from critical prevention programs to pay for children's 
healthcare. They are all equal priorities, and we shouldn't have to 
sacrifice the health of one population to pay for another. It is that 
simple.
  The changes that the bill makes to Medicare may sound innocuous--and 
I have great respect for the chairman--but the reality is they will 
threaten the future of Medicare.
  Means testing Social Security is a good sound bite, but it is a very 
slippery slope. I'm not worried about whether wealthy families can be 
able to afford to pay for increased Medicare premiums, but I am worried 
that these changes will result in wealthy people abandoning the program 
in large numbers, which would worsen the risk pool and ultimately 
increase the costs for middle- and lower-income seniors. It would 
fracture completely the universal nature of Medicare and put the entire 
program at risk. It is an unwise proposal that should be rejected.
  Mr. WALDEN. Mr. Speaker, may I get a time count, please, on how much 
each side has remaining?
  The SPEAKER pro tempore. The gentleman from Oregon has 45 seconds 
remaining. The gentleman from New Jersey has 4\1/2\ minutes remaining.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Doggett).
  Mr. DOGGETT. Mr. Speaker, the Children's Health Insurance Program 
began as a truly bipartisan initiative, but now it is being overwhelmed 
by Republican indifference. So low is it on their priority list that 
they let the law expire. Three States have already required emergency 
funding, and 400,000 Texas children are at risk if this program is not 
continued.
  In the face of this crisis, their response is: We won't put another 
new dollar into this program unless we take it from Medicare 
beneficiaries.
  Why should we begin calling on those who rely on Medicare to pay for 
non-Medicare purposes?
  It is wrong.
  The second way they propose to fund this bill is by reducing funding 
for public health and prevention, whether it is for Zika and West Nile 
virus, where I live down in Texas, or it is for the opioid crisis, 
which is affecting our State like every other one.
  Sure, we are glad to hear President Trump do a tweet and give a 
speech. But he did not add any new dollars to fight this opioid crisis. 
We need bold action, and it is not by reducing the Prevention and 
Public Health Fund. It is by supporting our children.
  Mr. WALDEN. Mr. Speaker, I will just point out that the gentleman who 
just spoke has voted to cut the Prevention Fund before to use it for 
other purposes.

[[Page H8464]]

  Mr. Speaker, I reserve the balance of my time.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from 
Michigan (Mrs. Lawrence).
  Mrs. LAWRENCE. Mr. Speaker, I rise today to support fully funding the 
CHIP Act, but to oppose to the Republican bill.
  Because of the reduction in the grace period, we are forcing 
Americans to go into their own pocket. Although this bill will 
reauthorize CHIP, it fails to show compassion for the low-income 
families and children who do not have access to critical healthcare, 
and it is a matter of life and death.
  CHIP's impact is overwhelmingly felt in communities of color. 
Together, CHIP and Medicaid help cover 52 percent of Hispanic and 54 
percent of all Black children nationwide.
  As Members of Congress, we have a duty to protect our Nation's 
children. We need to support the millions of families who rely on this 
vital program. This is not the right way. We need to work together in a 
bipartisan manner to pass an important piece of legislation like CHIP 
and not take away from our children but support them.
  Mr. PALLONE. Mr. Speaker, how much time remains on each side?
  The SPEAKER pro tempore. The gentleman from New Jersey has 2\1/2\ 
minutes remaining. The gentleman from Oregon has 45 seconds remaining.
  Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, I want to stress again that one of the pay-fors that the 
Republicans don't talk about much is the fact that they are reducing 
the grace period from 90 days to 30 days. So if someone misses a 
payment on their insurance, they currently have 90 days to make up for 
it. Under this bill, they will only have 30 days.
  Now, the CBO estimates that over 500,000 people will lose their 
health insurance and have to reapply for next year because of this 
reduction in the grace period. I know my colleague from the other side 
says: Well, that is too bad because they have the responsibility to pay 
it.
  But the fact of the matter is that a lot of people have a hard time 
paying their monthly premium, and we should not be passing legislation 
that ends up with half-a-million people losing their health insurance.
  Again, this is a way to sabotage the Affordable Care Act. The 
Affordable Care Act is trying to make more people covered, and has 
succeeded in covering 95 percent of the people in this country.
  Why in the world would we use a pay-for that cuts back on half-a-
million people who would lose their health insurance?
  I want to emphasize, Mr. Speaker, we did not have to be here today. 
We could have done a bipartisan bill without sabotaging the Affordable 
Care Act. That is what concerns me most, Mr. Speaker. The Republicans 
tried to repeal the Affordable Care Act. They failed, and now they are 
trying to repeal it piece by piece.
  The pay-fors that are in this legislation are unfair to the American 
people. The Prevention Fund is used for opiate prevention and used for 
kids for various programs. Don't cut back on that to pay for these 
other things.
  The grace period--half-a-million Americans are going to lose their 
insurance because of the cutbacks in the grace period--another effort 
to sabotage the Affordable Care Act.
  Lastly, and probably even most important, again, the Republicans are 
going against the Medicare program. They are trying to make cuts in the 
Medicare program and restructure the Medicare program in a way that I 
believe will hurt the Medicare program, reduce the amount of people in 
the insurance pool, and ultimately lead to higher costs for middle 
class and lower-income seniors and the disabled in the Medicare 
program.
  I urge my colleagues: Don't let the Republicans continue to sabotage 
the Affordable Care Act. We could have done this on a bipartisan basis. 
Passing this bill today does nothing for the Children's Health 
Initiative or for community health centers because this bill is going 
nowhere. It will end up in the Senate. The Senate will not take it up, 
and we will be waiting around until Christmas to actually find a way to 
fund these programs and put these programs at risk. Vote ``no.''
  Mr. Speaker, I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, let's get this back where it belongs. We are 
fully funding the Children's Health Insurance Program for 5 years and 
community health centers for 2 years. The only sabotage of the 
Affordable Care Act going on here today is stopping cuts for hospitals 
in our districts that serve low-income people that would otherwise 
occur under the Affordable Care Act. We do that for 2 years.
  The Democrats don't think seniors making $40,000 a month--$40,000 a 
month--should pay an extra $135 for their part B and part D Medicare so 
we can take care of our community health centers and children who need 
health insurance.
  We delayed this bill coming to the floor at a bipartisan request to 
find a bipartisan solution that was elusive, sadly. We have never had 
this problem before, but we have it today. We must act.
  Mr. Speaker, I urge a ``yes'' vote on this legislation, and I yield 
back the balance of my time.
  Ms. McCOLLUM. Mr. Speaker, I rise in opposition to the Community 
Health and Medical Professionals Improve Our Nation (CHAMPION) Act of 
2017 (H.R. 3922).
  While I support reauthorizing funding for the Children's Health 
Insurance Program (CHIP), the Federally Qualified Health Centers 
(FQHCs), and various other important public health programs, I oppose 
this bill because it cuts funding for public health, puts families at 
risk of losing their health insurance, and weakens Medicare.
  The health of children and expecting and new mothers is something 
that we can all agree on. In my home state of Minnesota, CHIP funding 
is essential for providing healthcare to 125,000 low income children 
and 1,700 expecting and new mothers. Minnesota also depends on FQHC 
funding with over 190,000 people receiving care from one of the more 
than 70 community health centers in my state last year.
  Unfortunately, House Republicans have turned these bipartisan issues 
into an opportunity to divide us. The offsets included in this 
legislation are unacceptable to me and to Minnesota families.
  Once again, Republicans are using this legislation as yet another 
opportunity to weaken the Affordable Care Act (ACA) by cutting $6.35 
billion from the Prevention and Public Health Fund over the next ten 
years. This fund, created by the ACA, directly funds our nation's 
prevention, preparedness, and response capabilities.
  If these Republican cuts become law, the Centers for Disease Control 
and Prevention would be forced to provide less funding to cities, 
states, and tribes to rapidly address public health crises. This money 
includes funding for vaccines, flu prevention, and addressing the 
opioid epidemic. When my home state of Minnesota had to recently deal 
with a serious outbreak of measles, our community health officials 
utilized these federal resources to rapidly contain the spread of 
disease. Simply put, this irresponsible offset leaves American 
communities more vulnerable to, and unprepared for, outbreaks of 
disease.
  In addition, this bill takes aim at yet another ACA provision by 
shortening the 90-day grace period for individuals to pay premiums 
before their insurer can terminate their coverage. The current grace 
period allows low and moderate income families experiencing temporary 
financial difficulties to remain covered by their health insurance. 
Shortening this grace period from 90 days to 30 days would cause nearly 
700,000 Americans to lose their health care and bars them from 
purchasing health insurance until the next season.
  I am also concerned by the provision that introduces means testing to 
Medicare. A key strength of Medicare is its universal nature. All 
Americans pay into Medicare and all Americans should receive at least 
some benefit from it. This provision breaks that guarantee and sets a 
dangerous precedent for the future. I am also concerned that it could 
weaken the Medicare risk pool and increase costs for the taxpayer.
  Mr. Speaker, even the Majority concedes that this bill is unlikely to 
pass the Senate due to the partisan nature of its provisions. 
Republicans need to stop playing games and reauthorize these programs 
before Minnesota faces a critical December 1 deadline to continue 
coverage for children and expecting mothers.
  I urge my colleagues to vote against this measure and instead to work 
together to fund CHIP and community health centers.
  Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in 
strong opposition to the bill being considered on the floor today, H.R. 
3922, the CHAMPIONING HEALTHY KIDS Act. Unfortunately, this deceitfully 
named measure to reauthorize the Children's Health

[[Page H8465]]

Insurance Program (CHIP) and Community Health Centers (CHCs) will 
reauthorize these programs through FY19--but does so by kicking 
thousands of Americans off private insurance.
  Like many of my colleagues, I strongly support CHIP, CHCs, and other 
critical public health initiatives. However, the bill in its current 
form was drafted as yet another attempt by Republicans to undermine the 
Affordable Care Act in order to justify its repeal. The bill is 
misguided in its attempt to cut $6.35 billion over ten years from the 
Prevention and Public Health Fund in order to fund the extension.
  H.R. 3922 also reduces grace periods from 90 to 30 days, putting more 
than 688,000 low- and moderate-income individuals at risk of losing 
their state Marketplace coverage for simply paying their premiums in 
the second of third month of the existing grace period. This grace 
period is essential to low-income households that are barely making 
ends meet. By reducing the current grace period, Republicans are 
exposing thousands of families to risk due to a lack of health 
coverage. It is frankly disgraceful that we would even consider 
undermining these important public health programs in such a manner.
  Mr. Speaker, CHIP, CHCs, the National Health Service Corps, and other 
programs funded under this measure are vitally important to our nation 
and the public health of our citizens. As the first registered nurse 
elected to Congress, I understand the critical need for proper long-
term funding of our public health centers and programs. However, these 
cuts to the Prevention and Public Health Fund represent a purely 
political move by the GOP to undermine the ACA. I oppose this 
controversial offset, not my support for health centers across America. 
I urge my colleagues to oppose this measure so that we can find offsets 
driven by policy, not politics, in order to sufficiently fund our 
health centers and promote public health for all.
  Ms. JACKSON LEE. Mr. Speaker, I rise to speak on House consideration 
of H.R. 3922, Championing Healthy Kids Act, which would reauthorize the 
State Children Health Insurance Program (S-CHIP).
  As the founder and chair of the Congressional Children's Caucus, I am 
well aware of the work that went into creating this important program.
  I joined with members of the bipartisan Children's Caucus to champion 
the worthy goals of S-CHIP.
  Congress and President Clinton responded to the needs of 10 million 
children in the United States who lacked health insurance, S-CHIP was 
created in 1997 to insure children in families with too much income to 
qualify for Medicaid and too little to afford private insurance.
  I voted for the S-CHIP program when it came to the floor for a vote 
as part of the Balanced Budget Act of 1997.
  I worked tirelessly along with other members of the House to make 
sure the S-CHIP program was created.
  I voted to extend the life of the program when Congress reauthorized 
S-CHIP in 2009 under the Children's Health Insurance Program 
Reauthorization Act and again when it became part of the Patient 
Protection and Affordable Care Act of 2010.
  The program represented a grand bargain that allowed Democrats and 
Republicans to agree that healthcare for the nation's children was a 
laudable and achievable goal.
  H.R. 3922, Championing Healthy Kids Act, is not a reauthorization of 
the S-CHIP program it is political theater at its worse.
  The leadership of the House is betraying all that this body has done 
for 20 years to sustain and improve S-CHIP.
  The bill before the House is political theater and not real 
legislating--a partisan attack against Medicare that has no place in a 
real bill about healthcare for children.
  I am a strong supporter of S-CHIP and would vote for that program any 
day it is brought to the House Floor.
  This imposter S-CHIP bill is not worthy to be considered by this 
body.
  The motion to recommit this bill should be supported so that the 
offensive offsets could be removed so that the bill can be brought back 
to the full House for consideration.
  After weeks of negotiations to reauthorize the Children's Health 
Insurance Program (CHIP), Community Health Centers (CHCs) and other 
important public health programs, which have always been bipartisan 
priorities, House Republicans have decided to bring a partisan bill to 
the Floor.
  This bill will only further delay the reauthorization of these 
programs, many of which expired on September 30th.
  The bill passed out of the Energy and Commerce Committee at the 
beginning of October with no Democratic support.
  Democrats in Committee instead offered a package that invests in our 
children and safety net providers, and does not sacrifice the nation's 
health.
  Democrats have made it clear for weeks that the pay-fors in this bill 
are problematic.
  Rather than working toward a bipartisan agreement, Republicans 
revised their bill to include even steeper cuts to public health 
programs, in addition to undermining the Affordable Care Act (ACA).
  The bill includes woefully inadequate funding for Medicaid programs 
in Puerto Rico and the U.S. Virgin Islands, which are facing 
unprecedented demands on their health care systems following the 
devastation caused by Hurricane Maria.
  Puerto Rico Governor Ricardo Rossello last week requested $1.6 
billion annually to deal with the state's underfunded Medicaid program 
that is expected to be further strained by the short- and long-term 
health implications of the natural disaster.
  The approximately $1 billion over two years in Puerto Rico Medicaid 
funding included in the Republican bill is not only insufficient, but 
it would also require Puerto Rico and the U.S. Virgin Islands to match 
those dollars at a time of increased demand and revenue collapse in 
both territories, exacerbating delays in recovery.
  This bill also seeks to cut $6.35 billion to the Prevention and 
Public Health Fund (PPHF).
  The Prevention Fund was created by the ACA to make national 
investments in prevention and public health, to improve health 
outcomes, to enhance health care quality, and reduce health care costs.
  It has been used to increase awareness of and access to preventive 
health services, such as cancer screenings, tobacco cessation and 
childhood vaccines--as well as concentrating on preventing chronic 
disease to help more Americans stay healthy.
  Cutting these funds will have a devastating impact on public health 
initiatives at the federal, state and local levels.
  Republicans are also shortening the grace period for missed premium 
payments from ninety days to thirty, which would result in up to 
688,000 people losing health coverage.
  House Republicans are insisting that in order to provide some of our 
most vulnerable Americans with coverage, it must be paid for by 
cancelling the health insurance of other Americans after a single 
payment is missed.
  While Republicans are pushing for tax cuts for the wealthy that 
explode the deficit, when it comes to health coverage for children and 
low-income Americans, Republicans are insisting that it be paid for at 
the cost of weakening our health care system and pushing other 
Americans off health insurance.
  States have begun to use emergency funding, cut benefits, and will 
soon begin sending disenrollment notices to thousands of families if 
CHIP is not reauthorized.
  Republicans' decision to advance a partisan bill rather than a 
compromise has very real consequences for families across the country.
  In 2016, 35,626,329 children in the United States had healthcare 
coverage under S-CHIP or the Medicaid Child Program.
  In 2016, although the state of Texas had 38 percent of our children 
covered under the S-CHIP program, there were still 9.2 percent children 
without health insurance coverage.
  Paying for this package by weakening health care in America:
  Shortening the grace period for missed premium payments will cause up 
to 688,000 Americans to lose their health coverage.
  Cutting $6.35 billion from the Prevention Fund will have a 
devastating impact on public health initiatives at the federal, state 
and local levels.
  Requiring Medicare means testing of 100 percent for beneficiaries 
making over $500,000. This provision will take away a benefit American 
seniors have paid into their entire lives.
  These offsets are even more egregious since they are being considered 
just one week after House Republicans began the process of passing tax 
cuts for the wealthy that is not offset and will add $1.5 trillion to 
the deficit.
  Instead of reauthorizing these programs, House Republicans wasted 
time attempting to repeal the ACA.
  There are better ways to pay for S-CHIP that do not put the guarantee 
of Medicare at risk our nation's seniors.
  1. Reduce tax expenditures for the top 1 percent of income-earners--
Our current tax code imposes higher tax rates on income earned through 
hard work while providing preferential treatment to unearned financial 
gains and allowing billions of dollars of stock profits and other 
capital gains to pass tax-free to heirs of multi-million-dollar 
fortunes. Reducing the benefit of these tax expenditures would help 
rebalance the tax code so that it stops favoring wealth over work. CBO 
has determined that 17 percent of the benefits of major ``tax 
expenditures'' go to households in the top one percent of income 
earners at a cost of more than $1.5 trillion over ten years. We could 
reduce this benefit to pay for needed national priorities.
  2. Cancel the tax break for corporate jets--Repeal tax breaks such as 
those for corporate jets, which are allowed a faster depreciation

[[Page H8466]]

schedule than passenger and freight aircraft. Based on past Joint 
Committee on Taxation estimates, repealing the tax break on corporate 
jets alone would raise $3 billion over ten years.
  3. Restrict deductions for egregious CEO bonuses when employees don't 
get a raise--Repeal the exemption to the $1 million limit on 
compensation for CEOs and other specified corporate employees that a 
publicly traded corporation can deduct as a business expense, unless 
their workers are getting paycheck increases that reflect increases in 
worker productivity and the cost of living. Based on Joint Committee on 
Taxation estimates, just limiting the deductibility of excessive CEO 
compensation would raise $12 billion over ten years.
  4. Close loopholes in the U.S. international corporate tax system 
that encourage companies to invert, and ship jobs and profits 
overseas--Prevent U.S. companies from ``inverting'' and pretending that 
they are based in other countries purely to reduce their taxes. Enact 
proposals that would limit the ability of corporations to reap 
substantial tax benefits by shifting operations, capital, intellectual 
property, and jobs overseas for tax purposes or to shelter their 
profits from U.S. taxation in foreign tax havens. Based on estimates of 
past proposals, over $500 billion over ten years could be raised under 
such proposals.
  5. Close the ``carried interest'' loophole taxing hedge fund 
managers' compensation at lower capital gains rates--End the loophole 
which allows certain investment managers at hedge funds and private 
equity firms to pay capital gains tax rates (up to a maximum of just 20 
percent) on income received as compensation for services they provided, 
rather than ordinary income tax rates up to 39.6 percent that all other 
working Americans pay on the compensation they receive for their labor. 
Past estimates show closing this loophole would raise over $19 billion 
over ten years.
  States have begun to use emergency funding, cut benefits, and will 
soon begin sending disenrollment notices to thousands of families if 
CHIP is not reauthorized.
  It is time for the House Leadership to stop playing politics with 
health insurance coverage for our nation's most vulnerable children and 
pass a clean S-CHIP bill.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 601, the previous question is ordered on 
the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.


                           Motion to Recommit

  Mr. CLYBURN. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. CLYBURN. I am opposed in its current form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Clyburn moves to recommit the bill H.R. 3922 to the 
     Committee on Energy and Commerce with instructions to report 
     the same back to the House forthwith with the following 
     amendment:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Continuing Community Health 
     and Medical Professional Programs to Improve Our Nation and 
     Keep Insurance Delivery Stable Act of 2017'' or the 
     ``CHAMPION KIDS Act of 2017''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

             TITLE I--MEDICAID AND PUBLIC HEALTH EXTENDERS

Sec. 101. Extension for community health centers and the National 
              Health Service Corps.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Reauthorization of program of payments to teaching health 
              centers that operate graduate medical education programs.
Sec. 104. Extension for family-to-family health information centers.
Sec. 105. Youth empowerment program; personal responsibility education.
Sec. 106. Decreasing reduction in Medicaid DSH allotments.
Sec. 107. Increase in territorial cap for Medicaid payments.
Sec. 108. Puerto Rico and United States Virgin Island Disaster Relief 
              Medicaid.
Sec. 109. Delay of Bipartisan Budget Act of 2013 third party liability 
              provisions.

                             TITLE II--CHIP

Sec. 201. Five-year funding extension of the Children's Health 
              Insurance Program.
Sec. 202. Extension of certain programs and demonstration projects.
Sec. 203. Extension of outreach and enrollment program.
Sec. 204. Extension of additional Federal financial participation for 
              CHIP.

                           TITLE III--OFFSET

Sec. 301. Implementation of Office of Inspector General recommendation 
              to delay certain Medicare plan prepayments.

             TITLE I--MEDICAID AND PUBLIC HEALTH EXTENDERS

     SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS AND THE 
                   NATIONAL HEALTH SERVICE CORPS.

       (a) Community Health Centers Funding.--Section 
     10503(b)(1)(E) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 254b-2(b)(1)(E)) is amended by striking 
     ``2017'' and inserting ``2019''.
       (b) Other Community Health Centers Provisions.--Section 330 
     of the Public Health Service Act (42 U.S.C. 254b) is 
     amended--
       (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
     inserting ``use disorder'';
       (2) in subsection (b)(2)(A), by striking ``abuse'' and 
     inserting ``use disorder'';
       (3) in subsection (c)--
       (A) in paragraph (1), by striking subparagraphs (B) through 
     (D);
       (B) by striking ``(1) In general'' and all that follows 
     through ``The Secretary'' and inserting the following:
       ``(1) Centers.--The Secretary''; and
       (C) in paragraph (1), as amended, by redesignating clauses 
     (i) through (v) as subparagraphs (A) through (E) and moving 
     the margin of each of such redesignated subparagraph 2 ems to 
     the left;
       (4) by striking subsection (d) and inserting the following:
       ``(d) Improving Quality of Care.--
       ``(1) Supplemental awards.--The Secretary may award 
     supplemental grant funds to health centers funded under this 
     section to implement evidence-based models for increasing 
     access to high-quality primary care services, which may 
     include models related to--
       ``(A) improving the delivery of care for individuals with 
     multiple chronic conditions;
       ``(B) workforce configuration;
       ``(C) reducing the cost of care;
       ``(D) enhancing care coordination;
       ``(E) expanding the use of telehealth and technology-
     enabled collaborative learning and capacity building models;
       ``(F) care integration, including integration of behavioral 
     health, mental health, or substance use disorder services; 
     and
       ``(G) addressing emerging public health or substance use 
     disorder issues to meet the health needs of the population 
     served by the health center.
       ``(2) Sustainability.--In making supplemental awards under 
     this subsection, the Secretary may consider whether the 
     health center involved has submitted a plan for continuing 
     the activities funded under this subsection after 
     supplemental funding is expended.
       ``(3) Special consideration.--The Secretary may give 
     special consideration to applications for supplemental 
     funding under this subsection that seek to address 
     significant barriers to access to care in areas with a 
     greater shortage of health care providers and health services 
     relative to the national average.'';
       (5) in subsection (e)(1)--
       (A) in subparagraph (B)--
       (i) by striking ``2 years'' and inserting ``1 year''; and
       (ii) by adding at the end the following: ``The Secretary 
     shall not make a grant under this paragraph unless the 
     applicant provides assurances to the Secretary that within 
     120 days of receiving grant funding for the operation of the 
     health center, the applicant will submit, for approval by the 
     Secretary, an implementation plan to meet the requirements of 
     subsection (l)(3). The Secretary may extend such 120-day 
     period for achieving compliance upon a demonstration of good 
     cause by the health center.''; and
       (B) in subparagraph (C)--
       (i) in the subparagraph heading, by striking ``and plans'';
       (ii) by striking ``or plan (as described in subparagraphs 
     (B) and (C) of subsection (c)(1))'';
       (iii) by striking ``or plan, including the purchase'' and 
     inserting the following: ``including--
       ``(i) the purchase'';
       (iv) by inserting ``, which may include data and 
     information systems'' after ``of equipment'';
       (v) by striking the period at the end and inserting a 
     semicolon; and
       (vi) by adding at the end the following:
       ``(ii) the provision of training and technical assistance; 
     and
       ``(iii) other activities that--

       ``(I) reduce costs associated with the provision of health 
     services;
       ``(II) improve access to, and availability of, health 
     services provided to individuals served by the centers;
       ``(III) enhance the quality and coordination of health 
     services; or
       ``(IV) improve the health status of communities.'';

       (6) in subsection (e)(5)(B)--
       (A) in the heading of subparagraph (B), by striking ``and 
     plans''; and
       (B) by striking ``and subparagraphs (B) and (C) of 
     subsection (c)(1) to a health center or

[[Page H8467]]

     to a network or plan'' and inserting ``to a health center or 
     to a network'';
       (7) by striking subsection (s);
       (8) by redesignating subsections (g) through (r) as 
     subsections (h) through (s), respectively;
       (9) by inserting after subsection (f), the following:
       ``(g) New Access Points and Expanded Services.--
       ``(1) Approval of new access points.--
       ``(A) In general.--The Secretary may approve applications 
     for grants under subparagraph (A) or (B) of subsection (e)(1) 
     to establish new delivery sites.
       ``(B) Special consideration.--In carrying out subparagraph 
     (A), the Secretary may give special consideration to 
     applicants that have demonstrated the new delivery site will 
     be located within a sparsely populated area, or an area which 
     has a level of unmet need that is higher relative to other 
     applicants.
       ``(C) Consideration of applications.--In carrying out 
     subparagraph (A), the Secretary shall approve applications 
     for grants under subparagraphs (A) and (B) of subsection 
     (e)(1) in such a manner that the ratio of the medically 
     underserved populations in rural areas which may be expected 
     to use the services provided by the applicants involved to 
     the medically underserved populations in urban areas which 
     may be expected to use the services provided by the 
     applicants is not less than two to three or greater than 
     three to two.
       ``(D) Service area overlap.--If in carrying out 
     subparagraph (A) the applicant proposes to serve an area that 
     is currently served by another health center funded under 
     this section, the Secretary may consider whether the award of 
     funding to an additional health center in the area can be 
     justified based on the unmet need for additional services 
     within the catchment area.
       ``(2) Approval of expanded service applications.--
       ``(A) In general.--The Secretary may approve applications 
     for grants under subparagraph (A) or (B) of subsection (e)(1) 
     to expand the capacity of the applicant to provide required 
     primary health services described in subsection (b)(1) or 
     additional health services described in subsection (b)(2).
       ``(B) Priority expansion projects.--In carrying out 
     subparagraph (A), the Secretary may give special 
     consideration to expanded service applications that seek to 
     address emerging public health or behavioral health, mental 
     health, or substance abuse issues through increasing the 
     availability of additional health services described in 
     subsection (b)(2) in an area in which there are significant 
     barriers to accessing care.
       ``(C) Consideration of applications.--In carrying out 
     subparagraph (A), the Secretary shall approve applications 
     for applicants in such a manner that the ratio of the 
     medically underserved populations in rural areas which may be 
     expected to use the services provided by the applicants 
     involved to the medically underserved populations in urban 
     areas which may be expected to use the services provided by 
     such applicants is not less than two to three or greater than 
     three to two.'';
       (10) in subsection (i) (as so redesignated)--
       (A) in paragraph (1), by striking ``and children and youth 
     at risk of homelessness'' and inserting ``, children and 
     youth at risk of homelessness, homeless veterans, and 
     veterans at risk of homelessness''; and
       (B) in paragraph (5)--
       (i) by striking subparagraph (B);
       (ii) by redesignating subparagraph (C) as subparagraph (B); 
     and
       (iii) in subparagraph (B) (as so redesignated)--

       (I) in the subparagraph heading, by striking ``abuse'' and 
     inserting ``use disorder''; and
       (II) by striking ``abuse'' and inserting ``use disorder'';

       (11) in subsection (l) (as so redesignated)--
       (A) in paragraph (2)--
       (i) in the paragraph heading, by inserting ``unmet'' before 
     ``need'';
       (ii) in the matter preceding subparagraph (A), by inserting 
     ``and an application for a grant under subsection (g)'' after 
     ``subsection (e)(1)'';
       (iii) in subparagraph (A), by inserting ``unmet'' before 
     ``need for health services'';
       (iv) in subparagraph (B), by striking ``and'' at the end;
       (v) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (vi) by adding after subparagraph (C) the following:
       ``(D) in the case of an application for a grant pursuant to 
     subsection (g)(1), a demonstration that the applicant has 
     consulted with appropriate State and local government 
     agencies, and health care providers regarding the need for 
     the health services to be provided at the proposed delivery 
     site.'';
       (B) in paragraph (3)--
       (i) in the matter preceding subparagraph (A), by inserting 
     ``or subsection (g)'' after ``subsection (e)(1)(B)'';
       (ii) in subparagraph (B), by striking ``in the catchment 
     area of the center'' and inserting ``, including other health 
     care providers that provide care within the catchment area, 
     local hospitals, and specialty providers in the catchment 
     area of the center, to provide access to services not 
     available through the health center and to reduce the non-
     urgent use of hospital emergency departments'';
       (iii) in subparagraph (H)(ii), by inserting ``who shall be 
     directly employed by the center'' after ``approves the 
     selection of a director for the center'';
       (iv) in subparagraph (L), by striking ``and'' at the end;
       (v) in subparagraph (M), by striking the period and 
     inserting ``; and''; and
       (vi) by inserting after subparagraph (M), the following:
       ``(N) the center has written policies and procedures in 
     place to ensure the appropriate use of Federal funds in 
     compliance with applicable Federal statutes, regulations, and 
     the terms and conditions of the Federal award.''; and
       (C) by striking paragraph (4);
       (12) in subsection (m) (as so redesignated), by adding at 
     the end the following: ``Funds expended to carry out 
     activities under this subsection and operational support 
     activities under subsection (n) shall not exceed 3 percent of 
     the amount appropriated for this section for the fiscal year 
     involved.'';
       (13) in subsection (q) (as so redesignated), by striking 
     ``grants for new health centers under subsections (c) and 
     (e)'' and inserting ``operating grants under subsection (e), 
     applications for new access points and expanded service 
     pursuant to subsection (g)'';
       (14) in subsection (r)(4) (as so redesignated), by adding 
     at the end the following: ``A waiver provided by the 
     Secretary under this paragraph may not remain in effect for 
     more than 1 year and may not be extended after such period. 
     An entity may not receive more than one waiver under this 
     paragraph in consecutive years.'';
       (15) in subsection (s)(3) (as so redesignated)--
       (A) by striking ``appropriate committees of Congress a 
     report concerning the distribution of funds under this 
     section'' and inserting the following: ``Committee on Health, 
     Education, Labor, and Pensions of the Senate, and the 
     Committee on Energy and Commerce of the House of 
     Representatives, a report including, at a minimum--
       ``(A) the distribution of funds for carrying out this 
     section'';
       (B) by striking ``populations. Such report shall include an 
     assessment'' and inserting the following: ``populations;
       ``(B) an assessment'';
       (C) by striking ``and the rationale for any substantial 
     changes in the distribution of funds.'' and inserting a 
     semicolon; and
       (D) by adding at the end the following:
       ``(C) the distribution of awards and funding for new or 
     expanded services in each of rural areas and urban areas;
       ``(D) the distribution of awards and funding for 
     establishing new access points, and the number of new access 
     points created;
       ``(E) the amount of unexpended funding for loan guarantees 
     and loan guarantee authority under title XVI;
       ``(F) the rationale for any substantial changes in the 
     distribution of funds;
       ``(G) the rate of closures for health centers and access 
     points;
       ``(H) the number and reason for any grants awarded pursuant 
     to subsection (e)(1)(B); and
       ``(I) the number and reason for any waivers provided 
     pursuant to subsection (r)(4).''; and
       (16) in subsection (s) (as so redesignated) by adding at 
     the end the following new paragraph:
       ``(5) Funding for participation of health centers in all of 
     us research program.--In addition to any amounts made 
     available pursuant to paragraph (1) of this subsection, 
     section 402A of this Act, or section 10503 of the Patient 
     Protection and Affordable Care Act, there is authorized to be 
     appropriated, and there is appropriated, out of any monies in 
     the Treasury not otherwise appropriated, to the Secretary 
     $25,000,000 for fiscal year 2018 to support the participation 
     of health centers in the All of Us Research Program under the 
     Precision Medicine Initiative under section 498E of this 
     Act.''.
       (c) National Health Service Corps.--Section 10503(b)(2)(E) 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     254b-2(b)(2)(E)) is amended by striking ``2017'' and 
     inserting ``2019''.
       (d) Conforming Amendment.--Section 3014(h)(1) of title 18, 
     United States Code, is amended by striking ``, as amended by 
     section 221 of the Medicare Access and CHIP Reauthorization 
     Act of 2015,''.

     SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

       (a) Special Diabetes Program for Type I Diabetes.--Section 
     330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 
     254c-2(b)(2)(C)) is amended by striking ``2017'' and 
     inserting ``2019''.
       (b) Special Diabetes Program for Indians.--Section 
     330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
     3(c)(2)) is amended--
       (1) in subparagraph (C), by striking ``and'' at the end;
       (2) in subparagraph (D), by striking the period at the end 
     and inserting ``and $112,500,000 for the period consisting of 
     the second, third, and fourth quarters of fiscal year 2018; 
     and''; and
       (3) by adding at the end the following:
       ``(E) $150,000,000 for fiscal year 2019.''.

     SEC. 103. REAUTHORIZATION OF PROGRAM OF PAYMENTS TO TEACHING 
                   HEALTH CENTERS THAT OPERATE GRADUATE MEDICAL 
                   EDUCATION PROGRAMS.

       (a) Payments.--Subsection (a) of section 340H of the Public 
     Health Service Act (42 U.S.C. 256h) is amended to read as 
     follows:
       ``(a) Payments.--
       ``(1) In general.--Subject to subsection (h)(2), the 
     Secretary shall make payments under this section for direct 
     expenses and indirect expenses to qualified teaching health

[[Page H8468]]

     centers that are listed as sponsoring institutions by the 
     relevant accrediting body for--
       ``(A) maintenance of existing approved graduate medical 
     residency training programs;
       ``(B) expansion of existing approved graduate medical 
     residency training programs; and
       ``(C) establishment of new approved graduate medical 
     residency training programs, as appropriate.
       ``(2) Priority.--In making payments pursuant to paragraph 
     (1)(C), the Secretary shall give priority to qualified 
     teaching health centers that--
       ``(A) serve a health professional shortage area with a 
     designation in effect under section 332 or a medically 
     underserved community (as defined in section 799B); or
       ``(B) are located in a rural area (as defined in section 
     1886(d)(2)(D) of the Social Security Act).''.
       (b) Funding.--Subsection (g) of section 340H of the Public 
     Health Service Act (42 U.S.C. 256h) is amended--
       (1) by striking ``To carry out'' and inserting the 
     following:
       ``(1) In general.--To carry out'';
       (2) by striking ``and $15,000,000 for the first quarter of 
     fiscal year 2018'' and inserting ``, $15,000,000 for the 
     first quarter of fiscal year 2018, $111,500,000 for the 
     period consisting of the second, third, and fourth quarters 
     of fiscal year 2018, and $126,500,000 for fiscal year 2019, 
     to remain available until expended''; and
       (3) by adding at the end the following:
       ``(2) Administrative expenses.--Of the amount made 
     available to carry out this section for any fiscal year, the 
     Secretary may not use more than 5 percent of such amount for 
     the expenses of administering this section.''.
       (c) Annual Reporting.--Subsection (h)(1) of section 340H of 
     the Public Health Service Act (42 U.S.C. 256h) is amended--
       (1) by redesignating subparagraph (D) as subparagraph (H); 
     and
       (2) by inserting after subparagraph (C) the following:
       ``(D) The number of patients treated by residents described 
     in paragraph (4).
       ``(E) The number of visits by patients treated by residents 
     described in paragraph (4).
       ``(F) Of the number of residents described in paragraph (4) 
     who completed their residency training at the end of such 
     residency academic year, the number and percentage of such 
     residents entering primary care practice (meaning any of the 
     areas of practice listed in the definition of a primary care 
     residency program in section 749A).
       ``(G) Of the number of residents described in paragraph (4) 
     who completed their residency training at the end of such 
     residency academic year, the number and percentage of such 
     residents who entered practice at a health care facility--
       ``(i) primarily serving a health professional shortage area 
     with a designation in effect under section 332 or a medically 
     underserved community (as defined in section 799B); or
       ``(ii) located in a rural area (as defined in section 
     1886(d)(2)(D) of the Social Security Act).''.
       (d) Report on Training Costs.--Not later than March 31, 
     2019, the Secretary of Health and Human Services shall submit 
     to the Congress a report on the direct graduate expenses of 
     approved graduate medical residency training programs, and 
     the indirect expenses associated with the additional costs of 
     teaching residents, of qualified teaching health centers (as 
     such terms are used or defined in section 340H of the Public 
     Health Service Act (42 U.S.C. 256h)).
       (e) Definition.--Subsection (j) of section 340H of the 
     Public Health Service Act (42 U.S.C. 256h) is amended--
       (1) by redesignating paragraphs (2) and (3) as paragraphs 
     (3) and (4), respectively; and
       (2) by inserting after paragraph (1) the following:
       ``(2) New approved graduate medical residency training 
     program.--The term `new approved graduate medical residency 
     training program' means an approved graduate medical 
     residency training program for which the sponsoring qualified 
     teaching health center has not received a payment under this 
     section for a previous fiscal year (other than pursuant to 
     subsection (a)(1)(C)).''.
       (f) Technical Correction.--Subsection (f) of section 340H 
     (42 U.S.C. 256h) is amended by striking ``hospital'' each 
     place it appears and inserting ``teaching health center''.
       (g) Payments for Previous Fiscal Years.--The provisions of 
     section 340H of the Public Health Service Act (42 U.S.C. 
     256h), as in effect on the day before the date of enactment 
     of this Act, shall continue to apply with respect to payments 
     under such section for fiscal years before fiscal year 2018.

     SEC. 104. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION 
                   CENTERS.

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

     SEC. 105. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY 
                   EDUCATION.

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

     ``SEC. 510. YOUTH EMPOWERMENT PROGRAM.

       ``(a) In General.--
       ``(1) Allotments to states.--For the purpose described in 
     subsection (b), the Secretary shall, for each of fiscal years 
     2018 and 2019, allot to each State which has transmitted an 
     application for the fiscal year under section 505(a) an 
     amount equal to the product of--
       ``(A) the amount appropriated pursuant to subsection (e)(1) 
     for the fiscal year, minus the amount reserved under 
     subsection (e)(2) for the fiscal year; and
       ``(B) the proportion that the number of low-income children 
     in the State bears to the total of such numbers of children 
     for all the States.
       ``(2) Other allotments.--
       ``(A) Other entities.--For the purpose described in 
     subsection (b), the Secretary shall, for each of fiscal years 
     2018 and 2019, for any State which has not transmitted an 
     application for the fiscal year under section 505(a), allot 
     to one or more entities in the State the amount that would 
     have been allotted to the State under paragraph (1) if the 
     State had submitted such an application.
       ``(B) Process.--The Secretary shall select the recipients 
     of allotments under subparagraph (A) by means of a 
     competitive grant process under which--
       ``(i) not later than 30 days after the deadline for the 
     State involved to submit an application for the fiscal year 
     under section 505(a), the Secretary publishes a notice 
     soliciting grant applications; and
       ``(ii) not later than 120 days after such deadline, all 
     such applications must be submitted.
       ``(b) Purpose.--
       ``(1) In general.--Except for research under paragraph (5) 
     and information collection and reporting under paragraph (6), 
     the purpose of an allotment under subsection (a) to a State 
     (or to another entity in the State pursuant to subsection 
     (a)(2)) is to enable the State or other entity to implement 
     education exclusively on sexual risk avoidance (meaning 
     voluntarily refraining from sexual activity).
       ``(2) Required components.--Education on sexual risk 
     avoidance pursuant to an allotment under this section shall--
       ``(A) ensure that the unambiguous and primary emphasis and 
     context for each topic described in paragraph (3) is a 
     message to youth that normalizes the optimal health behavior 
     of avoiding nonmarital sexual activity;
       ``(B) be medically accurate and complete;
       ``(C) be age-appropriate; and
       ``(D) be based on adolescent learning and developmental 
     theories for the age group receiving the education.
       ``(3) Topics.--Education on sexual risk avoidance pursuant 
     to an allotment under this section shall address each of the 
     following topics:
       ``(A) The holistic individual and societal benefits 
     associated with personal responsibility, self-regulation, 
     goal setting, healthy decisionmaking, and a focus on the 
     future.
       ``(B) The advantage of refraining from nonmarital sexual 
     activity in order to improve the future prospects and 
     physical and emotional health of youth.
       ``(C) The increased likelihood of avoiding poverty when 
     youth attain self-sufficiency and emotional maturity before 
     engaging in sexual activity.
       ``(D) The foundational components of healthy relationships 
     and their impact on the formation of healthy marriages and 
     safe and stable families.
       ``(E) How other youth risk behaviors, such as drug and 
     alcohol usage, increase the risk for teen sex.
       ``(F) How to resist and avoid, and receive help regarding, 
     sexual coercion and dating violence, recognizing that even 
     with consent teen sex remains a youth risk behavior.
       ``(4) Contraception.--Education on sexual risk avoidance 
     pursuant to an allotment under this section shall ensure 
     that--
       ``(A) any information provided on contraception is 
     medically accurate and ensures that students understand that 
     contraception offers physical risk reduction, but not risk 
     elimination; and
       ``(B) the education does not include demonstrations, 
     simulations, or distribution of contraceptive devices.
       ``(5) Research.--
       ``(A) In general.--A State or other entity receiving an 
     allotment pursuant to subsection (a) may use up to 20 percent 
     of such allotment to build the evidence base for sexual risk 
     avoidance education by conducting or supporting research.

[[Page H8469]]

       ``(B) Requirements.--Any research conducted or supported 
     pursuant to subparagraph (A) shall be--
       ``(i) rigorous;
       ``(ii) evidence-based; and
       ``(iii) designed and conducted by independent researchers 
     who have experience in conducting and publishing research in 
     peer-reviewed outlets.
       ``(6) Information collection and reporting.--A State or 
     other entity receiving an allotment pursuant to subsection 
     (a) shall, as specified by the Secretary--
       ``(A) collect information on the programs and activities 
     funded through the allotment; and
       ``(B) submit reports to the Secretary on the data from such 
     programs and activities.
       ``(c) National Evaluation.--
       ``(1) In general.--The Secretary shall--
       ``(A) in consultation with appropriate State and local 
     agencies, conduct one or more rigorous evaluations of the 
     education funded through this section and associated data; 
     and
       ``(B) submit a report to the Congress on the results of 
     such evaluations, together with a summary of the information 
     collected pursuant to subsection (b)(6).
       ``(2) Consultation.--In conducting the evaluations required 
     by paragraph (1), including the establishment of evaluation 
     methodologies, the Secretary shall consult with relevant 
     stakeholders.
       ``(d) Applicability of Certain Provisions.--
       ``(1) Sections 503, 507, and 508 apply to allotments under 
     subsection (a) to the same extent and in the same manner as 
     such sections apply to allotments under section 502(c).
       ``(2) Sections 505 and 506 apply to allotments under 
     subsection (a) to the extent determined by the Secretary to 
     be appropriate.
       ``(e) Funding.--
       ``(1) In general.--To carry out this section, there is 
     appropriated, out of any money in the Treasury not otherwise 
     appropriated, $75,000,000 for each of fiscal years 2018 and 
     2019.
       ``(2) Reservation.--The Secretary shall reserve, for each 
     of fiscal years 2018 and 2019, not more than 20 percent of 
     the amount appropriated pursuant to paragraph (1) for 
     administering the program under this section, including the 
     conducting of national evaluations and the provision of 
     technical assistance to the recipients of allotments.''.
       (2) Effective date.--The amendment made by this section 
     takes effect on October 1, 2017.
       (b) Personal Responsibility Education.--
       (1) In general.--Section 513 of the Social Security Act (42 
     U.S.C. 713) is amended--
       (A) in subsection (a)(1)(A), by striking ``2017'' and 
     inserting ``2019''; and
       (B) in subsection (a)(4)--
       (i) in subparagraph (A), by striking ``2017'' each place it 
     appears and inserting ``2019''; and
       (ii) in subparagraph (B)--

       (I) in the subparagraph heading, by striking ``3-year 
     grants'' and inserting ``Competitive prep grants''; and
       (II) in clause (i), by striking ``solicit applications to 
     award 3-year grants in each of fiscal years 2012 through 
     2017'' and inserting ``continue through fiscal year 2019 
     grants awarded for any of fiscal years 2015 through 2017'';

       (C) in subsection (c)(1), by inserting after ``youth with 
     HIV/AIDS,'' the following: ``victims of human trafficking,''; 
     and
       (D) in subsection (f), by striking ``2017'' and inserting 
     ``2019''.
       (2) Effective date.--The amendments made by this subsection 
     take effect on October 1, 2017.

     SEC. 106. DECREASING REDUCTION IN MEDICAID DSH ALLOTMENTS.

       Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 
     1396r-4(f)(7)(A)) is amended--
       (1) in clause (i), in the matter preceding subclause (I), 
     by striking ``2018'' and inserting ``2023''; and
       (2) in clause (ii), by striking subclauses (I) through 
     (VIII) and inserting the following:

       ``(I) $5,000,000,000 for fiscal year 2023;
       ``(II) $5,500,000,000 for fiscal year 2024; and
       ``(III) $6,000,000,000 for fiscal year 2025.''.

     SEC. 107. INCREASE IN TERRITORIAL CAP FOR MEDICAID PAYMENTS.

       Section 1108(g)(5) of the Social Security Act (42 U.S.C. 
     1308(g)(5)) is amended--
       (1) in subparagraph (A)--
       (A) by striking ``subparagraph (B)'' and inserting 
     ``subparagraphs (B), (C), and (D)''; and
       (B) by striking ``2019'' and inserting ``2022''; and
       (2) by adding at the end the following new subparagraphs:
       ``(C) The amount of the increase otherwise provided under 
     subparagraph (A) for--
       ``(i) Puerto Rico shall, after application of subparagraph 
     (B), be further increased by $1,600,000,000 for each of 
     fiscal years 2018 through 2022; and
       ``(ii) the Virgin Islands shall be further increased by 
     $55,000,000 for each of fiscal years 2018 through 2022.
       ``(D) The amount of the increase otherwise provided under 
     subparagraph (A) for Guam, the Northern Mariana Islands, and 
     America Samoa, respectively, shall be further increased by 
     such amounts that the total amount of increases under this 
     subparagraph is equal to $150,000,000. In applying the 
     previous sentence, the Secretary shall increase amounts for 
     such territories in such a proportion as would be applied 
     under subparagraph (A) if such territories were the only 
     territories to which such subparagraph applied.''.

     SEC. 108. PUERTO RICO AND UNITED STATES VIRGIN ISLAND 
                   DISASTER RELIEF MEDICAID.

       (a) Simplified Eligibility Determinations and 
     Redeterminations.--
       (1) In general.--Notwithstanding any provision of title XIX 
     of the Social Security Act (42 U.S.C. 1396 et seq.), a State 
     shall, as a condition of participation in the Medicaid 
     program under such title and without submitting an amendment 
     to the State Medicaid plan--
       (A) use streamlined procedures described in paragraph (2) 
     in processing applications and determining and redetermining 
     eligibility for medical assistance under the State Medicaid 
     plan for DRM-eligible Maria Survivors during the DRM coverage 
     period; and
       (B) provide, in the case of such a Survivor, for medical 
     assistance under the State Medicaid plan to such Survivor 
     during such period based on the family income level 
     eligibility requirements established under the State Medicaid 
     plan or, if higher, under the State Medicaid plan of the 
     State in which such Survivor resided as of September 17, 
     2017.
       (2) Streamlined procedures.--The streamlined procedures 
     described in this paragraph, with respect to a State and an 
     applicant for medical assistance under the State Medicaid 
     plan, are the following:
       (A) Common application form.--Use of a common 1-page 
     application form developed by the Secretary of Health and 
     Human Services, in consultation with the National Association 
     of State Medicaid Directors. Such form shall--
       (i) require an applicant to provide an expected address for 
     the duration of the DRM coverage period and to agree to 
     update that information if it changes during such period;
       (ii) include notice regarding the penalties for making a 
     fraudulent application;
       (iii) require the applicant to assign to the State any 
     rights of the applicant (or any other person who is a DRM-
     eligible Maria Survivor and on whose behalf the applicant has 
     the legal authority to execute an assignment of such rights) 
     under any group health plan or other third-party coverage for 
     health care; and
       (iv) require the applicant to list any health insurance 
     coverage which the applicant was enrolled in immediately 
     prior to submitting such application.
       (B) Self-attestation.--Self-attestation by the applicant 
     for medical assistance under the State Medicaid plan that the 
     applicant is a DRM-eligible Maria Survivor, including with 
     respect to citizenship, identity, immigration status, and 
     income requirements.
       (C) No documentation.--No requirement for documentation 
     evidencing the basis on which the applicant qualifies to be a 
     DRM-eligible Maria Survivor.
       (D) Issuance of eligibility card.--Issuance of a DRM 
     assistance eligibility card to an applicant who completes 
     such application, including the self-attestation required 
     under subparagraph (B). Such card shall be valid as long as 
     the DRM coverage period is in effect and shall be accompanied 
     by notice of the termination date for the DRM coverage period 
     and, if applicable, notice that such termination date may be 
     extended. If the President extends the DRM coverage period, 
     the State shall notify DRM-eligible Maria Survivors enrolled 
     in the State Medicaid plan of the new termination date for 
     the DRM coverage period.
       (E) Deemed eligibility.--If an applicant completes the 
     application and presents it to a provider or facility 
     participating in the State Medicaid plan that is qualified to 
     make presumptive eligibility determinations under such plan 
     (which at a minimum shall consist of facilities identified in 
     section 1902(a)(55) of the Social Security Act (42 U.S.C. 
     1396a(a)(55)) and it appears to the provider that the 
     applicant is a DRM-eligible Maria Survivor based on the 
     information in the application, the applicant will be deemed 
     to be a DRM-eligible Maria Survivor eligible for medical 
     assistance under the State Medicaid plan.
       (F) Continuous eligibility.--Continuous eligibility, 
     without the need for any redetermination of eligibility, for 
     the duration of the DRM coverage period.
       (b) No Continuation of DRM Assistance.--
       (1) In general.--Except as provided in paragraphs (2) and 
     (3), no DRM assistance shall be provided after the end of the 
     DRM coverage period.
       (2) Presumptive eligibility.--In the case of any DRM-
     eligible Maria Survivor who is receiving DRM assistance from 
     a State in accordance with this section and who, as of the 
     end of the DRM coverage period, has an application pending 
     for medical assistance under the State Medicaid plan for 
     periods beginning after the end of such period, the State 
     shall provide such Survivor with a period of presumptive 
     eligibility for medical assistance under the State Medicaid 
     plan (not to exceed 60 days) until a determination with 
     respect to the Survivor's application has been made.
       (3) Pregnant women.--In the case of a DRM-eligible Maria 
     Survivor who is receiving DRM assistance from a State in 
     accordance with this section and whose pregnancy ended during 
     the 60-day period prior to the end of the DRM coverage 
     period, or who is pregnant as of the end of such period, such 
     Survivor shall continue to be eligible for DRM assistance 
     after the end of the DRM coverage period, including (but not 
     limited

[[Page H8470]]

     to) all pregnancy-related and postpartum medical assistance 
     available under the State Medicaid plan, through the end of 
     the month in which the 60-day period (beginning on the last 
     day of her pregnancy) ends.
       (c) Treatment of Maria Survivors Provided Assistance Prior 
     to Date of Enactment.--Any Maria Survivor who is provided 
     medical assistance under a State Medicaid plan in accordance 
     with guidance from the Secretary during the period that 
     begins on September 17, 2017, and ends on the date of 
     enactment of this Act shall be treated as a DRM-eligible 
     Maria Survivor, without the need to file an additional 
     application, for purposes of eligibility for medical 
     assistance under this section.
       (d) Scope of Coverage.--
       (1) In general.--A State providing medical assistance under 
     a State Medicaid plan to a DRM-eligible Maria Survivor 
     pursuant to this section shall provide medical assistance 
     that is either--
       (A) equal in amount and scope to the medical assistance 
     that would otherwise be made available to such Survivor if 
     the Survivor were a State resident enrolled in the State 
     Medicaid plan; or
       (B) if greater in amount and scope, equal in amount and 
     scope to the medical assistance that would have been made 
     available to such Survivor under the State Medicaid plan of 
     the State in which such Survivor resided as of September 17, 
     2017.
     Coverage for such medical assistance for DRM-eligible Maria 
     Survivors shall be retroactive to items and services 
     furnished on or after September 17, 2017 (or in the case of 
     applications for DRM assistance submitted after January 1, 
     2018, the first day of the 5th month preceding the date on 
     which such application is submitted).
       (2) Children born to pregnant women.--In the case of a 
     child born to a DRM-eligible Maria Survivor who is provided 
     DRM assistance during the DRM coverage period, such child 
     shall be treated as having been born to a pregnant woman 
     eligible for medical assistance under the State Medicaid plan 
     and shall be eligible for medical assistance under such plan 
     in accordance with section 1902(e)(4) of the Social Security 
     Act (42 U.S.C. 1396a(e)(4)). The Federal medical assistance 
     percentage applicable to the State Medicaid plan shall apply 
     to medical assistance provided to a child under such plan in 
     accordance with the preceding sentence and Federal payments 
     for such assistance shall not be considered to be payments 
     under this section.
       (e) 100 Percent Federal Matching Payments.--
       (1) In general.--Notwithstanding section 1905(b) of the 
     Social Security Act (42 U.S.C. 1396d(b)), subject to 
     paragraph (2), the Federal medical assistance percentage or 
     the Federal matching rate otherwise applied under section 
     1903(a) of such Act (42 U.S.C. 1396b(a)) shall be 100 percent 
     for--
       (A) providing DRM assistance to DRM-eligible Maria 
     Survivors during the DRM coverage period in accordance with 
     this section;
       (B) costs directly attributable to administrative 
     activities related to the provision of such DRM assistance; 
     and
       (C) DRM assistance provided in accordance with paragraph 
     (2) or (3) of subsection (b) after the end of the DRM 
     coverage period.
       (2) Limitation.--
       (A) Territories.--Payments provided to a State that is a 
     territory (as defined in section 1108(c)(1) of the Social 
     Security Act (42 U.S.C. 1308(c)(1))) in accordance with this 
     subsection shall be subject to subsections (f) and (g) of 
     section 1108 of the Social Security Act (42 U.S.C. 1308).
       (B) Other states.--
       (i) In general.--In the case of States not described in 
     subparagraph (A), the difference between--

       (I) the total amount of payments made to such States in 
     accordance with this subsection, by reason of the Federal 
     medical assistance percentage or the Federal matching rate 
     applied under paragraph (1); and
       (II) the total amount of payments that would otherwise be 
     made to such States if the Federal medical assistance 
     percentage and the Federal matching rate under section 
     1905(b) of the Social Security Act and 1903(a) of such Act 
     were applied;

     may not exceed the amount appropriated under clause (ii).
       (ii) Appropriations.--There are appropriated, out of any 
     amounts in the Treasury not otherwise appropriated, 
     $1,000,000,000 for the DRM coverage period for purposes of 
     making payments in accordance with this subsection to States 
     not described in subparagraph (A).
       (3) Exemption from error rate penalties.--All payments 
     attributable to providing DRM assistance in accordance with 
     this section shall be disregarded for purposes of section 
     1903(u) of the Social Security Act (42 U.S.C. 1396b(u)).
       (f) Verification of Status as a Maria Survivor.--
       (1) In general.--A State shall make a good faith effort to 
     verify the status of an individual who is enrolled in the 
     State Medicaid plan as a DRM-eligible Maria Survivor under 
     the provisions of this section. Such effort shall not delay 
     the determination of the eligibility of the Survivor for DRM 
     assistance under this section.
       (2) Evidence of verification.--A State may satisfy the 
     verification requirement under paragraph (1) with respect to 
     an individual by showing that the State obtained information 
     from the Social Security Administration, the Internal Revenue 
     Service, or the State Medicaid Agency for the State from 
     which the individual is from (if the individual was not a 
     resident of such State on any day during the week preceding 
     September 17, 2017).
       (g) Provider Payment Rates.--In the case of any DRM 
     assistance provided in accordance with this section to a DRM-
     eligible Maria Survivor that is covered under the State 
     Medicaid plan (as applied without regard to this section) the 
     State shall pay a provider of such assistance the same 
     payment rate as the State would otherwise pay for the 
     assistance if the assistance were provided under the State 
     Medicaid plan (or, if no such payment rate applies under the 
     State Medicaid plan, the usual and customary prevailing rate 
     for the item or service for the community in which it is 
     provided).
       (h) Application to Individuals Eligible for Medical 
     Assistance.--Nothing in this section shall be construed as 
     affecting any rights accorded to an individual who is a 
     recipient of medical assistance under a State Medicaid plan 
     who is determined to be a DRM-eligible Maria Survivor but the 
     provision of DRM assistance to such individual shall be 
     limited to the provision of such assistance in accordance 
     with this section.
       (i) Definitions.--In this section:
       (1) DRM assistance.--The term ``DRM assistance'' means 
     medical assistance under a State Medicaid plan for a DRM-
     eligible Maria Survivor during the DRM coverage period.
       (2) DRM coverage period.--
       (A) In general.--The term ``DRM coverage period'' means the 
     period beginning on September 17, 2017, and, subject to 
     subparagraph (B), ending on the date that is 24 months after 
     the date of enactment of this Act.
       (B) Secretary authority to extend drm coverage period.--The 
     Secretary may extend the DRM coverage period for an 
     additional 12 months. Any reference to the term ``DRM 
     coverage period'' in this section shall include any extension 
     under this subparagraph.
       (3) DRM-eligible maria survivor defined.--
       (A) In general.--The term ``DRM-eligible Maria Survivor'' 
     means a Maria Survivor whose family income does not exceed 
     the income eligibility standard which would apply to the 
     Survivor under the State Medicaid plan of the State in which 
     the Survivor applies for medical assistance.
       (B) No resources, residency, or categorical eligibility 
     requirements.--Eligibility under subparagraph (A) shall be 
     determined without application of any resources test, State 
     residency, or categorical eligibility requirements.
       (C) Definition of child.--For purposes of subparagraph (A), 
     a DRM-eligible Maria Survivor shall be determined to be a 
     ``child'' in accordance with the definition of ``child'' 
     under the State Medicaid plan.
       (4) Maria survivor.--
       (A) In general.--The term ``Maria Survivor'' means an 
     individual who, on any day during the week preceding 
     September 17, 2017, had a primary residence in Puerto Rico or 
     the Virgin Islands.
       (B) Treatment of current medicaid beneficiaries.--Nothing 
     in this section shall be construed as preventing an 
     individual who is otherwise entitled to medical assistance 
     under a State Medicaid plan from being treated as a Maria 
     Survivor under this section.
       (C) Treatment of homeless persons.--For purposes of this 
     section, in the case of an individual who was homeless on any 
     day during the week described in subparagraph (A), the 
     individual's ``residence'' shall be deemed to be the place of 
     residence as otherwise determined for such an individual 
     under title XIX of the Social Security Act (42 U.S.C 1396 et 
     seq.).
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.
       (6) State.--The term ``State'' has the meaning given that 
     term for purposes of title XIX of the Social Security Act (42 
     U.S.C 1396 et seq.).
       (7) State medicaid plan.--The term ``State Medicaid plan'' 
     means a State plan under title XIX of the Social Security Act 
     (42 U.S.C. 1396 et seq.) (or a waiver of such plan).

     SEC. 109. DELAY OF BIPARTISAN BUDGET ACT OF 2013 THIRD PARTY 
                   LIABILITY PROVISIONS.

       (a) In General.--Section 202(c) of the Bipartisan Budget 
     Act of 2013 (Public Law 113-67; 127 Stat. 1177; 42 U.S.C. 
     1396a note), as amended by section 211 of the Protecting 
     Access to Medicare Act of 2014 (Public Law 113-93; 128 Stat. 
     1047; 42 U.S.C. 1396a note) and section 220 of the Medicare 
     Access and CHIP Reauthorization Act of 2015 (Public Law 114-
     10), is amended by striking ``2017'' and inserting ``2019''.
       (b) Effective Date; Treatment.--The amendment made by 
     subparagraph (A) shall take effect on September 30, 2017, and 
     shall apply with respect to claims pending, generated, or 
     filed after such date.

                             TITLE II--CHIP

     SEC. 201. FIVE-YEAR FUNDING EXTENSION OF THE CHILDREN'S 
                   HEALTH INSURANCE PROGRAM.

       (a) Appropriation; Total Allotment.--Section 2104(a) of the 
     Social Security Act (42 U.S.C. 1397dd(a)) is amended--
       (1) in paragraph (19), by striking ``and'';
       (2) in paragraph (20), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following new paragraphs:

[[Page H8471]]

       ``(21) for fiscal year 2018, $21,500,000,000;
       ``(22) for fiscal year 2019, $22,600,000,000;
       ``(23) for fiscal year 2020, $23,700,000,000;
       ``(24) for fiscal year 2021, $24,800,000,000; and
       ``(25) for fiscal year 2022, for purposes of making 2 semi-
     annual allotments--
       ``(A) $2,850,000,000 for the period beginning on October 1, 
     2021, and ending on March 31, 2022; and
       ``(B) $2,850,000,000 for the period beginning on April 1, 
     2022, and ending on September 30, 2022.''.
       (b) Allotments.--
       (1) In general.--Section 2104(m) of the Social Security Act 
     (42 U.S.C. 1397dd(m)) is amended--
       (A) in paragraph (2)--
       (i) in the heading, by striking ``through 2016'' and 
     inserting ``through 2022''; and
       (ii) in subparagraph (B)--

       (I) in the matter preceding clause (i), by striking 
     ``(19)'' and inserting ``(24)'';
       (II) in clause (ii), in the matter preceding subclause (I), 
     by inserting ``(other than fiscal year 2022)'' after ``even-
     numbered fiscal year''; and
       (III) in clause (ii)(I), by inserting ``(or, in the case of 
     fiscal year 2018, under paragraph (4))'' after ``clause 
     (i)'';

       (B) in paragraph (5)--
       (i) by striking ``or (4)'' and inserting ``(4), or (10)''; 
     and
       (ii) by striking ``or 2017'' and inserting ``, 2017, or 
     2022'';
       (C) in paragraph (7)--
       (i) in subparagraph (A), by striking ``2017'' and inserting 
     ``2022'';
       (ii) in subparagraph (B), in the matter preceding clause 
     (i), by inserting ``(or, in the case of fiscal year 2018, by 
     not later than the date that is 60 days after the date of the 
     enactment of the CHAMPION KIDS Act of 2017)'' after ``before 
     the August 31 preceding the beginning of the fiscal year''; 
     and
       (iii) in the matter following subparagraph (B), by striking 
     ``or fiscal year 2016'' and inserting ``fiscal year 2016, 
     fiscal year 2018, fiscal year 2020, or fiscal year 2022'';
       (D) in paragraph (9)--
       (i) in the heading, by striking ``fiscal years 2015 and 
     2017'' and inserting ``certain fiscal years'';
       (ii) by striking ``or (4)'' and inserting ``, (4), or 
     (10)''; and
       (iii) by striking ``or fiscal year 2017'' and inserting ``, 
     2017, or 2022''; and
       (E) by adding at the end the following new paragraph:
       ``(10) For fiscal year 2022.--
       ``(A) First half.--Subject to paragraphs (5) and (7), from 
     the amount made available under subparagraph (A) of paragraph 
     (25) of subsection (a) for the semi-annual period described 
     in such subparagraph, increased by the amount of the 
     appropriation for such period under section 201(b)(3) of the 
     CHAMPION KIDS Act of 2017, the Secretary shall compute a 
     State allotment for each State (including the District of 
     Columbia and each commonwealth and territory) for such semi-
     annual period in an amount equal to the first half ratio 
     (described in subparagraph (D)) of the amount described in 
     subparagraph (C).
       ``(B) Second half.--Subject to paragraphs (5) and (7), from 
     the amount made available under subparagraph (B) of paragraph 
     (25) of subsection (a) for the semi-annual period described 
     in such subparagraph, the Secretary shall compute a State 
     allotment for each State (including the District of Columbia 
     and each commonwealth and territory) for such semi-annual 
     period in an amount equal to the amount made available under 
     such subparagraph, multiplied by the ratio of--
       ``(i) the amount of the allotment to such State under 
     subparagraph (A); to
       ``(ii) the total of the amount of all of the allotments 
     made available under such subparagraph.
       ``(C) Full year amount based on growth factor updated 
     amount.--The amount described in this subparagraph for a 
     State is equal to the sum of--
       ``(i) the amount of the State allotment for fiscal year 
     2021 determined under paragraph (2)(B)(i); and
       ``(ii) the amount of any payments made to the State under 
     subsection (n) for fiscal year 2021,
     multiplied by the allotment increase factor under paragraph 
     (6) for fiscal year 2022.
       ``(D) First half ratio.--The first half ratio described in 
     this subparagraph is the ratio of--
       ``(i) the sum of--

       ``(I) the amount made available under subsection 
     (a)(25)(A); and
       ``(II) the amount of the appropriation for such period 
     under section 201(b)(3) of the CHAMPION KIDS Act of 2017; to

       ``(ii) the sum of--

       ``(I) the amount described in clause (i); and
       ``(II) the amount made available under subsection 
     (a)(25)(B).''.

       (2) Technical amendment.--Section 2104(m)(2)(A) of such Act 
     (42 U.S.C. 1397dd(m)(2)(A)) is amended by striking ``the 
     allotment increase factor under paragraph (5)'' each place it 
     appears and inserting ``the allotment increase factor under 
     paragraph (6)''.
       (3) One-time appropriation for fiscal year 2022.--There is 
     appropriated to the Secretary of Health and Human Services, 
     out of any money in the Treasury not otherwise appropriated, 
     $20,200,000,000 to accompany the allotment made for the 
     period beginning on October 1, 2021, and ending on March 31, 
     2022, under paragraph (25)(A) of section 2104(a) of the 
     Social Security Act (42 U.S.C. 1397dd(a)) (as added by 
     subsection (a)(3)), to remain available until expended. Such 
     amount shall be used to provide allotments to States under 
     paragraph (10) of section 2104(m) of such Act (as added by 
     subsection (b)(1)(E)) for the first 6 months of fiscal year 
     2022 in the same manner as allotments are provided under 
     subsection (a)(25)(A) of such section 2104 and subject to the 
     same terms and conditions as apply to the allotments provided 
     from such subsection (a)(25)(A).
       (c) Extension of the Child Enrollment Contingency Fund.--
     Section 2104(n) of the Social Security Act (42 U.S.C. 
     1397dd(n)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A)(ii)--
       (i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016'' 
     and inserting ``2010 through 2014, 2016, and 2018 through 
     2021''; and
       (ii) by striking ``fiscal year 2015 and fiscal year 2017'' 
     and inserting ``fiscal years 2015, 2017, and 2022''; and
       (B) in subparagraph (B)--
       (i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016'' 
     and inserting ``2010 through 2014, 2016, and 2018 through 
     2021''; and
       (ii) by striking ``fiscal year 2015 and fiscal year 2017'' 
     and inserting ``fiscal year 2015, 2017, and 2022''; and
       (2) in paragraph (3)(A), in the matter preceding clause 
     (i), by striking ``or a semi-annual allotment period for 
     fiscal year 2015 or 2017'' and inserting ``or in any of 
     fiscal years 2018 through 2021 (or a semi-annual allotment 
     period for fiscal year 2015, 2017, or 2022)''.
       (d) Extension of Qualifying States Option.--Section 
     2105(g)(4) of the Social Security Act (42 U.S.C. 
     1397ee(g)(4)) is amended--
       (1) in the heading, by striking ``through 2017'' and 
     inserting ``through 2022''; and
       (2) in subparagraph (A), by striking ``2017'' and inserting 
     ``2022''.
       (e) Extension of Express Lane Eligibility Option.--Section 
     1902(e)(13)(I) of the Social Security Act (42 U.S.C. 
     1396a(e)(13)(I)) is amended by striking ``2017'' and 
     inserting ``2022''.
       (f) Assurance of Affordability Standard for Children and 
     Families.--
       (1) In general.--Section 2105(d)(3) of the Social Security 
     Act (42 U.S.C. 1397ee(d)(3)) is amended--
       (A) in the paragraph heading, by striking ``until october 
     1, 2019'' and inserting ``through september 30, 2022''; and
       (B) in subparagraph (A), in the matter preceding clause 
     (i)--
       (i) by striking ``2019'' and inserting ``2022''; and
       (ii) by striking ``The preceding sentence shall not be 
     construed as preventing a State during such period'' and 
     inserting ``During the period that begins on October 1, 2019, 
     and ends on September 30, 2022, the preceding sentence shall 
     only apply with respect to children in families whose income 
     does not exceed 300 percent of the poverty line (as defined 
     in section 2110(c)(5)) applicable to a family of the size 
     involved. The preceding sentences shall not be construed as 
     preventing a State during any such periods''.
       (2) Conforming amendments.--Section 1902(gg)(2) of the 
     Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
       (A) in the paragraph heading, by striking ``until october 
     1, 2019'' and inserting ``through september 30, 2022''; and
       (B) by striking ``September 30, 2019,'' and inserting 
     ``September 30, 2022 (but during the period that begins on 
     October 1, 2019, and ends on September 30, 2022, only with 
     respect to children in families whose income does not exceed 
     300 percent of the poverty line (as defined in section 
     2110(c)(5)) applicable to a family of the size involved)''.

     SEC. 202. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION 
                   PROJECTS.

       (a) Childhood Obesity Demonstration Project.--Section 
     1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
     9a(e)(8)) is amended--
       (1) by striking ``and $10,000,000'' and inserting ``, 
     $10,000,000''; and
       (2) by inserting after ``2017'' the following: ``, and 
     $25,000,000 for the period of fiscal years 2018 through 
     2022''.
       (b) Pediatric Quality Measures Program.--Section 1139A(i) 
     of the Social Security Act (42 U.S.C. 1320b-9a(i)) is 
     amended--
       (1) by striking ``Out of any'' and inserting the following:
       ``(1) In general.--Out of any'';
       (2) by striking ``there is appropriated for each'' and 
     inserting ``there is appropriated--
       ``(A) for each'';
       (3) by striking ``, and there is appropriated for the 
     period'' and inserting ``;
       ``(B) for the period'';
       (4) by striking ``. Funds appropriated under this 
     subsection shall remain available until expended'' and 
     inserting ``; and''; and
       (5) by adding at the end the following:
       ``(C) for the period of fiscal years 2018 through 2022, 
     $75,000,000 for the purpose of carrying out this section 
     (other than subsections (e), (f), and (g)).
       ``(2) Availability.--Funds appropriated under this 
     subsection shall remain available until expended.''.

     SEC. 203. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.

       (a) Extension and Reauthorization.--Section 2113 of the 
     Social Security Act (42 U.S.C. 1397mm) is amended--
       (1) in subsection (a)(1), by striking ``2017'' and 
     inserting ``2022''; and
       (2) in subsection (g)--
       (A) by striking ``and $40,000,000'' and inserting ``, 
     $40,000,000''; and

[[Page H8472]]

       (B) by inserting after ``2017'' the following: ``, and 
     $100,000,000 for the period of fiscal years 2018 through 
     2022''.
       (b) Making Organizations That Use Parent Mentors Eligible 
     to Receive Grants.--Section 2113(f) of the Social Security 
     Act (42 U.S.C. 1397mm(f)) is amended--
       (1) in paragraph (1)(E), by striking ``or community-based 
     doula programs'' and inserting ``, community-based doula 
     programs, or parent mentors''; and
       (2) by adding at the end the following new paragraph:
       ``(5) Parent mentor.--The term `parent mentor' means an 
     individual who--
       ``(A) is a parent or guardian of at least one child who is 
     an eligible child under this title or title XIX; and
       ``(B) is trained to assist families with children who have 
     no health insurance coverage with respect to improving the 
     social determinants of the health of such children, including 
     by providing--
       ``(i) education about health insurance coverage, including, 
     with respect to obtaining such coverage, eligibility criteria 
     and application and renewal processes;
       ``(ii) assistance with completing and submitting 
     applications for health insurance coverage and renewal;
       ``(iii) a liaison between families and representatives of 
     State plans under title XIX or State child health plans under 
     this title;
       ``(iv) guidance on identifying medical and dental homes and 
     community pharmacies for children; and
       ``(v) assistance and referrals to successfully address 
     social determinants of children's health, including poverty, 
     food insufficiency, housing, and environmental hazards.''.
       (c) Exclusion From Modified Adjusted Gross Income.--Section 
     1902 of the Social Security Act (42 U.S.C. 1396a) is 
     amended--
       (1) in subsection (a)(17), by striking ``(e)(14), (e)(14)'' 
     and inserting ``(e)(14), (e)(15)'';
       (2) in subsection (e), in the first paragraph (14), 
     relating to income determined using modified adjusted gross 
     income, by adding at the end the following new subparagraph:
       ``(J) Exclusion of parent mentor compensation from income 
     determination.--Any nominal amount received by an individual 
     as compensation, including a stipend, for participation as a 
     parent mentor (as defined in paragraph (5) of section 
     2113(f)) in an activity or program funded through a grant 
     under such section shall be disregarded for purposes of 
     determining the income eligibility of such individual for 
     medical assistance under the State plan or any waiver of such 
     plan.''; and
       (3) in subsection (e), by striking ``(14) Exclusion'' and 
     inserting ``(15) Exclusion''.

     SEC. 204. EXTENSION OF ADDITIONAL FEDERAL FINANCIAL 
                   PARTICIPATION FOR CHIP.

       Section 2105(b) of the Social Security Act (42 U.S.C. 
     1397ee(b)) is amended in the second sentence by inserting 
     ``and during the period that begins on October 1, 2019, and 
     ends on September 30, 2020, the enhanced FMAP determined for 
     a State for a fiscal year (or for any portion of a fiscal 
     year occurring during such period) shall be increased by 11.5 
     percentage points'' after ``23 percentage points,''.

                           TITLE III--OFFSET

     SEC. 301. IMPLEMENTATION OF OFFICE OF INSPECTOR GENERAL 
                   RECOMMENDATION TO DELAY CERTAIN MEDICARE PLAN 
                   PREPAYMENTS.

       (a) Medicare Advantage Payments.--Section 1853(a)(1) of the 
     Social Security Act (42 U.S.C. 1395w-23(a)(1)) is amended--
       (1) in subparagraph (A), in the matter preceding clause 
     (i)--
       (A) by striking ``subsections (e), (g), (i), and (l)'' and 
     inserting ``subparagraph (J), subsections (e), (g), (i), and 
     (l),''; and
       (B) by inserting ``(or, for months beginning with January 
     2019, on the date specified in subparagraph (J))'' after ``in 
     advance''; and
       (2) by adding at the end the following new subparagraph:
       ``(J) Timing of payments.--
       ``(i) In general.--With respect to monthly payments under 
     this section for months in a year (beginning with 2019), the 
     date specified in this subparagraph with respect to a payment 
     for a month is the first business day occurring on or after 
     the applicable date defined in clause (ii).
       ``(ii) Applicable date.--For purposes of clause (i), with 
     respect to a year (beginning with 2019), the term `applicable 
     date' means, with respect to a payment for--

       ``(I) January of such year, January 2nd;
       ``(II) February of such year, February 5th;
       ``(III) March of such year, March 10th;
       ``(IV) April of such year, April 15th;
       ``(V) May of such year, May 20th;
       ``(VI) June of such year, June 25th;
       ``(VII) July and each succeeding month (other than 
     December) of such year, the first day of the next month; and
       ``(VIII) December of such year, December 24th.''.

       (b) Conforming Amendment to Part D.--Section 1860D-15(d)(1) 
     of the Social Security Act (42 U.S.C. 1395w-115(d)(1)) is 
     amended by inserting ``and shall be made consistent with the 
     timing of monthly payments to MA organizations under section 
     1853(a)(1)(J)'' after ``as the Secretary determines''.

  Mr. CLYBURN (during the reading). Mr. Speaker, I ask unanimous 
consent to dispense with the reading.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from South Carolina?
  There was no objection.
  Mr. WALDEN. Mr. Speaker, I reserve a point of order against the 
motion to recommit.
  The SPEAKER pro tempore. The gentleman's point of order is reserved.
  Pursuant to the rule, the gentleman from South Carolina is recognized 
for 5 minutes in support of his motion.
  Mr. CLYBURN. Mr. Speaker, the Republicans have reserved a point of 
order against this motion.
  Let me be clear about what this means. The Republican leadership does 
not want a vote on providing proper CHIP funds to our United States 
territories, including Puerto Rico and the Virgin Islands.
  There may be a point of order against this provision, but it is the 
same point of order that applies to the Republicans' bill.
  Do you know what that means?
  They waive the point of order for their bill, but they will not waive 
the point of order for this bill.
  I won't take up too much time, Mr. Speaker. I just want the body to 
know that the Republican leadership is, once again, rigging the game in 
favor of the majority.
  This isn't about hurting me and the Democratic Members of this body, 
no. This hurts the people who are already struggling in Puerto Rico and 
the Virgin Islands.

                              {time}  1030

  To my friends on the other side of the aisle, you may hide behind 
procedural tactics, but the fact remains that doing so denies our 
United States citizens living in the territories the proper funding 
that the Governor has requested to recover
  Mr. Speaker, this is the final amendment to the bill which will not 
kill the bill nor send it back to committee. If adopted, the bill will 
immediately proceed to final passage as amended.
  It has been 34 days, Mr. Speaker, since Republicans allowed the 
Children's Health Insurance Program and Community Health Centers to 
expire. These proven programs insure 9 million children and serve 27 
million people.
  The bill before us is the latest in a long line of cynical attempts 
by President Trump and Republican Leaders to sabotage and undermine the 
Affordable Care Act. We ought not be funding efforts to treat 
infectious diseases like the flu and measles by taking away the funds 
needed to prevent those illnesses from occurring in the first place.
  Mr. Speaker, this bill turns on its head that adage, ``an ounce of 
prevention is worth a pound of cure.'' Instead of joining President 
Trump's campaign to sabotage the ACA, the Members of this body, 
Republicans and Democrats, should join to reauthorize CHIP and CHCs for 
5 years, fully paid for without robbing Peter to pay Paul.
  Mr. Speaker, I yield back the balance of my time.
  Mr. WALDEN. Mr. Speaker, I withdraw my reservation of a point of 
order.
  The SPEAKER pro tempore. The reservation of a point of order is 
withdrawn.
  Mr. WALDEN. Mr. Speaker, I claim the time in opposition to the motion 
to recommit.
  The SPEAKER pro tempore. The gentleman from Oregon is recognized for 
5 minutes.
  Mr. WALDEN. Mr. Speaker, today, Members of this House can deliver 
peace of mind to parents of over 8 million low-income children who 
depend on the Children's Health Insurance Program. The House can extend 
funding for important public health programs, including resources for 
the critical work community health centers do in our communities and in 
my district and yours. This bill will help deliver much-needed 
healthcare resources to our friends and fellow citizens in the Virgin 
Islands and in Puerto Rico.
  Yet we have heard complaints about how this package is paid for. 
Well, let us be clear how this bill funds healthcare for kids and 
important public health priorities like community health centers.
  In paying for this package, we have taken a fiscally responsible and 
reasonable approach. Our bill funds kids' healthcare by allowing States 
to dis-enroll lottery winners--these are winners making $80,000 or 
above--from the low-income Medicaid program. We ensure high-dollar 
lottery winners are removed from the Medicaid program so that those 
resources can go to Medicaid-eligible, low-income people in our 
districts.
  Our bill directs funding from the Prevention and Public Health Fund 
to finance important prevention and public

[[Page H8473]]

health needs, like funding the National Health Service Corps, Teaching 
Health Center Graduate Medical Education, Family-to-Family Health 
Information Centers, and community health centers. If these are not 
important programs for prevention, wellness, and public health, I don't 
know what are.
  Our bill before us today, which I predict will have bipartisan 
support, directs funds from the Prevention Fund for important public 
health priorities that have long had bipartisan support. We are using a 
bipartisan fund to pay for bipartisan healthcare support for health and 
wellness, which was its intent from the beginning.
  Most recently, nearly every House Republican and Democrat supported 
this idea just a year ago. Just a year ago, when we passed the 21st 
Century Cures Act, we said: Here is a health and wellness fund and a 
Prevention Fund that makes sense for cures, make sense for, we believe 
today, our community health centers, and for Children's Health 
Insurance.
  Our bill also asks the wealthiest among us, the 1 percent of 
beneficiaries, those making $40,000 a month, over half-a-million 
dollars a year--that is an individual--to pay a little more to help 
fund health insurance for low-income children. I think they are willing 
to do that, and I think we should be as well.
  On multiple budgets, President Obama said this is a reasonable way to 
pay for other priorities. That was bipartisan. It is bipartisan today.
  These reasonable pay-fors have been opposed by some in the Democratic 
leadership. Some House Democrats want to use children's healthcare and 
funding for community health centers as a bargaining chip for a bigger 
end-of-the-year goulash, yet kids and our frontline providers can't 
wait any longer.
  In just a few weeks, States like Minnesota run out of funding for the 
Children's Health Insurance Program. At the request of my colleagues on 
the other side of the aisle, we have agreed to postpone it time and 
again, but time has run out. The negotiations did not end as we all 
hoped they would.
  But we can't wait any longer. It is time for this House to deliver 
peace of mind to the families that rely on these critical programs. It 
is time to vote ``yes.''
  Mr. Speaker, I urge my colleagues to vote ``no'' on the motion to 
recommit and to approve the underlying bill, and I yield back the 
balance of my time.
  Ms. BLUNT ROCHESTER. Mr. Speaker, I thank my friend and mentor, the 
gentleman from South Carolina, for his kind words and for yielding.
  Mr. Speaker, we deal with important issues every day in this House, 
but there are few issues as meaningful to so many lives as the 
Children's Health Insurance Program.
  At this time the divisions in this House mimic those in our nation.
  And on many issues, those divisions can be challenging to bridge.
  One of my top priorities as a new Member of this body is to help 
bridge those divides, instead of widening them.
  I hope that my colleagues--both Democrats and Republicans--will tell 
me if I fall short on that commitment.
  One of the few things that does not divide us is the importance of 
children's healthcare and the CHIP program.
  When it was signed into law 20 years ago, this landmark legislation 
meant so much to me.
  First, as a mother of then 9-year-old, Alyssa, and 11-year-old, Alex 
I deeply understood the fear a parent could feel with a sick child and 
no insurance.
  But also because at that time, I was the Deputy Secretary of Health & 
Social Services for Delaware.
  And I had the honor of helping implement the law and seeing thousands 
of children who had never had healthcare get the coverage they 
deserved.
  From the 600,000 children across the nation who were the program's 
first enrollees in 1998 to the nearly 9,000,000 children in 2016.
  Kids across this country owe their yearly check-ups, their 
immunizations, and their doctor's office lollipops to this program.
  And in Delaware we owe a big debt to the CHIP program, Medicaid, and 
the Affordable Care Act.
  Today, 97 percent of Delaware's children obtain medical coverage 
because of these programs.
  In 1997, the legislation passed in a Republican Congress with a 
Democratic President, highlighting how this truly was not a partisan 
issue.
  That's why it's disappointing to me that we aren't moving forward on 
renewing the Children's Health Insurance Program with that same 
reasonable, bipartisan approach.
  The bill before us today forces us to choose between healthcare for 
children and healthcare for other vulnerable populations.
  Choosing between prevention and healthcare for kids is unacceptable--
particularly in a nation as great as ours.
  I have spoken to many of you over the past 10 months.
  I know that the people I have met in both political parties know--in 
their hearts--that we should not play games with the healthcare of our 
children.
  I know that it may seem hard to oppose one's party leadership. But 
today I ask you to consider whether this is one of those rare times . . 
. those rare subjects . . .
  Where we can come together to stand up for the those in need . . .
  And to stand up for a clean reauthorization of the Children's Health 
Insurance Program.
  That's what our motion to recommit does.
  Let's step back and consider whether we can use our common desire to 
deliver healthcare to our children, as a moment to surprise the public 
. . .
  To set a new tone for how we deal with one another . . . and how we 
address issues on which both of our parties fundamentally agree.
  Please join with me on this vote to put our children first--they're 
watching.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. CLYBURN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on the motion to recommit will be followed by 
5-minute votes on the question of passage of H.R. 3922, if ordered, and 
approval of the Journal, if ordered.
  The vote was taken by electronic device, and there were--yeas 187, 
nays 231, not voting 14, as follows:

                             [Roll No. 605]

                               YEAS--187

     Adams
     Aguilar
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Conyers
     Cooper
     Correa
     Costa
     Courtney
     Crist
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Grijalva
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jayapal
     Jeffries
     Johnson (GA)
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Moulton
     Murphy (FL)
     Nadler
     Napolitano
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Peterson
     Pingree
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sinema
     Sires
     Slaughter
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Yarmuth

                               NAYS--231

     Abraham
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess

[[Page H8474]]


     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Costello (PA)
     Cramer
     Crawford
     Culberson
     Curbelo (FL)
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Jones
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     Lamborn
     Lance
     Latta
     Lewis (MN)
     LoBiondo
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Noem
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Renacci
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Stivers
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                             NOT VOTING--14

     Aderholt
     Bishop (GA)
     Black
     Bridenstine
     Brooks (AL)
     Gutierrez
     Jackson Lee
     Johnson, E. B.
     Johnson, Sam
     LaMalfa
     Peters
     Pocan
     Upton
     Wilson (FL)

                              {time}  1058

  Messrs. BARTON, PALAZZO, CALVERT, SMITH of Texas, COLLINS of New 
York, WITTMAN, Ms. GRANGER, Messrs. HOLDING, SCALISE, and Ms. HERRERA 
BEUTLER changed their vote from ``yea'' to ``nay.''
  Ms. JAYAPAL, Messrs. TAKANO, LANGEVIN, and DAVID SCOTT of Georgia 
changed their vote from ``nay'' to ``yea.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--yeas 242, 
nays 174, not voting 16, as follows:

                             [Roll No. 606]

                               YEAS--242

     Abraham
     Allen
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bera
     Bergman
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carbajal
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Correa
     Costa
     Costello (PA)
     Cramer
     Crawford
     Cuellar
     Culberson
     Curbelo (FL)
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Handel
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Jones
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     Kind
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     Lamborn
     Lance
     Latta
     Lewis (MN)
     Lipinski
     LoBiondo
     Loebsack
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (FL)
     Newhouse
     Noem
     Norman
     Nunes
     O'Halleran
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Peterson
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Renacci
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Rosen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Scalise
     Schneider
     Schrader
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Sinema
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Stivers
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                               NAYS--174

     Adams
     Aguilar
     Amash
     Barragan
     Bass
     Beatty
     Beyer
     Biggs
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Conyers
     Cooper
     Courtney
     Crist
     Crowley
     Cummings
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Grijalva
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jayapal
     Jeffries
     Johnson (GA)
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Krishnamoorthi
     Kuster (NH)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Massie
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Moulton
     Nadler
     Napolitano
     Neal
     Nolan
     Norcross
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Pingree
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sires
     Slaughter
     Smith (WA)
     Soto
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Yarmuth

                             NOT VOTING--16

     Aderholt
     Bishop (GA)
     Black
     Bridenstine
     Brooks (AL)
     Gutierrez
     Jackson Lee
     Johnson, E. B.
     Johnson, Sam
     LaMalfa
     Peters
     Pocan
     Speier
     Upton
     Williams
     Wilson (FL)


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1106

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. PETERS. Mr. Speaker, my vote was not recorded on rollcall No. 606 
on H.R. 3922--The Community Health and Medical Professionals Improve 
Our Nation Act due to my attendance at the Vatican's Health of People, 
Health of Planet and Our Responsibility: Climate Change, Air Pollution 
and Health. I intended to vote ``aye.''
  Mr. LaMALFA. Mr. Speaker, on rollcall No. 606 on passage of H.R. 
3922, I am not recorded due to a family concern. Had I been present, I 
would have voted ``yea.''

[[Page H8475]]

  



                          PERSONAL EXPLANATION

  Ms. SPEIER. Mr. Speaker, due to an unavoidable conflict, I missed the 
following votes on November 1, 2, and 3. Had I been present, I would 
have voted ``yea'' on rollcall No. 597, ``nay'' on rollcall No. 604, 
``yea'' on rollcall No. 605, and ``nay'' on rollcall No. 606.


                          PERSONAL EXPLANATION

  Mrs. BLACK. Mr. Speaker, I was unavoidably detained. Had I been 
present, I would have voted ``yea'' on rollcall No. 604, and ``yea'' on 
rollcall No. 606.

                          ____________________