[Congressional Record Volume 164, Number 23 (Tuesday, February 6, 2018)]
[House]
[Pages H834-H896]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      HONORING HOMETOWN HEROES ACT


                             General Leave

  Mr. FRELINGHUYSEN. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include extraneous material on the further consideration of 
the Senate amendment to H.R. 1892.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. FRELINGHUYSEN. Mr. Speaker, pursuant to House Resolution 727, I 
call up the bill (H.R. 1892) to amend title 4, United States Code, to 
provide for the flying of the flag at half-staff in the event of the 
death of a first responder in the line of duty, with the Senate 
amendment thereto, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. The Clerk will designate the Senate 
amendment.
  Senate amendment:

       On page 3, line 6 through 8, strike [``section 1204 of the 
     Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. 
     3796b)''] and insert ``section 1204 of title I of the Omnibus 
     Crime Control and Safe Streets Act of 1968 (34 U.S.C. 
     10281)''.


                            Motion to Concur

  Mr. FRELINGHUYSEN. Mr. Speaker, I have a motion at the desk.
  The SPEAKER pro tempore. The Clerk will designate the motion.
  The text of the motion is as follows:

       Mr. Frelinghuysen moves that the House concur in the Senate 
     amendment to H.R. 1892 with an amendment consisting of the 
     text of Rules Committee Print 115-58 as modified by the 
     amendment printed in House Report 115-547.

  The text of the House amendment to the Senate amendment to the text 
is as follows:

       At the end of the matter inserted by the Senate amendment, 
     insert the following:

  DIVISION B--FURTHER EXTENSION OF CONTINUING APPROPRIATIONS ACT, 2018

       Sec. 1001.  The Continuing Appropriations Act, 2018 
     (division D of Public Law 115-56) is further amended--
       (1) by striking the date specified in section 106(3) and 
     inserting ``March 23, 2018''; and
       (2) by adding after section 155 the following:
       ``Sec. 156.  Notwithstanding section 101, amounts are 
     provided for `Department of Commerce--Bureau of the Census--
     Periodic Censuses and Programs' at a rate for operations of 
     $1,251,000,000, and such amounts may be apportioned up to the 
     rate for operations necessary to maintain the schedule and 
     deliver the required data according to statutory deadlines in 
     the 2020 Decennial Census Program.
       ``Sec. 157.  Notwithstanding section 101, the matter 
     preceding the first proviso and the first proviso under the 
     heading `Power Marketing Administrations--Operation and 
     Maintenance, Southeastern Power Administration' in division D 
     of Public Law 115-31 shall be applied by substituting 
     `$6,379,000' for `$1,000,000' each place it appears.
       ``Sec. 158.  As authorized by section 404 of the Bipartisan 
     Budget Act of 2015 (Public Law 114-74; 42 U.S.C. 6239 note), 
     the Secretary of Energy shall draw down and sell not to 
     exceed $350,000,000 of crude oil from the Strategic Petroleum 
     Reserve in fiscal year 2018: Provided, That the proceeds from 
     such drawdown and sale shall be deposited into the `Energy 
     Security and Infrastructure Modernization Fund' (in this 
     section referred to as the `Fund') during fiscal year 2018: 
     Provided further, That in addition to amounts otherwise made 
     available by section 101, and notwithstanding section 104, 
     any amounts deposited in the Fund shall be made available and 
     shall remain available until expended at a rate for 
     operations of $350,000,000, for necessary expenses in 
     carrying out the Life Extension II project for the Strategic 
     Petroleum Reserve.
       ``Sec. 159.  Amounts made available by section 101 for `The 
     Judiciary--Courts of Appeals, District Courts, and Other 
     Judicial Services--Fees of Jurors and Commissioners' may be 
     apportioned up to the rate for operations necessary to 
     accommodate increased juror usage.
       ``Sec. 160. (a) In addition to amounts otherwise made 
     available by section 101, there is appropriated for an 
     additional amount for the `Small Business Administration--
     Disaster Loans Program Account' $225,000,000, to remain 
     available until expended, for the cost of direct loans 
     authorized by section 7(b) of the Small Business Act: 
     Provided, That such amount is designated by the Congress as 
     an emergency requirement pursuant to section 251(b)(2)(A)(i) 
     of the Balanced Budget and Emergency Deficit Control Act of 
     1985.
       ``(b) The amount designated in subsection (a) by the 
     Congress as an emergency requirement pursuant to section 
     251(b)(2)(A)(i) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985 shall be available only if the President 
     subsequently so designates such amount and transmits such 
     designation to the Congress.''.
        This division may be cited as the ``Further Extension of 
     Continuing Appropriations Act, 2018''.

       DIVISION C--DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2018

        That the following sums are appropriated, out of any money 
     in the Treasury not otherwise appropriated, for the fiscal 
     year ending September 30, 2018, for military functions 
     administered by the Department of Defense and for other 
     purposes, namely:

[[Page H835]]

  


                                TITLE I

                           MILITARY PERSONNEL

                        Military Personnel, Army

       For pay, allowances, individual clothing, subsistence, 
     interest on deposits, gratuities, permanent change of station 
     travel (including all expenses thereof for organizational 
     movements), and expenses of temporary duty travel between 
     permanent duty stations, for members of the Army on active 
     duty (except members of reserve components provided for 
     elsewhere), cadets, and aviation cadets; for members of the 
     Reserve Officers' Training Corps; and for payments pursuant 
     to section 156 of Public Law 97-377, as amended (42 U.S.C. 
     402 note), and to the Department of Defense Military 
     Retirement Fund, $41,427,054,000.

                        Military Personnel, Navy

       For pay, allowances, individual clothing, subsistence, 
     interest on deposits, gratuities, permanent change of station 
     travel (including all expenses thereof for organizational 
     movements), and expenses of temporary duty travel between 
     permanent duty stations, for members of the Navy on active 
     duty (except members of the Reserve provided for elsewhere), 
     midshipmen, and aviation cadets; for members of the Reserve 
     Officers' Training Corps; and for payments pursuant to 
     section 156 of Public Law 97-377, as amended (42 U.S.C. 402 
     note), and to the Department of Defense Military Retirement 
     Fund, $28,707,918,000 (reduced by $2,000,000) (increased by 
     $2,000,000).

                    Military Personnel, Marine Corps

       For pay, allowances, individual clothing, subsistence, 
     interest on deposits, gratuities, permanent change of station 
     travel (including all expenses thereof for organizational 
     movements), and expenses of temporary duty travel between 
     permanent duty stations, for members of the Marine Corps on 
     active duty (except members of the Reserve provided for 
     elsewhere); and for payments pursuant to section 156 of 
     Public Law 97-377, as amended (42 U.S.C. 402 note), and to 
     the Department of Defense Military Retirement Fund, 
     $13,165,714,000.

                     Military Personnel, Air Force

       For pay, allowances, individual clothing, subsistence, 
     interest on deposits, gratuities, permanent change of station 
     travel (including all expenses thereof for organizational 
     movements), and expenses of temporary duty travel between 
     permanent duty stations, for members of the Air Force on 
     active duty (except members of reserve components provided 
     for elsewhere), cadets, and aviation cadets; for members of 
     the Reserve Officers' Training Corps; and for payments 
     pursuant to section 156 of Public Law 97-377, as amended (42 
     U.S.C. 402 note), and to the Department of Defense Military 
     Retirement Fund, $28,738,320,000.

                        Reserve Personnel, Army

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Army 
     Reserve on active duty under sections 10211, 10302, and 3038 
     of title 10, United States Code, or while serving on active 
     duty under section 12301(d) of title 10, United States Code, 
     in connection with performing duty specified in section 
     12310(a) of title 10, United States Code, or while undergoing 
     reserve training, or while performing drills or equivalent 
     duty or other duty, and expenses authorized by section 16131 
     of title 10, United States Code; and for payments to the 
     Department of Defense Military Retirement Fund, 
     $4,721,128,000.

                        Reserve Personnel, Navy

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Navy 
     Reserve on active duty under section 10211 of title 10, 
     United States Code, or while serving on active duty under 
     section 12301(d) of title 10, United States Code, in 
     connection with performing duty specified in section 12310(a) 
     of title 10, United States Code, or while undergoing reserve 
     training, or while performing drills or equivalent duty, and 
     expenses authorized by section 16131 of title 10, United 
     States Code; and for payments to the Department of Defense 
     Military Retirement Fund, $1,987,662,000.

                    Reserve Personnel, Marine Corps

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Marine 
     Corps Reserve on active duty under section 10211 of title 10, 
     United States Code, or while serving on active duty under 
     section 12301(d) of title 10, United States Code, in 
     connection with performing duty specified in section 12310(a) 
     of title 10, United States Code, or while undergoing reserve 
     training, or while performing drills or equivalent duty, and 
     for members of the Marine Corps platoon leaders class, and 
     expenses authorized by section 16131 of title 10, United 
     States Code; and for payments to the Department of Defense 
     Military Retirement Fund, $762,793,000.

                      Reserve Personnel, Air Force

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Air Force 
     Reserve on active duty under sections 10211, 10305, and 8038 
     of title 10, United States Code, or while serving on active 
     duty under section 12301(d) of title 10, United States Code, 
     in connection with performing duty specified in section 
     12310(a) of title 10, United States Code, or while undergoing 
     reserve training, or while performing drills or equivalent 
     duty or other duty, and expenses authorized by section 16131 
     of title 10, United States Code; and for payments to the 
     Department of Defense Military Retirement Fund, 
     $1,808,434,000.

                     National Guard Personnel, Army

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Army 
     National Guard while on duty under sections 10211, 10302, or 
     12402 of title 10 or section 708 of title 32, United States 
     Code, or while serving on duty under section 12301(d) of 
     title 10 or section 502(f) of title 32, United States Code, 
     in connection with performing duty specified in section 
     12310(a) of title 10, United States Code, or while undergoing 
     training, or while performing drills or equivalent duty or 
     other duty, and expenses authorized by section 16131 of title 
     10, United States Code; and for payments to the Department of 
     Defense Military Retirement Fund, $8,252,426,000.

                  National Guard Personnel, Air Force

       For pay, allowances, clothing, subsistence, gratuities, 
     travel, and related expenses for personnel of the Air 
     National Guard on duty under sections 10211, 10305, or 12402 
     of title 10 or section 708 of title 32, United States Code, 
     or while serving on duty under section 12301(d) of title 10 
     or section 502(f) of title 32, United States Code, in 
     connection with performing duty specified in section 12310(a) 
     of title 10, United States Code, or while undergoing 
     training, or while performing drills or equivalent duty or 
     other duty, and expenses authorized by section 16131 of title 
     10, United States Code; and for payments to the Department of 
     Defense Military Retirement Fund, $3,406,137,000.

                                TITLE II

                       OPERATION AND MAINTENANCE

                    Operation and Maintenance, Army

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance of the Army, as authorized by law, 
     $38,483,846,000 (reduced by $5,000,000) (reduced by 
     $5,600,000) (reduced by $6,000,000):  Provided, That not to 
     exceed $12,478,000 can be used for emergencies and 
     extraordinary expenses, to be expended on the approval or 
     authority of the Secretary of the Army, and payments may be 
     made on his certificate of necessity for confidential 
     military purposes.

                    Operation and Maintenance, Navy

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance of the Navy and the Marine Corps, 
     as authorized by law, $45,980,133,000 (reduced by $598,000) 
     (reduced by $7,000,000):  Provided, That not to exceed 
     $15,055,000 can be used for emergencies and extraordinary 
     expenses, to be expended on the approval or authority of the 
     Secretary of the Navy, and payments may be made on his 
     certificate of necessity for confidential military purposes.

                Operation and Maintenance, Marine Corps

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance of the Marine Corps, as authorized 
     by law, $6,885,884,000.

                  Operation and Maintenance, Air Force

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance of the Air Force, as authorized by 
     law, $38,592,745,000:  Provided, That not to exceed 
     $7,699,000 can be used for emergencies and extraordinary 
     expenses, to be expended on the approval or authority of the 
     Secretary of the Air Force, and payments may be made on his 
     certificate of necessity for confidential military purposes.

                Operation and Maintenance, Defense-Wide

                     (including transfer of funds)

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance of activities and agencies of the 
     Department of Defense (other than the military departments), 
     as authorized by law, $33,771,769,000 (increased by 
     $5,000,000) (reduced by $10,000,000) (reduced by $100,000) 
     (increased by $100,000) (reduced by $194,897,000) (increased 
     by $194,897,000) (reduced by $26,200,000) (reduced by 
     $20,000,000) (reduced by $6,000,000) (reduced by $4,000,000) 
     (reduced by $20,000,000) (reduced by $1,000,000) (reduced by 
     $10,000,000) (reduced by $2,500,000) (reduced by $2,000,000) 
     (reduced by $8,000,000) (reduced by $6,250,000) (reduced by 
     $10,000,000) (reduced by $10,000,000) (reduced by 
     $30,000,000) (reduced by $34,734,000) (reduced by 
     $60,000,000):  Provided, That not more than $15,000,000 may 
     be used for the Combatant Commander Initiative Fund 
     authorized under section 166a of title 10, United States 
     Code:  Provided further, That not to exceed $36,000,000 can 
     be used for emergencies and extraordinary expenses, to be 
     expended on the approval or authority of the Secretary of 
     Defense, and payments may be made on his certificate of 
     necessity for confidential military purposes:  Provided 
     further, That of the funds provided under this heading, not 
     less than $38,458,000 shall be made available for the 
     Procurement Technical Assistance Cooperative Agreement 
     Program, of which not less than $3,600,000 shall be available 
     for centers defined in 10 U.S.C. 2411(1)(D):  Provided 
     further, That none of the funds appropriated or otherwise 
     made available by this Act may be used to plan or implement 
     the consolidation of a budget or appropriations liaison 
     office of the Office of the Secretary of Defense, the office 
     of the Secretary of a military department, or the service 
     headquarters of one of the Armed Forces into a legislative 
     affairs or legislative liaison office:  Provided further, 
     That $9,385,000, to remain available until expended, is 
     available only for expenses relating to certain classified 
     activities, and may be transferred as necessary by the 
     Secretary

[[Page H836]]

     of Defense to operation and maintenance appropriations or 
     research, development, test and evaluation appropriations, to 
     be merged with and to be available for the same time period 
     as the appropriations to which transferred:  Provided 
     further, That any ceiling on the investment item unit cost of 
     items that may be purchased with operation and maintenance 
     funds shall not apply to the funds described in the preceding 
     proviso:  Provided further, That of the funds provided under 
     this heading, $415,000,000, of which $100,000,000 to remain 
     available until September 30, 2019, shall be available to 
     provide support and assistance to foreign security forces or 
     other groups or individuals to conduct, support or facilitate 
     counterterrorism, crisis response, or other Department of 
     Defense security cooperation programs:  Provided further, 
     That the transfer authority provided under this heading is in 
     addition to any other transfer authority provided elsewhere 
     in this Act.

                Operation and Maintenance, Army Reserve

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance, including training, organization, 
     and administration, of the Army Reserve; repair of facilities 
     and equipment; hire of passenger motor vehicles; travel and 
     transportation; care of the dead; recruiting; procurement of 
     services, supplies, and equipment; and communications, 
     $2,870,163,000.

                Operation and Maintenance, Navy Reserve

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance, including training, organization, 
     and administration, of the Navy Reserve; repair of facilities 
     and equipment; hire of passenger motor vehicles; travel and 
     transportation; care of the dead; recruiting; procurement of 
     services, supplies, and equipment; and communications, 
     $1,038,507,000.

            Operation and Maintenance, Marine Corps Reserve

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance, including training, organization, 
     and administration, of the Marine Corps Reserve; repair of 
     facilities and equipment; hire of passenger motor vehicles; 
     travel and transportation; care of the dead; recruiting; 
     procurement of services, supplies, and equipment; and 
     communications, $282,337,000.

              Operation and Maintenance, Air Force Reserve

       For expenses, not otherwise provided for, necessary for the 
     operation and maintenance, including training, organization, 
     and administration, of the Air Force Reserve; repair of 
     facilities and equipment; hire of passenger motor vehicles; 
     travel and transportation; care of the dead; recruiting; 
     procurement of services, supplies, and equipment; and 
     communications, $3,233,745,000.

             Operation and Maintenance, Army National Guard

       For expenses of training, organizing, and administering the 
     Army National Guard, including medical and hospital treatment 
     and related expenses in non-Federal hospitals; maintenance, 
     operation, and repairs to structures and facilities; hire of 
     passenger motor vehicles; personnel services in the National 
     Guard Bureau; travel expenses (other than mileage), as 
     authorized by law for Army personnel on active duty, for Army 
     National Guard division, regimental, and battalion commanders 
     while inspecting units in compliance with National Guard 
     Bureau regulations when specifically authorized by the Chief, 
     National Guard Bureau; supplying and equipping the Army 
     National Guard as authorized by law; and expenses of repair, 
     modification, maintenance, and issue of supplies and 
     equipment (including aircraft), $7,275,820,000.

             Operation and Maintenance, Air National Guard

       For expenses of training, organizing, and administering the 
     Air National Guard, including medical and hospital treatment 
     and related expenses in non-Federal hospitals; maintenance, 
     operation, and repairs to structures and facilities; 
     transportation of things, hire of passenger motor vehicles; 
     supplying and equipping the Air National Guard, as authorized 
     by law; expenses for repair, modification, maintenance, and 
     issue of supplies and equipment, including those furnished 
     from stocks under the control of agencies of the Department 
     of Defense; travel expenses (other than mileage) on the same 
     basis as authorized by law for Air National Guard personnel 
     on active Federal duty, for Air National Guard commanders 
     while inspecting units in compliance with National Guard 
     Bureau regulations when specifically authorized by the Chief, 
     National Guard Bureau, $6,735,930,000.

          United States Court of Appeals for the Armed Forces

       For salaries and expenses necessary for the United States 
     Court of Appeals for the Armed Forces, $14,538,000, of which 
     not to exceed $5,000 may be used for official representation 
     purposes.

                    Environmental Restoration, Army

                     (including transfer of funds)

       For the Department of the Army, $215,809,000, to remain 
     available until transferred:  Provided, That the Secretary of 
     the Army shall, upon determining that such funds are required 
     for environmental restoration, reduction and recycling of 
     hazardous waste, removal of unsafe buildings and debris of 
     the Department of the Army, or for similar purposes, transfer 
     the funds made available by this appropriation to other 
     appropriations made available to the Department of the Army, 
     to be merged with and to be available for the same purposes 
     and for the same time period as the appropriations to which 
     transferred:  Provided further, That upon a determination 
     that all or part of the funds transferred from this 
     appropriation are not necessary for the purposes provided 
     herein, such amounts may be transferred back to this 
     appropriation:  Provided further, That the transfer authority 
     provided under this heading is in addition to any other 
     transfer authority provided elsewhere in this Act.

                    Environmental Restoration, Navy

                     (including transfer of funds)

       For the Department of the Navy, $288,915,000 (increased by 
     $34,734,000) (increased by $30,000,000), to remain available 
     until transferred:  Provided, That the Secretary of the Navy 
     shall, upon determining that such funds are required for 
     environmental restoration, reduction and recycling of 
     hazardous waste, removal of unsafe buildings and debris of 
     the Department of the Navy, or for similar purposes, transfer 
     the funds made available by this appropriation to other 
     appropriations made available to the Department of the Navy, 
     to be merged with and to be available for the same purposes 
     and for the same time period as the appropriations to which 
     transferred:  Provided further, That upon a determination 
     that all or part of the funds transferred from this 
     appropriation are not necessary for the purposes provided 
     herein, such amounts may be transferred back to this 
     appropriation:  Provided further, That the transfer authority 
     provided under this heading is in addition to any other 
     transfer authority provided elsewhere in this Act.

                  Environmental Restoration, Air Force

                     (including transfer of funds)

       For the Department of the Air Force, $308,749,000 
     (increased by $30,000,000), to remain available until 
     transferred:  Provided, That the Secretary of the Air Force 
     shall, upon determining that such funds are required for 
     environmental restoration, reduction and recycling of 
     hazardous waste, removal of unsafe buildings and debris of 
     the Department of the Air Force, or for similar purposes, 
     transfer the funds made available by this appropriation to 
     other appropriations made available to the Department of the 
     Air Force, to be merged with and to be available for the same 
     purposes and for the same time period as the appropriations 
     to which transferred:  Provided further, That upon a 
     determination that all or part of the funds transferred from 
     this appropriation are not necessary for the purposes 
     provided herein, such amounts may be transferred back to this 
     appropriation:  Provided further, That the transfer authority 
     provided under this heading is in addition to any other 
     transfer authority provided elsewhere in this Act.

                Environmental Restoration, Defense-Wide

                     (including transfer of funds)

       For the Department of Defense, $9,002,000 (increased by 
     $10,000,000), to remain available until transferred:  
     Provided, That the Secretary of Defense shall, upon 
     determining that such funds are required for environmental 
     restoration, reduction and recycling of hazardous waste, 
     removal of unsafe buildings and debris of the Department of 
     Defense, or for similar purposes, transfer the funds made 
     available by this appropriation to other appropriations made 
     available to the Department of Defense, to be merged with and 
     to be available for the same purposes and for the same time 
     period as the appropriations to which transferred:  Provided 
     further, That upon a determination that all or part of the 
     funds transferred from this appropriation are not necessary 
     for the purposes provided herein, such amounts may be 
     transferred back to this appropriation:  Provided further, 
     That the transfer authority provided under this heading is in 
     addition to any other transfer authority provided elsewhere 
     in this Act.

         Environmental Restoration, Formerly Used Defense Sites

                     (including transfer of funds)

       For the Department of the Army, $233,673,000, to remain 
     available until transferred:  Provided, That the Secretary of 
     the Army shall, upon determining that such funds are required 
     for environmental restoration, reduction and recycling of 
     hazardous waste, removal of unsafe buildings and debris at 
     sites formerly used by the Department of Defense, transfer 
     the funds made available by this appropriation to other 
     appropriations made available to the Department of the Army, 
     to be merged with and to be available for the same purposes 
     and for the same time period as the appropriations to which 
     transferred:  Provided further, That upon a determination 
     that all or part of the funds transferred from this 
     appropriation are not necessary for the purposes provided 
     herein, such amounts may be transferred back to this 
     appropriation:  Provided further, That the transfer authority 
     provided under this heading is in addition to any other 
     transfer authority provided elsewhere in this Act.

             Overseas Humanitarian, Disaster, and Civic Aid

       For expenses relating to the Overseas Humanitarian, 
     Disaster, and Civic Aid programs of the Department of Defense 
     (consisting of the programs provided under sections 401, 402, 
     404, 407, 2557, and 2561 of title

[[Page H837]]

     10, United States Code), $107,900,000, to remain available 
     until September 30, 2018.

                  Cooperative Threat Reduction Account

       For assistance, including assistance provided by contract 
     or by grants, under programs and activities of the Department 
     of Defense Cooperative Threat Reduction Program authorized 
     under the Department of Defense Cooperative Threat Reduction 
     Act, $324,600,000, to remain available until September 30, 
     2019.

      Operation and Maintenance, National Defense Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $5,000,000,000, for the ``Operation and 
     Maintenance, National Defense Restoration Fund'': Provided, 
     That such funds provided under this heading shall only be 
     available for programs, projects and activities necessary to 
     implement the 2018 National Defense Strategy: Provided 
     further, That such funds shall not be available for transfer 
     until 30 days after the Secretary has submitted, and the 
     congressional defense committees have approved, the proposed 
     allocation plan for the use of such funds to implement such 
     strategy: Provided further, That such allocation plan shall 
     include a detailed justification for the use of such funds 
     and a description of how such investments are necessary to 
     implement the strategy: Provided further, That the Secretary 
     of Defense may transfer these funds only to operation and 
     maintenance accounts: Provided further, That the funds 
     transferred shall be merged with and shall be available for 
     the same purposes and for the same time period, as the 
     appropriation to which transferred: Provided further, That 
     none of the funds made available under this heading may be 
     transferred to any program, project, or activity specifically 
     limited or denied by this Act: Provided further, That the 
     transfer authority provided under this heading is in addition 
     to any other transfer authority available to the Department 
     of Defense.

                               TITLE III

                              PROCUREMENT

                       Aircraft Procurement, Army

       For construction, procurement, production, modification, 
     and modernization of aircraft, equipment, including ordnance, 
     ground handling equipment, spare parts, and accessories 
     therefor; specialized equipment and training devices; 
     expansion of public and private plants, including the land 
     necessary therefor, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $4,456,533,000, to remain available for obligation until 
     September 30, 2020.

                       Missile Procurement, Army

       For construction, procurement, production, modification, 
     and modernization of missiles, equipment, including ordnance, 
     ground handling equipment, spare parts, and accessories 
     therefor; specialized equipment and training devices; 
     expansion of public and private plants, including the land 
     necessary therefor, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $2,581,600,000, to remain available for obligation until 
     September 30, 2020.

        Procurement of Weapons and Tracked Combat Vehicles, Army

       For construction, procurement, production, and modification 
     of weapons and tracked combat vehicles, equipment, including 
     ordnance, spare parts, and accessories therefor; specialized 
     equipment and training devices; expansion of public and 
     private plants, including the land necessary therefor, for 
     the foregoing purposes, and such lands and interests therein, 
     may be acquired, and construction prosecuted thereon prior to 
     approval of title; and procurement and installation of 
     equipment, appliances, and machine tools in public and 
     private plants; reserve plant and Government and contractor-
     owned equipment layaway; and other expenses necessary for the 
     foregoing purposes, $3,556,175,000, to remain available for 
     obligation until September 30, 2020.

                    Procurement of Ammunition, Army

       For construction, procurement, production, and modification 
     of ammunition, and accessories therefor; specialized 
     equipment and training devices; expansion of public and 
     private plants, including ammunition facilities, authorized 
     by section 2854 of title 10, United States Code, and the land 
     necessary therefor, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $1,811,808,000, to remain available for obligation until 
     September 30, 2020.

                        Other Procurement, Army

       For construction, procurement, production, and modification 
     of vehicles, including tactical, support, and non-tracked 
     combat vehicles; the purchase of passenger motor vehicles for 
     replacement only; communications and electronic equipment; 
     other support equipment; spare parts, ordnance, and 
     accessories therefor; specialized equipment and training 
     devices; expansion of public and private plants, including 
     the land necessary therefor, for the foregoing purposes, and 
     such lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $6,356,044,000 (increased by $30,000,000), to remain 
     available for obligation until September 30, 2020.

                       Aircraft Procurement, Navy

       For construction, procurement, production, modification, 
     and modernization of aircraft, equipment, including ordnance, 
     spare parts, and accessories therefor; specialized equipment; 
     expansion of public and private plants, including the land 
     necessary therefor, and such lands and interests therein, may 
     be acquired, and construction prosecuted thereon prior to 
     approval of title; and procurement and installation of 
     equipment, appliances, and machine tools in public and 
     private plants; reserve plant and Government and contractor-
     owned equipment layaway, $17,908,270,000, to remain available 
     for obligation until September 30, 2020.

                       Weapons Procurement, Navy

       For construction, procurement, production, modification, 
     and modernization of missiles, torpedoes, other weapons, and 
     related support equipment including spare parts, and 
     accessories therefor; expansion of public and private plants, 
     including the land necessary therefor, and such lands and 
     interests therein, may be acquired, and construction 
     prosecuted thereon prior to approval of title; and 
     procurement and installation of equipment, appliances, and 
     machine tools in public and private plants; reserve plant and 
     Government and contractor-owned equipment layaway, 
     $3,387,826,000 (increased by $26,200,000), to remain 
     available for obligation until September 30, 2020.

            Procurement of Ammunition, Navy and Marine Corps

       For construction, procurement, production, and modification 
     of ammunition, and accessories therefor; specialized 
     equipment and training devices; expansion of public and 
     private plants, including ammunition facilities, authorized 
     by section 2854 of title 10, United States Code, and the land 
     necessary therefor, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $735,651,000, to remain available for obligation until 
     September 30, 2020.

                   Shipbuilding and Conversion, Navy

       For expenses necessary for the construction, acquisition, 
     or conversion of vessels as authorized by law, including 
     armor and armament thereof, plant equipment, appliances, and 
     machine tools and installation thereof in public and private 
     plants; reserve plant and Government and contractor-owned 
     equipment layaway; procurement of critical, long lead time 
     components and designs for vessels to be constructed or 
     converted in the future; and expansion of public and private 
     plants, including land necessary therefor, and such lands and 
     interests therein, may be acquired, and construction 
     prosecuted thereon prior to approval of title, as follows:
       Ohio Replacement Submarine (AP), $842,853,000;
       Carrier Replacement Program, $1,869,646,000;
       Carrier Replacement Program (AP), $2,561,058,000;
       Virginia Class Submarine, $3,305,315,000;
       Virginia Class Submarine (AP), $1,920,596,000;
       CVN Refueling Overhauls, $1,569,669,000;
       CVN Refueling Overhauls (AP), $75,897,000;
       DDG-1000 Program, $164,976,000;
       DDG-51 Destroyer, $3,499,079,000;
       DDG-51 Destroyer (AP), $90,336,000;
       Littoral Combat Ship, $1,566,971,000;
       Expeditionary Sea Base, $635,000,000;
       LHA Replacement, $1,695,077,000;
       TAO Fleet Oiler, $449,415,000;
       TAO Fleet Oiler (AP), $75,068,000;
       Ship to Shore Connector, $390,554,000;
       Service Craft, $23,994,000;
       Towing, Salvage, and Rescue Ship, $76,204,000;
       LCU 1700, $31,850,000;
       For outfitting, post delivery, conversions, and first 
     destination transportation, $542,626,000; and
       Completion of Prior Year Shipbuilding Programs, 
     $117,542,000.
       In all: $21,503,726,000, to remain available for obligation 
     until September 30, 2022:  Provided, That additional 
     obligations may be incurred after September 30, 2022, for 
     engineering services, tests, evaluations, and other such 
     budgeted work that must be performed in the final stage of 
     ship construction:  Provided further, That none of the funds 
     provided under this heading for the construction or

[[Page H838]]

     conversion of any naval vessel to be constructed in shipyards 
     in the United States shall be expended in foreign facilities 
     for the construction of major components of such vessel:  
     Provided further, That none of the funds provided under this 
     heading shall be used for the construction of any naval 
     vessel in foreign shipyards:  Provided further, That funds 
     appropriated or otherwise made available by this Act for 
     production of the common missile compartment of nuclear-
     powered vessels may be available for multiyear procurement of 
     critical components to support continuous production of such 
     compartments only in accordance with the provisions of 
     subsection (i) of section 2218a of title 10, United States 
     Code (as added by section 1023 of the National Defense 
     Authorization Act for Fiscal Year 2017 (Public Law 114-328)).

                        Other Procurement, Navy

       For procurement, production, and modernization of support 
     equipment and materials not otherwise provided for, Navy 
     ordnance (except ordnance for new aircraft, new ships, and 
     ships authorized for conversion); the purchase of passenger 
     motor vehicles for replacement only; expansion of public and 
     private plants, including the land necessary therefor, and 
     such lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway, 
     $7,852,952,000, to remain available for obligation until 
     September 30, 2020.

                       Procurement, Marine Corps

       For expenses necessary for the procurement, manufacture, 
     and modification of missiles, armament, military equipment, 
     spare parts, and accessories therefor; plant equipment, 
     appliances, and machine tools, and installation thereof in 
     public and private plants; reserve plant and Government and 
     contractor-owned equipment layaway; vehicles for the Marine 
     Corps, including the purchase of passenger motor vehicles for 
     replacement only; and expansion of public and private plants, 
     including land necessary therefor, and such lands and 
     interests therein, may be acquired, and construction 
     prosecuted thereon prior to approval of title, $1,818,846,000 
     (increased by $20,000,000), to remain available for 
     obligation until September 30, 2020.

                    Aircraft Procurement, Air Force

       For construction, procurement, and modification of aircraft 
     and equipment, including armor and armament, specialized 
     ground handling equipment, and training devices, spare parts, 
     and accessories therefor; specialized equipment; expansion of 
     public and private plants, Government-owned equipment and 
     installation thereof in such plants, erection of structures, 
     and acquisition of land, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     reserve plant and Government and contractor-owned equipment 
     layaway; and other expenses necessary for the foregoing 
     purposes including rents and transportation of things, 
     $16,553,196,000 (increased by $16,000,000), to remain 
     available for obligation until September 30, 2020.

                     Missile Procurement, Air Force

       For construction, procurement, and modification of 
     missiles, rockets, and related equipment, including spare 
     parts and accessories therefor; ground handling equipment, 
     and training devices; expansion of public and private plants, 
     Government-owned equipment and installation thereof in such 
     plants, erection of structures, and acquisition of land, for 
     the foregoing purposes, and such lands and interests therein, 
     may be acquired, and construction prosecuted thereon prior to 
     approval of title; reserve plant and Government and 
     contractor-owned equipment layaway; and other expenses 
     necessary for the foregoing purposes including rents and 
     transportation of things, $2,203,101,000, to remain available 
     for obligation until September 30, 2020.

                      Space Procurement, Air Force

       For construction, procurement, and modification of 
     spacecraft, rockets, and related equipment, including spare 
     parts and accessories therefor; ground handling equipment, 
     and training devices; expansion of public and private plants, 
     Government-owned equipment and installation thereof in such 
     plants, erection of structures, and acquisition of land, for 
     the foregoing purposes, and such lands and interests therein, 
     may be acquired, and construction prosecuted thereon prior to 
     approval of title; reserve plant and Government and 
     contractor-owned equipment layaway; and other expenses 
     necessary for the foregoing purposes including rents and 
     transportation of things, $3,210,355,000, to remain available 
     for obligation until September 30, 2020.

                  Procurement of Ammunition, Air Force

       For construction, procurement, production, and modification 
     of ammunition, and accessories therefor; specialized 
     equipment and training devices; expansion of public and 
     private plants, including ammunition facilities, authorized 
     by section 2854 of title 10, United States Code, and the land 
     necessary therefor, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon prior to approval of title; 
     and procurement and installation of equipment, appliances, 
     and machine tools in public and private plants; reserve plant 
     and Government and contractor-owned equipment layaway; and 
     other expenses necessary for the foregoing purposes, 
     $1,316,977,000, to remain available for obligation until 
     September 30, 2020.

                      Other Procurement, Air Force

       For procurement and modification of equipment (including 
     ground guidance and electronic control equipment, and ground 
     electronic and communication equipment), and supplies, 
     materials, and spare parts therefor, not otherwise provided 
     for; the purchase of passenger motor vehicles for replacement 
     only; lease of passenger motor vehicles; and expansion of 
     public and private plants, Government-owned equipment and 
     installation thereof in such plants, erection of structures, 
     and acquisition of land, for the foregoing purposes, and such 
     lands and interests therein, may be acquired, and 
     construction prosecuted thereon, prior to approval of title; 
     reserve plant and Government and contractor-owned equipment 
     layaway, $19,318,814,000, to remain available for obligation 
     until September 30, 2020.

                       Procurement, Defense-Wide

       For expenses of activities and agencies of the Department 
     of Defense (other than the military departments) necessary 
     for procurement, production, and modification of equipment, 
     supplies, materials, and spare parts therefor, not otherwise 
     provided for; the purchase of passenger motor vehicles for 
     replacement only; expansion of public and private plants, 
     equipment, and installation thereof in such plants, erection 
     of structures, and acquisition of land for the foregoing 
     purposes, and such lands and interests therein, may be 
     acquired, and construction prosecuted thereon prior to 
     approval of title; reserve plant and Government and 
     contractor-owned equipment layaway, $5,239,239,000 (reduced 
     by $10,000,000), to remain available for obligation until 
     September 30, 2020.

                    Defense Production Act Purchases

       For activities by the Department of Defense pursuant to 
     sections 108, 301, 302, and 303 of the Defense Production Act 
     of 1950 (50 U.S.C. 4518, 4531, 4532, and 4533), $67,401,000, 
     to remain available until expended.

             Procurement, National Defense Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $12,622,931,000, for the ``Procurement, 
     National Defense Restoration Fund'': Provided, That such 
     funds provided under this heading shall only be available for 
     programs, projects and activities necessary to implement the 
     2018 National Defense Strategy: Provided further, That such 
     funds shall not be available for transfer until 30 days after 
     the Secretary has submitted, and the congressional defense 
     committees have approved, the proposed allocation plan for 
     the use of such funds to implement such strategy: Provided 
     further, That such allocation plan shall include a detailed 
     justification for the use of such funds and a description of 
     how such investments are necessary to implement the strategy: 
     Provided further, That the Secretary of Defense may transfer 
     these funds only to procurement accounts: Provided further, 
     That the funds transferred shall be merged with and shall be 
     available for the same purposes and for the same time period, 
     as the appropriation to which transferred: Provided further, 
     That none of the funds made available under this heading may 
     be transferred to any program, project, or activity 
     specifically limited or denied by this Act, except for 
     missile defense requirements resulting from urgent or 
     emergent operational needs: Provided further, That the 
     transfer authority provided under this heading is in addition 
     to any other transfer authority available to the Department 
     of Defense.

                                TITLE IV

               RESEARCH, DEVELOPMENT, TEST AND EVALUATION

            Research, Development, Test and Evaluation, Army

       For expenses necessary for basic and applied scientific 
     research, development, test and evaluation, including 
     maintenance, rehabilitation, lease, and operation of 
     facilities and equipment, $9,674,222,000 (increased by 
     $6,000,000) (increased by $4,000,000) (increased by 
     $12,000,000) (increased by $5,000,000), to remain available 
     for obligation until September 30, 2019.

            Research, Development, Test and Evaluation, Navy

       For expenses necessary for basic and applied scientific 
     research, development, test and evaluation, including 
     maintenance, rehabilitation, lease, and operation of 
     facilities and equipment, $17,196,521,000 (increased by 
     $598,000) (increased by $20,000,000) (reduced by $2,500,000) 
     (increased by $24,000,000), to remain available for 
     obligation until September 30, 2019:  Provided, That funds 
     appropriated in this paragraph which are available for the V-
     22 may be used to meet unique operational requirements of the 
     Special Operations Forces.

         Research, Development, Test and Evaluation, Air Force

       For expenses necessary for basic and applied scientific 
     research, development, test and evaluation, including 
     maintenance, rehabilitation, lease, and operation of 
     facilities and equipment, $33,874,980,000 (increased by 
     $5,000,000) (increased by $6,000,000) (increased by 
     $10,000,000) (reduced by $30,000,000)

[[Page H839]]

     (increased by $30,000,000), to remain available for 
     obligation until September 30, 2019.

        Research, Development, Test and Evaluation, Defense-Wide

                     (including transfer of funds)

       For expenses of activities and agencies of the Department 
     of Defense (other than the military departments), necessary 
     for basic and applied scientific research, development, test 
     and evaluation; advanced research projects as may be 
     designated and determined by the Secretary of Defense, 
     pursuant to law; maintenance, rehabilitation, lease, and 
     operation of facilities and equipment, $20,698,353,000 
     (reduced by $16,000,000) (reduced by $12,000,000) (reduced by 
     $2,500,000) (reduced by $12,500,000) (increased by 
     $20,000,000) (reduced by $20,000,000) (reduced by $4,135,000) 
     (increased by $4,135,000) (reduced by $27,500,000) (increased 
     by $10,000,000), to remain available for obligation until 
     September 30, 2019:  Provided, That, of the funds made 
     available in this paragraph, $250,000,000 for the Defense 
     Rapid Innovation Program shall only be available for 
     expenses, not otherwise provided for, to include program 
     management and oversight, to conduct research, development, 
     test and evaluation to include proof of concept 
     demonstration; engineering, testing, and validation; and 
     transition to full-scale production:  Provided further, That 
     the Secretary of Defense may transfer funds provided herein 
     for the Defense Rapid Innovation Program to appropriations 
     for research, development, test and evaluation to accomplish 
     the purpose provided herein:  Provided further, That this 
     transfer authority is in addition to any other transfer 
     authority available to the Department of Defense:  Provided 
     further, That the Secretary of Defense shall, not fewer than 
     30 days prior to making transfers from this appropriation, 
     notify the congressional defense committees in writing of the 
     details of any such transfer.

                Operational Test and Evaluation, Defense

       For expenses, not otherwise provided for, necessary for the 
     independent activities of the Director, Operational Test and 
     Evaluation, in the direction and supervision of operational 
     test and evaluation, including initial operational test and 
     evaluation which is conducted prior to, and in support of, 
     production decisions; joint operational testing and 
     evaluation; and administrative expenses in connection 
     therewith, $210,900,000, to remain available for obligation 
     until September 30, 2019.

     Research, Development, Test and Evaluation, National Defense 
                            Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $1,000,000,000, for the ``Research, 
     Development, Test and Evaluation, National Defense 
     Restoration Fund'': Provided, That such funds provided under 
     this heading shall only be available for programs, projects 
     and activities necessary to implement the 2018 National 
     Defense Strategy: Provided further, That such funds shall not 
     be available for transfer until 30 days after the Secretary 
     has submitted, and the congressional defense committees have 
     approved, the proposed allocation plan for the use of such 
     funds to implement such strategy: Provided further, That such 
     allocation plan shall include a detailed justification for 
     the use of such funds and a description of how such 
     investments are necessary to implement the strategy: Provided 
     further, That the Secretary of Defense may transfer these 
     funds only to research, development, test and evaluation 
     accounts: Provided further, That the funds transferred shall 
     be merged with and shall be available for the same purposes 
     and for the same time period, as the appropriation to which 
     transferred: Provided further, That none of the funds made 
     available under this heading may be transferred to any 
     program, project, or activity specifically limited or denied 
     by this Act, except for missile defense requirements 
     resulting from urgent or emergent operational needs: Provided 
     further, That the transfer authority provided under this 
     heading is in addition to any other transfer authority 
     available to the Department of Defense.

                                TITLE V

                     REVOLVING AND MANAGEMENT FUNDS

                     Defense Working Capital Funds

       For the Defense Working Capital Funds, $1,586,596,000.

                                TITLE VI

                  OTHER DEPARTMENT OF DEFENSE PROGRAMS

                         Defense Health Program

       For expenses, not otherwise provided for, for medical and 
     health care programs of the Department of Defense as 
     authorized by law, $33,931,566,000 (increased by $7,000,000) 
     (increased by $1,000,000) (increased by $10,000,000) 
     (increased by $2,000,000) (increased by $2,000,000) 
     (increased by $10,000,000) (increased by $5,000,000) 
     (increased by $10,000,000); of which $31,735,923,000 
     (increased by $2,000,000) (increased by $5,000,000) shall be 
     for operation and maintenance, of which not to exceed one 
     percent shall remain available for obligation until September 
     30, 2019, and of which up to $15,349,700,000 may be available 
     for contracts entered into under the TRICARE program; of 
     which $895,328,000, to remain available for obligation until 
     September 30, 2020, shall be for procurement; and of which 
     $1,300,315,000 (increased by $7,000,000) (increased by 
     $1,000,000) (increased by $10,000,000) (increased by 
     $2,000,000) (increased by $10,000,000) (increased by 
     $10,000,000), to remain available for obligation until 
     September 30, 2019, shall be for research, development, test 
     and evaluation:  Provided, That, notwithstanding any other 
     provision of law, of the amount made available under this 
     heading for research, development, test and evaluation, not 
     less than $8,000,000 shall be available for HIV prevention 
     educational activities undertaken in connection with United 
     States military training, exercises, and humanitarian 
     assistance activities conducted primarily in African nations: 
      Provided further, That of the funds provided under this 
     heading for research, development, test and evaluation, not 
     less than $627,100,000 shall be made available to the United 
     States Army Medical Research and Materiel Command to carry 
     out the congressionally directed medical research programs.

           Chemical Agents and Munitions Destruction, Defense

       For expenses, not otherwise provided for, necessary for the 
     destruction of the United States stockpile of lethal chemical 
     agents and munitions in accordance with the provisions of 
     section 1412 of the Department of Defense Authorization Act, 
     1986 (50 U.S.C. 1521), and for the destruction of other 
     chemical warfare materials that are not in the chemical 
     weapon stockpile, $961,732,000, of which $104,237,000 shall 
     be for operation and maintenance, of which no less than 
     $49,401,000 shall be for the Chemical Stockpile Emergency 
     Preparedness Program, consisting of $21,045,000 for 
     activities on military installations and $28,356,000, to 
     remain available until September 30, 2019, to assist State 
     and local governments; $18,081,000 shall be for procurement, 
     to remain available until September 30, 2020, of which 
     $18,081,000 shall be for the Chemical Stockpile Emergency 
     Preparedness Program to assist State and local governments; 
     and $839,414,000, to remain available until September 30, 
     2019, shall be for research, development, test and 
     evaluation, of which $750,700,000 shall only be for the 
     Assembled Chemical Weapons Alternatives program.

         Drug Interdiction and Counter-Drug Activities, Defense

                     (including transfer of funds)

       For drug interdiction and counter-drug activities of the 
     Department of Defense, for transfer to appropriations 
     available to the Department of Defense for military personnel 
     of the reserve components serving under the provisions of 
     title 10 and title 32, United States Code; for operation and 
     maintenance; for procurement; and for research, development, 
     test and evaluation, $854,814,000, of which $532,648,000 
     shall be for counter-narcotics support; $120,813,000 shall be 
     for the drug demand reduction program; and $201,353,000 shall 
     be for the National Guard counter-drug program:  Provided, 
     That the funds appropriated under this heading shall be 
     available for obligation for the same time period and for the 
     same purpose as the appropriation to which transferred:  
     Provided further, That upon a determination that all or part 
     of the funds transferred from this appropriation are not 
     necessary for the purposes provided herein, such amounts may 
     be transferred back to this appropriation:  Provided further, 
     That the transfer authority provided under this heading is in 
     addition to any other transfer authority contained elsewhere 
     in this Act.

                    Office of the Inspector General

       For expenses and activities of the Office of the Inspector 
     General in carrying out the provisions of the Inspector 
     General Act of 1978, as amended, $336,887,000, of which 
     $334,087,000 shall be for operation and maintenance, of which 
     not to exceed $700,000 is available for emergencies and 
     extraordinary expenses to be expended on the approval or 
     authority of the Inspector General, and payments may be made 
     on the Inspector General's certificate of necessity for 
     confidential military purposes; and of which $2,800,000, to 
     remain available until September 30, 2019, shall be for 
     research, development, test and evaluation.

                               TITLE VII

                            RELATED AGENCIES

   Central Intelligence Agency Retirement and Disability System Fund

       For payment to the Central Intelligence Agency Retirement 
     and Disability System Fund, to maintain the proper funding 
     level for continuing the operation of the Central 
     Intelligence Agency Retirement and Disability System, 
     $514,000,000.

               Intelligence Community Management Account

       For necessary expenses of the Intelligence Community 
     Management Account, $522,100,000.

                               TITLE VIII

                           GENERAL PROVISIONS

       Sec. 1101.  No part of any appropriation contained in this 
     Act shall be used for publicity or propaganda purposes not 
     authorized by the Congress.
       Sec. 1102.  During the current fiscal year, provisions of 
     law prohibiting the payment of compensation to, or employment 
     of, any person not a citizen of the United States shall not 
     apply to personnel of the Department of Defense:  Provided, 
     That salary increases granted to direct and indirect hire 
     foreign national employees of the Department of Defense 
     funded by this Act shall not be at a

[[Page H840]]

     rate in excess of the percentage increase authorized by law 
     for civilian employees of the Department of Defense whose pay 
     is computed under the provisions of section 5332 of title 5, 
     United States Code, or at a rate in excess of the percentage 
     increase provided by the appropriate host nation to its own 
     employees, whichever is higher:  Provided further, That this 
     section shall not apply to Department of Defense foreign 
     service national employees serving at United States 
     diplomatic missions whose pay is set by the Department of 
     State under the Foreign Service Act of 1980:  Provided 
     further, That the limitations of this provision shall not 
     apply to foreign national employees of the Department of 
     Defense in the Republic of Turkey.
       Sec. 1103.  No part of any appropriation contained in this 
     Act shall remain available for obligation beyond the current 
     fiscal year, unless expressly so provided herein.
       Sec. 1104.  No more than 20 percent of the appropriations 
     in this Act which are limited for obligation during the 
     current fiscal year shall be obligated during the last 2 
     months of the fiscal year:  Provided, That this section shall 
     not apply to obligations for support of active duty training 
     of reserve components or summer camp training of the Reserve 
     Officers' Training Corps.

                          (transfer of funds)

       Sec. 1105.  Upon determination by the Secretary of Defense 
     that such action is necessary in the national interest, he 
     may, with the approval of the Office of Management and 
     Budget, transfer not to exceed $4,500,000,000 of working 
     capital funds of the Department of Defense or funds made 
     available in this Act to the Department of Defense for 
     military functions (except military construction) between 
     such appropriations or funds or any subdivision thereof, to 
     be merged with and to be available for the same purposes, and 
     for the same time period, as the appropriation or fund to 
     which transferred:  Provided, That such authority to transfer 
     may not be used unless for higher priority items, based on 
     unforeseen military requirements, than those for which 
     originally appropriated and in no case where the item for 
     which funds are requested has been denied by the Congress:  
     Provided further, That the Secretary of Defense shall notify 
     the Congress promptly of all transfers made pursuant to this 
     authority or any other authority in this Act:  Provided 
     further, That no part of the funds in this Act shall be 
     available to prepare or present a request to the Committees 
     on Appropriations for reprogramming of funds, unless for 
     higher priority items, based on unforeseen military 
     requirements, than those for which originally appropriated 
     and in no case where the item for which reprogramming is 
     requested has been denied by the Congress:  Provided further, 
     That a request for multiple reprogrammings of funds using 
     authority provided in this section shall be made prior to 
     June 30, 2017:  Provided further, That transfers among 
     military personnel appropriations shall not be taken into 
     account for purposes of the limitation on the amount of funds 
     that may be transferred under this section.
       Sec. 1106. (a) With regard to the list of specific 
     programs, projects, and activities (and the dollar amounts 
     and adjustments to budget activities corresponding to such 
     programs, projects, and activities) contained in the tables 
     titled Explanation of Project Level Adjustments in the 
     explanatory statement regarding this Act, the obligation and 
     expenditure of amounts appropriated or otherwise made 
     available in this Act for those programs, projects, and 
     activities for which the amounts appropriated exceed the 
     amounts requested are hereby required by law to be carried 
     out in the manner provided by such tables to the same extent 
     as if the tables were included in the text of this Act.
       (b) Amounts specified in the referenced tables described in 
     subsection (a) shall not be treated as subdivisions of 
     appropriations for purposes of section 8005 of this Act:  
     Provided, That section 8005 shall apply when transfers of the 
     amounts described in subsection (a) occur between 
     appropriation accounts.
       Sec. 1107. (a) Not later than 60 days after enactment of 
     this Act, the Department of Defense shall submit a report to 
     the congressional defense committees to establish the 
     baseline for application of reprogramming and transfer 
     authorities for fiscal year 2018:  Provided, That the report 
     shall include--
       (1) a table for each appropriation with a separate column 
     to display the President's budget request, adjustments made 
     by Congress, adjustments due to enacted rescissions, if 
     appropriate, and the fiscal year enacted level;
       (2) a delineation in the table for each appropriation both 
     by budget activity and program, project, and activity as 
     detailed in the Budget Appendix; and
       (3) an identification of items of special congressional 
     interest.
       (b) Notwithstanding section 8005 of this Act, none of the 
     funds provided in this Act shall be available for 
     reprogramming or transfer until the report identified in 
     subsection (a) is submitted to the congressional defense 
     committees, unless the Secretary of Defense certifies in 
     writing to the congressional defense committees that such 
     reprogramming or transfer is necessary as an emergency 
     requirement:  Provided, That this subsection shall not apply 
     to transfers from the following appropriations accounts:
       (1) ``Environmental Restoration, Army'';
       (2) ``Environmental Restoration, Navy'' ;
       (3) ``Environmental Restoration, Air Force'';
       (4) ``Environmental Restoration, Defense-Wide''
       (5) ``Environmental Restoration, Formerly Used Defense 
     Sites''; and
       (6) ``Drug Interdiction and Counter-drug Activities, 
     Defense''.

                          (transfer of funds)

       Sec. 1108.  During the current fiscal year, cash balances 
     in working capital funds of the Department of Defense 
     established pursuant to section 2208 of title 10, United 
     States Code, may be maintained in only such amounts as are 
     necessary at any time for cash disbursements to be made from 
     such funds:  Provided, That transfers may be made between 
     such funds:  Provided further, That transfers may be made 
     between working capital funds and the ``Foreign Currency 
     Fluctuations, Defense'' appropriation and the ``Operation and 
     Maintenance'' appropriation accounts in such amounts as may 
     be determined by the Secretary of Defense, with the approval 
     of the Office of Management and Budget, except that such 
     transfers may not be made unless the Secretary of Defense has 
     notified the Congress of the proposed transfer:  Provided 
     further, That except in amounts equal to the amounts 
     appropriated to working capital funds in this Act, no 
     obligations may be made against a working capital fund to 
     procure or increase the value of war reserve material 
     inventory, unless the Secretary of Defense has notified the 
     Congress prior to any such obligation.
       Sec. 1109.  Funds appropriated by this Act may not be used 
     to initiate a special access program without prior 
     notification 30 calendar days in advance to the congressional 
     defense committees.
       Sec. 1110.  None of the funds provided in this Act shall be 
     available to initiate: (1) a multiyear contract that employs 
     economic order quantity procurement in excess of $20,000,000 
     in any one year of the contract or that includes an unfunded 
     contingent liability in excess of $20,000,000; or (2) a 
     contract for advance procurement leading to a multiyear 
     contract that employs economic order quantity procurement in 
     excess of $20,000,000 in any one year, unless the 
     congressional defense committees have been notified at least 
     30 days in advance of the proposed contract award:  Provided, 
     That no part of any appropriation contained in this Act shall 
     be available to initiate a multiyear contract for which the 
     economic order quantity advance procurement is not funded at 
     least to the limits of the Government's liability:  Provided 
     further, That no part of any appropriation contained in this 
     Act shall be available to initiate multiyear procurement 
     contracts for any systems or component thereof if the value 
     of the multiyear contract would exceed $500,000,000 unless 
     specifically provided in this Act:  Provided further, That no 
     multiyear procurement contract can be terminated without 30-
     day prior notification to the congressional defense 
     committees:  Provided further, That the execution of 
     multiyear authority shall require the use of a present value 
     analysis to determine lowest cost compared to an annual 
     procurement:  Provided further, That none of the funds 
     provided in this Act may be used for a multiyear contract 
     executed after the date of the enactment of this Act unless 
     in the case of any such contract--
       (1) the Secretary of Defense has submitted to Congress a 
     budget request for full funding of units to be procured 
     through the contract and, in the case of a contract for 
     procurement of aircraft, that includes, for any aircraft unit 
     to be procured through the contract for which procurement 
     funds are requested in that budget request for production 
     beyond advance procurement activities in the fiscal year 
     covered by the budget, full funding of procurement of such 
     unit in that fiscal year;
       (2) cancellation provisions in the contract do not include 
     consideration of recurring manufacturing costs of the 
     contractor associated with the production of unfunded units 
     to be delivered under the contract;
       (3) the contract provides that payments to the contractor 
     under the contract shall not be made in advance of incurred 
     costs on funded units; and
       (4) the contract does not provide for a price adjustment 
     based on a failure to award a follow-on contract.

     Funds appropriated in title III of this Act may be used, 
     subject to section 2306b of title 10 , United States Code, 
     for multiyear procurement contracts as follows: V-22 Osprey 
     aircraft variants; up to 13 SSN Virginia Class Submarines and 
     Government-furnished equipment; and DDG-51 Arleigh Burke 
     class Flight III guided missile destroyers, the MK 41 
     Vertical Launching Systems, and associated Government-
     furnished systems and subsystems.
       Sec. 1111.  Within the funds appropriated for the operation 
     and maintenance of the Armed Forces, funds are hereby 
     appropriated pursuant to section 401 of title 10, United 
     States Code, for humanitarian and civic assistance costs 
     under chapter 20 of title 10, United States Code. Such funds 
     may also be obligated for humanitarian and civic assistance 
     costs incidental to authorized operations and pursuant to 
     authority granted in section 401 of chapter 20 of title 10, 
     United States Code, and these obligations shall be reported 
     as required by section 401(d) of title 10, United States 
     Code:  Provided, That funds available for operation and 
     maintenance shall be available for providing humanitarian and 
     similar assistance by using Civic

[[Page H841]]

     Action Teams in the Trust Territories of the Pacific Islands 
     and freely associated states of Micronesia, pursuant to the 
     Compact of Free Association as authorized by Public Law 99-
     239:  Provided further, That upon a determination by the 
     Secretary of the Army that such action is beneficial for 
     graduate medical education programs conducted at Army medical 
     facilities located in Hawaii, the Secretary of the Army may 
     authorize the provision of medical services at such 
     facilities and transportation to such facilities, on a 
     nonreimbursable basis, for civilian patients from American 
     Samoa, the Commonwealth of the Northern Mariana Islands, the 
     Marshall Islands, the Federated States of Micronesia, Palau, 
     and Guam.
       Sec. 1112. (a) During the current fiscal year, the civilian 
     personnel of the Department of Defense may not be managed on 
     the basis of any end-strength, and the management of such 
     personnel during that fiscal year shall not be subject to any 
     constraint or limitation (known as an end-strength) on the 
     number of such personnel who may be employed on the last day 
     of such fiscal year.
       (b) The fiscal year 2019 budget request for the Department 
     of Defense as well as all justification material and other 
     documentation supporting the fiscal year 2019 Department of 
     Defense budget request shall be prepared and submitted to the 
     Congress as if subsections (a) and (b) of this provision were 
     effective with regard to fiscal year 2019.
       (c) As required by section 1107 of the National Defense 
     Authorization Act for Fiscal Year 2014 (Public Law 113-66; 10 
     U.S.C. 2358 note) civilian personnel at the Department of 
     Army Science and Technology Reinvention Laboratories may not 
     be managed on the basis of the Table of Distribution and 
     Allowances, and the management of the workforce strength 
     shall be done in a manner consistent with the budget 
     available with respect to such Laboratories.
       (d) Nothing in this section shall be construed to apply to 
     military (civilian) technicians.
       Sec. 1113.  None of the funds made available by this Act 
     shall be used in any way, directly or indirectly, to 
     influence congressional action on any legislation or 
     appropriation matters pending before the Congress.
       Sec. 1114.  None of the funds appropriated by this Act 
     shall be available for the basic pay and allowances of any 
     member of the Army participating as a full-time student and 
     receiving benefits paid by the Secretary of Veterans Affairs 
     from the Department of Defense Education Benefits Fund when 
     time spent as a full-time student is credited toward 
     completion of a service commitment:  Provided, That this 
     section shall not apply to those members who have reenlisted 
     with this option prior to October 1, 1987:  Provided further, 
     That this section applies only to active components of the 
     Army.

                          (transfer of funds)

       Sec. 1115.  Funds appropriated in title III of this Act for 
     the Department of Defense Pilot Mentor-Protege Program may be 
     transferred to any other appropriation contained in this Act 
     solely for the purpose of implementing a Mentor-Protege 
     Program developmental assistance agreement pursuant to 
     section 831 of the National Defense Authorization Act for 
     Fiscal Year 1991 (Public Law 101-510; 10 U.S.C. 2302 note), 
     as amended, under the authority of this provision or any 
     other transfer authority contained in this Act.
       Sec. 1116.  None of the funds in this Act may be available 
     for the purchase by the Department of Defense (and its 
     departments and agencies) of welded shipboard anchor and 
     mooring chain 4 inches in diameter and under unless the 
     anchor and mooring chain are manufactured in the United 
     States from components which are substantially manufactured 
     in the United States:  Provided, That for the purpose of this 
     section, the term ``manufactured'' shall include cutting, 
     heat treating, quality control, testing of chain and welding 
     (including the forging and shot blasting process):  Provided 
     further, That for the purpose of this section substantially 
     all of the components of anchor and mooring chain shall be 
     considered to be produced or manufactured in the United 
     States if the aggregate cost of the components produced or 
     manufactured in the United States exceeds the aggregate cost 
     of the components produced or manufactured outside the United 
     States:  Provided further, That when adequate domestic 
     supplies are not available to meet Department of Defense 
     requirements on a timely basis, the Secretary of the service 
     responsible for the procurement may waive this restriction on 
     a case-by-case basis by certifying in writing to the 
     Committees on Appropriations that such an acquisition must be 
     made in order to acquire capability for national security 
     purposes.
       Sec. 1117.  None of the funds available to the Department 
     of Defense may be used to demilitarize or dispose of M-1 
     Carbines, M-1 Garand rifles, M-14 rifles, .22 caliber rifles, 
     .30 caliber rifles, or M-1911 pistols, or to demilitarize or 
     destroy small arms ammunition or ammunition components that 
     are not otherwise prohibited from commercial sale under 
     Federal law, unless the small arms ammunition or ammunition 
     components are certified by the Secretary of the Army or 
     designee as unserviceable or unsafe for further use.
       Sec. 1118.  No more than $500,000 of the funds appropriated 
     or made available in this Act shall be used during a single 
     fiscal year for any single relocation of an organization, 
     unit, activity or function of the Department of Defense into 
     or within the National Capital Region:  Provided, That the 
     Secretary of Defense may waive this restriction on a case-by-
     case basis by certifying in writing to the congressional 
     defense committees that such a relocation is required in the 
     best interest of the Government.
       Sec. 1119.  Of the funds made available in this Act, 
     $20,000,000 shall be available for incentive payments 
     authorized by section 504 of the Indian Financing Act of 1974 
     (25 U.S.C. 1544):  Provided, That a prime contractor or a 
     subcontractor at any tier that makes a subcontract award to 
     any subcontractor or supplier as defined in section 1544 of 
     title 25, United States Code, or a small business owned and 
     controlled by an individual or individuals defined under 
     section 4221(9) of title 25, United States Code, shall be 
     considered a contractor for the purposes of being allowed 
     additional compensation under section 504 of the Indian 
     Financing Act of 1974 (25 U.S.C. 1544) whenever the prime 
     contract or subcontract amount is over $500,000 and involves 
     the expenditure of funds appropriated by an Act making 
     appropriations for the Department of Defense with respect to 
     any fiscal year:  Provided further, That notwithstanding 
     section 1906 of title 41, United States Code, this section 
     shall be applicable to any Department of Defense acquisition 
     of supplies or services, including any contract and any 
     subcontract at any tier for acquisition of commercial items 
     produced or manufactured, in whole or in part, by any 
     subcontractor or supplier defined in section 1544 of title 
     25, United States Code, or a small business owned and 
     controlled by an individual or individuals defined under 
     section 4221(9) of title 25, United States Code.
       Sec. 1120.  Funds appropriated by this Act for the Defense 
     Media Activity shall not be used for any national or 
     international political or psychological activities.
       Sec. 1121.  During the current fiscal year, the Department 
     of Defense is authorized to incur obligations of not to 
     exceed $350,000,000 for purposes specified in section 
     2350j(c) of title 10, United States Code, in anticipation of 
     receipt of contributions, only from the Government of Kuwait, 
     under that section:  Provided, That, upon receipt, such 
     contributions from the Government of Kuwait shall be credited 
     to the appropriations or fund which incurred such 
     obligations.
       Sec. 1122. (a) Of the funds made available in this Act, not 
     less than $43,100,000 shall be available for the Civil Air 
     Patrol Corporation, of which--
       (1) $30,800,000 shall be available from ``Operation and 
     Maintenance, Air Force'' to support Civil Air Patrol 
     Corporation operation and maintenance, readiness, counter-
     drug activities, and drug demand reduction activities 
     involving youth programs;
       (2) $10,600,000 shall be available from ``Aircraft 
     Procurement, Air Force''; and
       (3) $1,700,000 shall be available from ``Other Procurement, 
     Air Force'' for vehicle procurement.
       (b) The Secretary of the Air Force should waive 
     reimbursement for any funds used by the Civil Air Patrol for 
     counter-drug activities in support of Federal, State, and 
     local government agencies.
       Sec. 1123. (a) None of the funds appropriated in this Act 
     are available to establish a new Department of Defense 
     (department) federally funded research and development center 
     (FFRDC), either as a new entity, or as a separate entity 
     administrated by an organization managing another FFRDC, or 
     as a nonprofit membership corporation consisting of a 
     consortium of other FFRDCs and other nonprofit entities.
       (b) No member of a Board of Directors, Trustees, Overseers, 
     Advisory Group, Special Issues Panel, Visiting Committee, or 
     any similar entity of a defense FFRDC, and no paid consultant 
     to any defense FFRDC, except when acting in a technical 
     advisory capacity, may be compensated for his or her services 
     as a member of such entity, or as a paid consultant by more 
     than one FFRDC in a fiscal year:  Provided, That a member of 
     any such entity referred to previously in this subsection 
     shall be allowed travel expenses and per diem as authorized 
     under the Federal Joint Travel Regulations, when engaged in 
     the performance of membership duties.
       (c) Notwithstanding any other provision of law, none of the 
     funds available to the department from any source during the 
     current fiscal year may be used by a defense FFRDC, through a 
     fee or other payment mechanism, for construction of new 
     buildings not located on a military installation, for payment 
     of cost sharing for projects funded by Government grants, for 
     absorption of contract overruns, or for certain charitable 
     contributions, not to include employee participation in 
     community service and/or development.
       (d) Notwithstanding any other provision of law, of the 
     funds available to the department during fiscal year 2018, 
     not more than 6,000 staff years of technical effort (staff 
     years) may be funded for defense FFRDCs:  Provided, That, of 
     the specific amount referred to previously in this 
     subsection, not more than 1,180 staff years may be funded for 
     the defense studies and analysis FFRDCs:  Provided further, 
     That this subsection shall not apply to staff years funded in 
     the National Intelligence Program (NIP) and the Military 
     Intelligence Program (MIP).
       (e) The Secretary of Defense shall, with the submission of 
     the department's fiscal year 2019 budget request, submit a 
     report presenting the specific amounts of staff years of 
     technical effort to be allocated for each defense FFRDC 
     during that fiscal year and the associated budget estimates.
       (f) Notwithstanding any other provision of this Act, the 
     total amount appropriated in

[[Page H842]]

     this Act for FFRDCs is hereby reduced by $210,000,000.
       Sec. 1124.  None of the funds appropriated or made 
     available in this Act shall be used to procure carbon, alloy, 
     or armor steel plate for use in any Government-owned facility 
     or property under the control of the Department of Defense 
     which were not melted and rolled in the United States or 
     Canada:  Provided, That these procurement restrictions shall 
     apply to any and all Federal Supply Class 9515, American 
     Society of Testing and Materials (ASTM) or American Iron and 
     Steel Institute (AISI) specifications of carbon, alloy or 
     armor steel plate:  Provided further, That the Secretary of 
     the military department responsible for the procurement may 
     waive this restriction on a case-by-case basis by certifying 
     in writing to the Committees on Appropriations of the House 
     of Representatives and the Senate that adequate domestic 
     supplies are not available to meet Department of Defense 
     requirements on a timely basis and that such an acquisition 
     must be made in order to acquire capability for national 
     security purposes:  Provided further, That these restrictions 
     shall not apply to contracts which are in being as of the 
     date of the enactment of this Act.
       Sec. 1125.  For the purposes of this Act, the term 
     ``congressional defense committees'' means the Armed Services 
     Committee of the House of Representatives, the Armed Services 
     Committee of the Senate, the Subcommittee on Defense of the 
     Committee on Appropriations of the Senate, and the 
     Subcommittee on Defense of the Committee on Appropriations of 
     the House of Representatives.
       Sec. 1126.  During the current fiscal year, the Department 
     of Defense may acquire the modification, depot maintenance 
     and repair of aircraft, vehicles and vessels as well as the 
     production of components and other Defense-related articles, 
     through competition between Department of Defense depot 
     maintenance activities and private firms:  Provided, That the 
     Senior Acquisition Executive of the military department or 
     Defense Agency concerned, with power of delegation, shall 
     certify that successful bids include comparable estimates of 
     all direct and indirect costs for both public and private 
     bids:  Provided further, That Office of Management and Budget 
     Circular A-76 shall not apply to competitions conducted under 
     this section.
       Sec. 1127. (a)(1) If the Secretary of Defense, after 
     consultation with the United States Trade Representative, 
     determines that a foreign country which is party to an 
     agreement described in paragraph (2) has violated the terms 
     of the agreement by discriminating against certain types of 
     products produced in the United States that are covered by 
     the agreement, the Secretary of Defense shall rescind the 
     Secretary's blanket waiver of the Buy American Act with 
     respect to such types of products produced in that foreign 
     country.
       (2) An agreement referred to in paragraph (1) is any 
     reciprocal defense procurement memorandum of understanding, 
     between the United States and a foreign country pursuant to 
     which the Secretary of Defense has prospectively waived the 
     Buy American Act for certain products in that country.
       (b) The Secretary of Defense shall submit to the Congress a 
     report on the amount of Department of Defense purchases from 
     foreign entities in fiscal year 2018. Such report shall 
     separately indicate the dollar value of items for which the 
     Buy American Act was waived pursuant to any agreement 
     described in subsection (a)(2), the Trade Agreement Act of 
     1979 (19 U.S.C. 2501 et seq.), or any international agreement 
     to which the United States is a party.
       (c) For purposes of this section, the term Buy American Act 
     means chapter 83 of title 41, United States Code.
       Sec. 1128.  During the current fiscal year, amounts 
     contained in the Department of Defense Overseas Military 
     Facility Investment Recovery Account established by section 
     2921(c)(1) of the National Defense Authorization Act of 1991 
     (Public Law 101-510; 10 U.S.C. 2687 note) shall be available 
     until expended for the payments specified by section 
     2921(c)(2) of that Act.
       Sec. 1129. (a) Notwithstanding any other provision of law, 
     the Secretary of the Air Force may convey at no cost to the 
     Air Force, without consideration, to Indian tribes located in 
     the States of Nevada, Idaho, North Dakota, South Dakota, 
     Montana, Oregon, Minnesota, and Washington relocatable 
     military housing units located at Grand Forks Air Force Base, 
     Malmstrom Air Force Base, Mountain Home Air Force Base, 
     Ellsworth Air Force Base, and Minot Air Force Base that are 
     excess to the needs of the Air Force.
       (b) The Secretary of the Air Force shall convey, at no cost 
     to the Air Force, military housing units under subsection (a) 
     in accordance with the request for such units that are 
     submitted to the Secretary by the Operation Walking Shield 
     Program on behalf of Indian tribes located in the States of 
     Nevada, Idaho, North Dakota, South Dakota, Montana, Oregon, 
     Minnesota, and Washington. Any such conveyance shall be 
     subject to the condition that the housing units shall be 
     removed within a reasonable period of time, as determined by 
     the Secretary.
       (c) The Operation Walking Shield Program shall resolve any 
     conflicts among requests of Indian tribes for housing units 
     under subsection (a) before submitting requests to the 
     Secretary of the Air Force under subsection (b).
       (d) In this section, the term Indian tribe means any 
     recognized Indian tribe included on the current list 
     published by the Secretary of the Interior under section 104 
     of the Federally Recognized Indian Tribe Act of 1994 (Public 
     Law 103-454; 108 Stat. 4792; 25 U.S.C. 479a-1).
       Sec. 1130.  During the current fiscal year, appropriations 
     which are available to the Department of Defense for 
     operation and maintenance may be used to purchase items 
     having an investment item unit cost of not more than 
     $250,000.
       Sec. 1131.  None of the funds made available by this Act 
     may be used to--
       (1) disestablish, or prepare to disestablish, a Senior 
     Reserve Officers' Training Corps program in accordance with 
     Department of Defense Instruction Number 1215.08, dated June 
     26, 2006; or
       (2) close, downgrade from host to extension center, or 
     place on probation a Senior Reserve Officers' Training Corps 
     program in accordance with the information paper of the 
     Department of the Army titled ``Army Senior Reserve Officers' 
     Training Corps (SROTC) Program Review and Criteria'', dated 
     January 27, 2014.
       Sec. 1132.  The Secretary of Defense shall issue 
     regulations to prohibit the sale of any tobacco or tobacco-
     related products in military resale outlets in the United 
     States, its territories and possessions at a price below the 
     most competitive price in the local community:  Provided, 
     That such regulations shall direct that the prices of tobacco 
     or tobacco-related products in overseas military retail 
     outlets shall be within the range of prices established for 
     military retail system stores located in the United States.
       Sec. 1133. (a) During the current fiscal year, none of the 
     appropriations or funds available to the Department of 
     Defense Working Capital Funds shall be used for the purchase 
     of an investment item for the purpose of acquiring a new 
     inventory item for sale or anticipated sale during the 
     current fiscal year or a subsequent fiscal year to customers 
     of the Department of Defense Working Capital Funds if such an 
     item would not have been chargeable to the Department of 
     Defense Business Operations Fund during fiscal year 1994 and 
     if the purchase of such an investment item would be 
     chargeable during the current fiscal year to appropriations 
     made to the Department of Defense for procurement.
       (b) The fiscal year 2019 budget request for the Department 
     of Defense as well as all justification material and other 
     documentation supporting the fiscal year 2019 Department of 
     Defense budget shall be prepared and submitted to the 
     Congress on the basis that any equipment which was classified 
     as an end item and funded in a procurement appropriation 
     contained in this Act shall be budgeted for in a proposed 
     fiscal year 2019 procurement appropriation and not in the 
     supply management business area or any other area or category 
     of the Department of Defense Working Capital Funds.
       Sec. 1134.  None of the funds appropriated by this Act for 
     programs of the Central Intelligence Agency shall remain 
     available for obligation beyond the current fiscal year, 
     except for funds appropriated for the Reserve for 
     Contingencies, which shall remain available until September 
     30, 2019:  Provided, That funds appropriated, transferred, or 
     otherwise credited to the Central Intelligence Agency Central 
     Services Working Capital Fund during this or any prior or 
     subsequent fiscal year shall remain available until expended: 
      Provided further, That any funds appropriated or transferred 
     to the Central Intelligence Agency for advanced research and 
     development acquisition, for agent operations, and for covert 
     action programs authorized by the President under section 503 
     of the National Security Act of 1947 (50 U.S.C. 3093) shall 
     remain available until September 30, 2019.
       Sec. 1135.  Notwithstanding any other provision of law, 
     funds made available in this Act and hereafter for the 
     Defense Intelligence Agency may be used for the design, 
     development, and deployment of General Defense Intelligence 
     Program intelligence communications and intelligence 
     information systems for the Services, the Unified and 
     Specified Commands, and the component commands.
       Sec. 1136.  Of the funds appropriated to the Department of 
     Defense under the heading ``Operation and Maintenance, 
     Defense-Wide'', not less than $12,000,000 shall be made 
     available only for the mitigation of environmental impacts, 
     including training and technical assistance to tribes, 
     related administrative support, the gathering of information, 
     documenting of environmental damage, and developing a system 
     for prioritization of mitigation and cost to complete 
     estimates for mitigation, on Indian lands resulting from 
     Department of Defense activities.
       Sec. 1137. (a) None of the funds appropriated in this Act 
     may be expended by an entity of the Department of Defense 
     unless the entity, in expending the funds, complies with the 
     Buy American Act. For purposes of this subsection, the term 
     Buy American Act means chapter 83 of title 41, United States 
     Code.
       (b) If the Secretary of Defense determines that a person 
     has been convicted of intentionally affixing a label bearing 
     a ``Made in America'' inscription to any product sold in or 
     shipped to the United States that is not made in America, the 
     Secretary shall determine, in accordance with section 2410f 
     of title 10, United States Code, whether the person should be 
     debarred from contracting with the Department of Defense.
       (c) In the case of any equipment or products purchased with 
     appropriations provided under this Act, it is the sense of 
     the Congress

[[Page H843]]

     that any entity of the Department of Defense, in expending 
     the appropriation, purchase only American-made equipment and 
     products, provided that American-made equipment and products 
     are cost-competitive, quality competitive, and available in a 
     timely fashion.
       Sec. 1138. (a) Except as provided in subsections (b) and 
     (c), none of the funds made available by this Act may be 
     used--
       (1) to establish a field operating agency; or
       (2) to pay the basic pay of a member of the Armed Forces or 
     civilian employee of the department who is transferred or 
     reassigned from a headquarters activity if the member or 
     employee's place of duty remains at the location of that 
     headquarters.
       (b) The Secretary of Defense or Secretary of a military 
     department may waive the limitations in subsection (a), on a 
     case-by-case basis, if the Secretary determines, and 
     certifies to the Committees on Appropriations of the House of 
     Representatives and the Senate that the granting of the 
     waiver will reduce the personnel requirements or the 
     financial requirements of the department.
       (c) This section does not apply to--
       (1) field operating agencies funded within the National 
     Intelligence Program;
       (2) an Army field operating agency established to 
     eliminate, mitigate, or counter the effects of improvised 
     explosive devices, and, as determined by the Secretary of the 
     Army, other similar threats;
       (3) an Army field operating agency established to improve 
     the effectiveness and efficiencies of biometric activities 
     and to integrate common biometric technologies throughout the 
     Department of Defense; or
       (4) an Air Force field operating agency established to 
     administer the Air Force Mortuary Affairs Program and 
     Mortuary Operations for the Department of Defense and 
     authorized Federal entities.
       Sec. 1139. (a) None of the funds appropriated by this Act 
     shall be available to convert to contractor performance an 
     activity or function of the Department of Defense that, on or 
     after the date of the enactment of this Act, is performed by 
     Department of Defense civilian employees unless--
       (1) the conversion is based on the result of a public-
     private competition that includes a most efficient and cost 
     effective organization plan developed by such activity or 
     function;
       (2) the Competitive Sourcing Official determines that, over 
     all performance periods stated in the solicitation of offers 
     for performance of the activity or function, the cost of 
     performance of the activity or function by a contractor would 
     be less costly to the Department of Defense by an amount that 
     equals or exceeds the lesser of--
       (A) 10 percent of the most efficient organization's 
     personnel-related costs for performance of that activity or 
     function by Federal employees; or
       (B) $10,000,000; and
       (3) the contractor does not receive an advantage for a 
     proposal that would reduce costs for the Department of 
     Defense by--
       (A) not making an employer-sponsored health insurance plan 
     available to the workers who are to be employed in the 
     performance of that activity or function under the contract; 
     or
       (B) offering to such workers an employer-sponsored health 
     benefits plan that requires the employer to contribute less 
     towards the premium or subscription share than the amount 
     that is paid by the Department of Defense for health benefits 
     for civilian employees under chapter 89 of title 5, United 
     States Code.
       (b)(1) The Department of Defense, without regard to 
     subsection (a) of this section or subsection (a), (b), or (c) 
     of section 2461 of title 10, United States Code, and 
     notwithstanding any administrative regulation, requirement, 
     or policy to the contrary shall have full authority to enter 
     into a contract for the performance of any commercial or 
     industrial type function of the Department of Defense that--
       (A) is included on the procurement list established 
     pursuant to section 2 of the Javits-Wagner-O'Day Act (section 
     8503 of title 41, United States Code);
       (B) is planned to be converted to performance by a 
     qualified nonprofit agency for the blind or by a qualified 
     nonprofit agency for other severely handicapped individuals 
     in accordance with that Act; or
       (C) is planned to be converted to performance by a 
     qualified firm under at least 51 percent ownership by an 
     Indian tribe, as defined in section 4(e) of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 
     450b(e)), or a Native Hawaiian Organization, as defined in 
     section 8(a)(15) of the Small Business Act (15 U.S.C. 
     637(a)(15)).
       (2) This section shall not apply to depot contracts or 
     contracts for depot maintenance as provided in sections 2469 
     and 2474 of title 10, United States Code.
       (c) The conversion of any activity or function of the 
     Department of Defense under the authority provided by this 
     section shall be credited toward any competitive or 
     outsourcing goal, target, or measurement that may be 
     established by statute, regulation, or policy and is deemed 
     to be awarded under the authority of, and in compliance with, 
     subsection (h) of section 2304 of title 10, United States 
     Code, for the competition or outsourcing of commercial 
     activities.

                             (rescissions)

       Sec. 1140.  Of the funds appropriated in Department of 
     Defense Appropriations Acts, the following funds are hereby 
     rescinded from the following accounts and programs in the 
     specified amounts:  Provided, That no amounts may be 
     rescinded from amounts that were designated by the Congress 
     for Overseas Contingency Operations/Global War on Terrorism 
     or as an emergency requirement pursuant to the Concurrent 
     Resolution on the Budget or the Balanced Budget and Emergency 
     Deficit Control Act of 1985, as amended:
       ``Aircraft Procurement, Navy'', 2016/2018, $274,000,000;
       ``Aircraft Procurement, Air Force'', 2016/2018, 
     $82,700,000;
       ``Missile Procurement, Army'', 2017/2019, $19,319,000;
       ``Procurement of Weapons and Tracked Combat Vehicles, 
     Army'', 2017/2019, $9,764,000;
       ``Other Procurement, Army'', 2017/2019, $10,000,000;
       ``Aircraft Procurement, Navy'', 2017/2019, $105,600,000;
       ``Weapons Procurement, Navy'', 2017/2019, $54,122,000;
       ``Shipbuilding and Conversion, Navy'', 2017/2021, 
     $45,116,000;
       ``Aircraft Procurement, Air Force'', 2017/2019, 
     $63,293,000;
       ``Missile Procurement, Air Force'', 2017/2019, $31,639,000;
       ``Space Procurement, Air Force'', 2017/2019, $15,000,000;
       ``Other Procurement, Air Force'', 2017/2019, $105,000,000;
       ``Research, Development, Test and Evaluation, Navy'', 2017/
     2018, $34,128,000;
       ``Research, Development, Test and Evaluation, Air Force'', 
     2017/2018, $41,700,000.
       Sec. 1141.  None of the funds available in this Act may be 
     used to reduce the authorized positions for military 
     technicians (dual status) of the Army National Guard, Air 
     National Guard, Army Reserve and Air Force Reserve for the 
     purpose of applying any administratively imposed civilian 
     personnel ceiling, freeze, or reduction on military 
     technicians (dual status), unless such reductions are a 
     direct result of a reduction in military force structure.
       Sec. 1142.  None of the funds appropriated or otherwise 
     made available in this Act may be obligated or expended for 
     assistance to the Democratic People's Republic of Korea 
     unless specifically appropriated for that purpose.
       Sec. 1143.  Funds appropriated in this Act for operation 
     and maintenance of the Military Departments, Combatant 
     Commands and Defense Agencies shall be available for 
     reimbursement of pay, allowances and other expenses which 
     would otherwise be incurred against appropriations for the 
     National Guard and Reserve when members of the National Guard 
     and Reserve provide intelligence or counterintelligence 
     support to Combatant Commands, Defense Agencies and Joint 
     Intelligence Activities, including the activities and 
     programs included within the National Intelligence Program 
     and the Military Intelligence Program:  Provided, That 
     nothing in this section authorizes deviation from established 
     Reserve and National Guard personnel and training procedures.
       Sec. 1144. (a) None of the funds available to the 
     Department of Defense for any fiscal year for drug 
     interdiction or counter-drug activities may be transferred to 
     any other department or agency of the United States except as 
     specifically provided in an appropriations law.
       (b) None of the funds available to the Central Intelligence 
     Agency for any fiscal year for drug interdiction or counter-
     drug activities may be transferred to any other department or 
     agency of the United States except as specifically provided 
     in an appropriations law.
       Sec. 1145.  None of the funds appropriated by this Act may 
     be used for the procurement of ball and roller bearings other 
     than those produced by a domestic source and of domestic 
     origin:  Provided, That the Secretary of the military 
     department responsible for such procurement may waive this 
     restriction on a case-by-case basis by certifying in writing 
     to the Committees on Appropriations of the House of 
     Representatives and the Senate, that adequate domestic 
     supplies are not available to meet Department of Defense 
     requirements on a timely basis and that such an acquisition 
     must be made in order to acquire capability for national 
     security purposes:  Provided further, That this restriction 
     shall not apply to the purchase of ``commercial items'', as 
     defined by section 103 of title 41, United States Code, 
     except that the restriction shall apply to ball or roller 
     bearings purchased as end items.
       Sec. 1146.  None of the funds made available by this Act 
     for Evolved Expendable Launch Vehicle service competitive 
     procurements may be used unless the competitive procurements 
     are open for award to all certified providers of Evolved 
     Expendable Launch Vehicle-class systems:  Provided, That the 
     award shall be made to the provider that offers the best 
     value to the government.
       Sec. 1147.  In addition to the amounts appropriated or 
     otherwise made available elsewhere in this Act, $44,000,000 
     is hereby appropriated to the Department of Defense:  
     Provided, That upon the determination of the Secretary of 
     Defense that it shall serve the national interest, the 
     Secretary shall make grants in the amounts specified as 
     follows: $20,000,000 to the United Service Organizations and 
     $24,000,000 to the Red Cross.
       Sec. 1148.  None of the funds in this Act may be used to 
     purchase any supercomputer which is not manufactured in the 
     United States, unless the Secretary of Defense certifies to 
     the congressional defense committees that such an acquisition 
     must be made

[[Page H844]]

     in order to acquire capability for national security purposes 
     that is not available from United States manufacturers.
       Sec. 1149.  Notwithstanding any other provision in this 
     Act, the Small Business Innovation Research program and the 
     Small Business Technology Transfer program set-asides shall 
     be taken proportionally from all programs, projects, or 
     activities to the extent they contribute to the extramural 
     budget.
       Sec. 1150.  None of the funds available to the Department 
     of Defense under this Act shall be obligated or expended to 
     pay a contractor under a contract with the Department of 
     Defense for costs of any amount paid by the contractor to an 
     employee when--
       (1) such costs are for a bonus or otherwise in excess of 
     the normal salary paid by the contractor to the employee; and
       (2) such bonus is part of restructuring costs associated 
     with a business combination.

                     (including transfer of funds)

       Sec. 1151.  During the current fiscal year, no more than 
     $30,000,000 of appropriations made in this Act under the 
     heading ``Operation and Maintenance, Defense-Wide'' may be 
     transferred to appropriations available for the pay of 
     military personnel, to be merged with, and to be available 
     for the same time period as the appropriations to which 
     transferred, to be used in support of such personnel in 
     connection with support and services for eligible 
     organizations and activities outside the Department of 
     Defense pursuant to section 2012 of title 10, United States 
     Code.
       Sec. 1152.  During the current fiscal year, in the case of 
     an appropriation account of the Department of Defense for 
     which the period of availability for obligation has expired 
     or which has closed under the provisions of section 1552 of 
     title 31, United States Code, and which has a negative 
     unliquidated or unexpended balance, an obligation or an 
     adjustment of an obligation may be charged to any current 
     appropriation account for the same purpose as the expired or 
     closed account if--
       (1) the obligation would have been properly chargeable 
     (except as to amount) to the expired or closed account before 
     the end of the period of availability or closing of that 
     account;
       (2) the obligation is not otherwise properly chargeable to 
     any current appropriation account of the Department of 
     Defense; and
       (3) in the case of an expired account, the obligation is 
     not chargeable to a current appropriation of the Department 
     of Defense under the provisions of section 1405(b)(8) of the 
     National Defense Authorization Act for Fiscal Year 1991, 
     Public Law 101-510, as amended (31 U.S.C. 1551 note):  
     Provided, That in the case of an expired account, if 
     subsequent review or investigation discloses that there was 
     not in fact a negative unliquidated or unexpended balance in 
     the account, any charge to a current account under the 
     authority of this section shall be reversed and recorded 
     against the expired account:  Provided further, That the 
     total amount charged to a current appropriation under this 
     section may not exceed an amount equal to 1 percent of the 
     total appropriation for that account.
       Sec. 1153. (a) Notwithstanding any other provision of law, 
     the Chief of the National Guard Bureau may permit the use of 
     equipment of the National Guard Distance Learning Project by 
     any person or entity on a space-available, reimbursable 
     basis. The Chief of the National Guard Bureau shall establish 
     the amount of reimbursement for such use on a case-by-case 
     basis.
       (b) Amounts collected under subsection (a) shall be 
     credited to funds available for the National Guard Distance 
     Learning Project and be available to defray the costs 
     associated with the use of equipment of the project under 
     that subsection. Such funds shall be available for such 
     purposes without fiscal year limitation.
       Sec. 1154.  None of the funds available to the Department 
     of Defense may be obligated to modify command and control 
     relationships to give Fleet Forces Command operational and 
     administrative control of United States Navy forces assigned 
     to the Pacific fleet:  Provided, That the command and control 
     relationships which existed on October 1, 2004, shall remain 
     in force until a written modification has been proposed to 
     the House and Senate Appropriations Committees:  Provided 
     further, That the proposed modification may be implemented 30 
     days after the notification unless an objection is received 
     from either the House or Senate Appropriations Committees:  
     Provided further, That any proposed modification shall not 
     preclude the ability of the commander of United States 
     Pacific Command to meet operational requirements.

                     (including transfer of funds)

       Sec. 1155.  Of the funds appropriated in this Act under the 
     heading ``Operation and Maintenance, Defense-Wide'', 
     $25,000,000 (increased by $10,000,000) shall be for continued 
     implementation and expansion of the Sexual Assault Special 
     Victims' Counsel Program:  Provided, That the funds are made 
     available for transfer to the Department of the Army, the 
     Department of the Navy, and the Department of the Air Force:  
     Provided further, That funds transferred shall be merged with 
     and available for the same purposes and for the same time 
     period as the appropriations to which the funds are 
     transferred:  Provided further, That this transfer authority 
     is in addition to any other transfer authority provided in 
     this Act.
       Sec. 1156.  None of the funds appropriated in title IV of 
     this Act may be used to procure end-items for delivery to 
     military forces for operational training, operational use or 
     inventory requirements:  Provided, That this restriction does 
     not apply to end-items used in development, prototyping, and 
     test activities preceding and leading to acceptance for 
     operational use:  Provided further, That this restriction 
     does not apply to programs funded within the National 
     Intelligence Program:  Provided further, That the Secretary 
     of Defense may waive this restriction on a case-by-case basis 
     by certifying in writing to the Committees on Appropriations 
     of the House of Representatives and the Senate that it is in 
     the national security interest to do so.
       Sec. 1157. (a) The Secretary of Defense may, on a case-by-
     case basis, waive with respect to a foreign country each 
     limitation on the procurement of defense items from foreign 
     sources provided in law if the Secretary determines that the 
     application of the limitation with respect to that country 
     would invalidate cooperative programs entered into between 
     the Department of Defense and the foreign country, or would 
     invalidate reciprocal trade agreements for the procurement of 
     defense items entered into under section 2531 of title 10, 
     United States Code, and the country does not discriminate 
     against the same or similar defense items produced in the 
     United States for that country.
       (b) Subsection (a) applies with respect to--
       (1) contracts and subcontracts entered into on or after the 
     date of the enactment of this Act; and
       (2) options for the procurement of items that are exercised 
     after such date under contracts that are entered into before 
     such date if the option prices are adjusted for any reason 
     other than the application of a waiver granted under 
     subsection (a).
       (c) Subsection (a) does not apply to a limitation regarding 
     construction of public vessels, ball and roller bearings, 
     food, and clothing or textile materials as defined by section 
     XI (chapters 50-65) of the Harmonized Tariff Schedule of the 
     United States and products classified under headings 4010, 
     4202, 4203, 6401 through 6406, 6505, 7019, 7218 through 7229, 
     7304.41 through 7304.49, 7306.40, 7502 through 7508, 8105, 
     8108, 8109, 8211, 8215, and 9404.
       Sec. 1158.  None of the funds appropriated or otherwise 
     made available by this or other Department of Defense 
     Appropriations Acts may be obligated or expended for the 
     purpose of performing repairs or maintenance to military 
     family housing units of the Department of Defense, including 
     areas in such military family housing units that may be used 
     for the purpose of conducting official Department of Defense 
     business.
       Sec. 1159.  Notwithstanding any other provision of law, 
     funds appropriated in this Act under the heading ``Research, 
     Development, Test and Evaluation, Defense-Wide'' for any new 
     start advanced concept technology demonstration project or 
     joint capability demonstration project may only be obligated 
     45 days after a report, including a description of the 
     project, the planned acquisition and transition strategy and 
     its estimated annual and total cost, has been provided in 
     writing to the congressional defense committees:  Provided, 
     That the Secretary of Defense may waive this restriction on a 
     case-by-case basis by certifying to the congressional defense 
     committees that it is in the national interest to do so.
       Sec. 1160.  The Secretary of Defense shall continue to 
     provide a classified quarterly report to the House and Senate 
     Appropriations Committees, Subcommittees on Defense on 
     certain matters as directed in the classified annex 
     accompanying this Act.
       Sec. 1161.  Notwithstanding section 12310(b) of title 10, 
     United States Code, a Reserve who is a member of the National 
     Guard serving on full-time National Guard duty under section 
     502(f) of title 32, United States Code, may perform duties in 
     support of the ground-based elements of the National 
     Ballistic Missile Defense System.
       Sec. 1162.  None of the funds provided in this Act may be 
     used to transfer to any nongovernmental entity ammunition 
     held by the Department of Defense that has a center-fire 
     cartridge and a United States military nomenclature 
     designation of ``armor penetrator'', ``armor piercing (AP)'', 
     ``armor piercing incendiary (API)'', or ``armor-piercing 
     incendiary tracer (API-T)'', except to an entity performing 
     demilitarization services for the Department of Defense under 
     a contract that requires the entity to demonstrate to the 
     satisfaction of the Department of Defense that armor piercing 
     projectiles are either:
       (1) rendered incapable of reuse by the demilitarization 
     process; or
       (2) used to manufacture ammunition pursuant to a contract 
     with the Department of Defense or the manufacture of 
     ammunition for export pursuant to a License for Permanent 
     Export of Unclassified Military Articles issued by the 
     Department of State.
       Sec. 1163.  Notwithstanding any other provision of law, the 
     Chief of the National Guard Bureau, or his designee, may 
     waive payment of all or part of the consideration that 
     otherwise would be required under section 2667 of title 10, 
     United States Code, in the case of a lease of personal 
     property for a period not in excess of 1 year to any 
     organization specified in section 508(d) of title 32, United 
     States Code, or any other youth, social, or fraternal 
     nonprofit organization as may be approved by the Chief of the 
     National Guard Bureau, or his designee, on a case-by-case 
     basis.

                     (including transfer of funds)

       Sec. 1164.  Of the amounts appropriated in this Act under 
     the heading ``Operation and

[[Page H845]]

     Maintenance, Army'', $66,881,780 shall remain available until 
     expended:  Provided, That, notwithstanding any other 
     provision of law, the Secretary of Defense is authorized to 
     transfer such funds to other activities of the Federal 
     Government:  Provided further, That the Secretary of Defense 
     is authorized to enter into and carry out contracts for the 
     acquisition of real property, construction, personal 
     services, and operations related to projects carrying out the 
     purposes of this section:  Provided further, That contracts 
     entered into under the authority of this section may provide 
     for such indemnification as the Secretary determines to be 
     necessary:  Provided further, That projects authorized by 
     this section shall comply with applicable Federal, State, and 
     local law to the maximum extent consistent with the national 
     security, as determined by the Secretary of Defense.
       Sec. 1165. (a) None of the funds appropriated in this or 
     any other Act may be used to take any action to modify--
       (1) the appropriations account structure for the National 
     Intelligence Program budget, including through the creation 
     of a new appropriation or new appropriation account;
       (2) how the National Intelligence Program budget request is 
     presented in the unclassified P-1, R-1, and O-1 documents 
     supporting the Department of Defense budget request;
       (3) the process by which the National Intelligence Program 
     appropriations are apportioned to the executing agencies; or
       (4) the process by which the National Intelligence Program 
     appropriations are allotted, obligated and disbursed.
       (b) Nothing in section (a) shall be construed to prohibit 
     the merger of programs or changes to the National 
     Intelligence Program budget at or below the Expenditure 
     Center level, provided such change is otherwise in accordance 
     with paragraphs (a)(1)-(3).
       (c) The Director of National Intelligence and the Secretary 
     of Defense may jointly, only for the purposes of achieving 
     auditable financial statements and improving fiscal 
     reporting, study and develop detailed proposals for 
     alternative financial management processes. Such study shall 
     include a comprehensive counterintelligence risk assessment 
     to ensure that none of the alternative processes will 
     adversely affect counterintelligence.
       (d) Upon development of the detailed proposals defined 
     under subsection (c), the Director of National Intelligence 
     and the Secretary of Defense shall--
       (1) provide the proposed alternatives to all affected 
     agencies;
       (2) receive certification from all affected agencies 
     attesting that the proposed alternatives will help achieve 
     auditability, improve fiscal reporting, and will not 
     adversely affect counterintelligence; and
       (3) not later than 30 days after receiving all necessary 
     certifications under paragraph (2), present the proposed 
     alternatives and certifications to the congressional defense 
     and intelligence committees.
       Sec. 1166.  In addition to amounts provided elsewhere in 
     this Act, $5,000,000 (increased by $5,000,000) is hereby 
     appropriated to the Department of Defense, to remain 
     available for obligation until expended:  Provided, That 
     notwithstanding any other provision of law, that upon the 
     determination of the Secretary of Defense that it shall serve 
     the national interest, these funds shall be available only 
     for a grant to the Fisher House Foundation, Inc., only for 
     the construction and furnishing of additional Fisher Houses 
     to meet the needs of military family members when confronted 
     with the illness or hospitalization of an eligible military 
     beneficiary.

                     (including transfer of funds)

       Sec. 1167.  Of the amounts appropriated in this Act under 
     the headings ``Procurement, Defense-Wide'' and ``Research, 
     Development, Test and Evaluation, Defense-Wide'', 
     $705,800,000 shall be for the Israeli Cooperative Programs:  
     Provided, That of this amount, $92,000,000 shall be for the 
     Secretary of Defense to provide to the Government of Israel 
     for the procurement of the Iron Dome defense system to 
     counter short-range rocket threats, subject to the U.S.-
     Israel Iron Dome Procurement Agreement, as amended; 
     $221,500,000 shall be for the Short Range Ballistic Missile 
     Defense (SRBMD) program, including cruise missile defense 
     research and development under the SRBMD program, of which 
     $120,000,000 shall be for co-production activities of SRBMD 
     missiles in the United States and in Israel to meet Israel's 
     defense requirements consistent with each nation's laws, 
     regulations, and procedures, subject to the U.S.-Israeli co-
     production agreement for SRBMD, as amended; $205,000,000 
     shall be for an upper-tier component to the Israeli Missile 
     Defense Architecture, of which $120,000,000 shall be for co-
     production activities of Arrow 3 Upper Tier missiles in the 
     United States and in Israel to meet Israel's defense 
     requirements consistent with each nation's laws, regulations, 
     and procedures, subject to the U.S.-Israeli co-production 
     agreement for Arrow 3 Upper Tier, as amended; $105,000,000 
     shall be for testing of the upper-tier component to the 
     Israeli Missile Defense Architecture in the United States; 
     and $82,300,000 shall be for the Arrow System Improvement 
     Program including development of a long range, ground and 
     airborne, detection suite:  Provided further, That the 
     transfer authority provided under this provision is in 
     addition to any other transfer authority contained in this 
     Act.

                     (including transfer of funds)

       Sec. 1168.  Of the amounts appropriated in this Act under 
     the heading ``Shipbuilding and Conversion, Navy'', 
     $117,542,000 shall be available until September 30, 2018, to 
     fund prior year shipbuilding cost increases:  Provided, That 
     upon enactment of this Act, the Secretary of the Navy shall 
     transfer funds to the following appropriations in the amounts 
     specified:  Provided further, That the amounts transferred 
     shall be merged with and be available for the same purposes 
     as the appropriations to which transferred to:
       (1) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2012/2018: Carrier Replacement Program $20,000,000;
       (2) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2008/2018: DDG-51 Destroyer $19,436,000;
       (3) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2012/2018: Littoral Combat Ship $6,394,000;
       (4) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2012/2018: LHA Replacement $14,200,000;
       (5) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2013/2018: DDG-51 Destroyer $31,941,000;
       (6) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2014/2018: Litoral Combat Ship $20,471,000; and
       (7) Under the heading ``Shipbuilding and Conversion, 
     Navy'', 2015/2018: LCAC $5,100,000.
       Sec. 1169.  Funds appropriated by this Act, or made 
     available by the transfer of funds in this Act, for 
     intelligence activities are deemed to be specifically 
     authorized by the Congress for purposes of section 504 of the 
     National Security Act of 1947 (50 U.S.C. 3094) during fiscal 
     year 2018 until the enactment of the Intelligence 
     Authorization Act for Fiscal Year 2018.
       Sec. 1170.  None of the funds provided in this Act shall be 
     available for obligation or expenditure through a 
     reprogramming of funds that creates or initiates a new 
     program, project, or activity unless such program, project, 
     or activity must be undertaken immediately in the interest of 
     national security and only after written prior notification 
     to the congressional defense committees.
       Sec. 1171.  The budget of the President for fiscal year 
     2018 submitted to the Congress pursuant to section 1105 of 
     title 31, United States Code, shall include separate budget 
     justification documents for costs of United States Armed 
     Forces' participation in contingency operations for the 
     Military Personnel accounts, the Operation and Maintenance 
     accounts, the Procurement accounts, and the Research, 
     Development, Test and Evaluation accounts:  Provided, That 
     these documents shall include a description of the funding 
     requested for each contingency operation, for each military 
     service, to include all Active and Reserve components, and 
     for each appropriations account:  Provided further, That 
     these documents shall include estimated costs for each 
     element of expense or object class, a reconciliation of 
     increases and decreases for each contingency operation, and 
     programmatic data including, but not limited to, troop 
     strength for each Active and Reserve component, and estimates 
     of the major weapons systems deployed in support of each 
     contingency:  Provided further, That these documents shall 
     include budget exhibits OP-5 and OP-32 (as defined in the 
     Department of Defense Financial Management Regulation) for 
     all contingency operations for the budget year and the two 
     preceding fiscal years.
       Sec. 1172.  None of the funds in this Act may be used for 
     research, development, test, evaluation, procurement or 
     deployment of nuclear armed interceptors of a missile defense 
     system.
       Sec. 1173.  Notwithstanding any other provision of this 
     Act, to reflect savings due to favorable foreign exchange 
     rates, the total amount appropriated in this Act is hereby 
     reduced by $289,000,000.
       Sec. 1174.  None of the funds appropriated or made 
     available in this Act shall be used to reduce or disestablish 
     the operation of the 53rd Weather Reconnaissance Squadron of 
     the Air Force Reserve, if such action would reduce the WC-130 
     Weather Reconnaissance mission below the levels funded in 
     this Act:  Provided, That the Air Force shall allow the 53rd 
     Weather Reconnaissance Squadron to perform other missions in 
     support of national defense requirements during the non-
     hurricane season.
       Sec. 1175.  None of the funds provided in this Act shall be 
     available for integration of foreign intelligence information 
     unless the information has been lawfully collected and 
     processed during the conduct of authorized foreign 
     intelligence activities:  Provided, That information 
     pertaining to United States persons shall only be handled in 
     accordance with protections provided in the Fourth Amendment 
     of the United States Constitution as implemented through 
     Executive Order No. 12333.
       Sec. 1176. (a) None of the funds appropriated by this Act 
     may be used to transfer research and development, 
     acquisition, or other program authority relating to current 
     tactical unmanned aerial vehicles (TUAVs) from the Army.
       (b) The Army shall retain responsibility for and 
     operational control of the MQ-1C Gray Eagle Unmanned Aerial 
     Vehicle (UAV) in order to support the Secretary of Defense in 
     matters relating to the employment of unmanned aerial 
     vehicles.
       Sec. 1177.  None of the funds appropriated by this Act for 
     programs of the Office of the Director of National 
     Intelligence shall remain available for obligation beyond the 
     current fiscal year, except for funds appropriated for 
     research and technology, which

[[Page H846]]

     shall remain available until September 30, 2019.
       Sec. 1178.  For purposes of section 1553(b) of title 31, 
     United States Code, any subdivision of appropriations made in 
     this Act under the heading ``Shipbuilding and Conversion, 
     Navy'' shall be considered to be for the same purpose as any 
     subdivision under the heading ``Shipbuilding and Conversion, 
     Navy'' appropriations in any prior fiscal year, and the 1 
     percent limitation shall apply to the total amount of the 
     appropriation.
       Sec. 1179. (a) Not later than 60 days after the date of 
     enactment of this Act, the Director of National Intelligence 
     shall submit a report to the congressional intelligence 
     committees to establish the baseline for application of 
     reprogramming and transfer authorities for fiscal year 2018:  
     Provided, That the report shall include--
       (1) a table for each appropriation with a separate column 
     to display the President's budget request, adjustments made 
     by Congress, adjustments due to enacted rescissions, if 
     appropriate, and the fiscal year enacted level;
       (2) a delineation in the table for each appropriation by 
     Expenditure Center and project; and
       (3) an identification of items of special congressional 
     interest.
       (b) None of the funds provided for the National 
     Intelligence Program in this Act shall be available for 
     reprogramming or transfer until the report identified in 
     subsection (a) is submitted to the congressional intelligence 
     committees, unless the Director of National Intelligence 
     certifies in writing to the congressional intelligence 
     committees that such reprogramming or transfer is necessary 
     as an emergency requirement.
       Sec. 1180.  None of the funds made available by this Act 
     may be used to eliminate, restructure, or realign Army 
     Contracting Command--New Jersey or make disproportionate 
     personnel reductions at any Army Contracting Command--New 
     Jersey sites without 30-day prior notification to the 
     congressional defense committees.

                              (rescission)

       Sec. 1181.  Of the unobligated balances available to the 
     Department of Defense, the following funds are permanently 
     rescinded from the following accounts and programs in the 
     specified amounts to reflect excess cash balances in the 
     Department of Defense Acquisition Workforce Development Fund:
       From ``Department of Defense Acquisition Workforce 
     Development Fund, Defense'', $10,000,000.
       Sec. 1182.  None of the funds made available by this Act 
     for excess defense articles, assistance under section 333 of 
     title 10, United States Code, or peacekeeping operations for 
     the countries designated annually to be in violation of the 
     standards of the Child Soldiers Prevention Act of 2008 
     (Public Law 110-457; 22 U.S.C. 2370c-1) may be used to 
     support any military training or operation that includes 
     child soldiers, as defined by the Child Soldiers Prevention 
     Act of 2008, unless such assistance is otherwise permitted 
     under section 404 of the Child Soldiers Prevention Act of 
     2008.
       Sec. 1183. (a) None of the funds provided for the National 
     Intelligence Program in this or any prior appropriations Act 
     shall be available for obligation or expenditure through a 
     reprogramming or transfer of funds in accordance with section 
     102A(d) of the National Security Act of 1947 (50 U.S.C. 
     3024(d)) that--
       (1) creates a new start effort;
       (2) terminates a program with appropriated funding of 
     $10,000,000 or more;
       (3) transfers funding into or out of the National 
     Intelligence Program; or
       (4) transfers funding between appropriations, unless the 
     congressional intelligence committees are notified 30 days in 
     advance of such reprogramming of funds; this notification 
     period may be reduced for urgent national security 
     requirements.
       (b) None of the funds provided for the National 
     Intelligence Program in this or any prior appropriations Act 
     shall be available for obligation or expenditure through a 
     reprogramming or transfer of funds in accordance with section 
     102A(d) of the National Security Act of 1947 (50 U.S.C. 
     3024(d)) that results in a cumulative increase or decrease of 
     the levels specified in the classified annex accompanying the 
     Act unless the congressional intelligence committees are 
     notified 30 days in advance of such reprogramming of funds; 
     this notification period may be reduced for urgent national 
     security requirements.
       Sec. 1184.  The Director of National Intelligence shall 
     submit to Congress each year, at or about the time that the 
     President's budget is submitted to Congress that year under 
     section 1105(a) of title 31, United States Code, a future-
     years intelligence program (including associated annexes) 
     reflecting the estimated expenditures and proposed 
     appropriations included in that budget. Any such future-years 
     intelligence program shall cover the fiscal year with respect 
     to which the budget is submitted and at least the four 
     succeeding fiscal years.
       Sec. 1185.  For the purposes of this Act, the term 
     ``congressional intelligence committees'' means the Permanent 
     Select Committee on Intelligence of the House of 
     Representatives, the Select Committee on Intelligence of the 
     Senate, the Subcommittee on Defense of the Committee on 
     Appropriations of the House of Representatives, and the 
     Subcommittee on Defense of the Committee on Appropriations of 
     the Senate.

                     (including transfer of funds)

       Sec. 1186.  During the current fiscal year, not to exceed 
     $11,000,000 from each of the appropriations made in title II 
     of this Act for ``Operation and Maintenance, Army'', 
     ``Operation and Maintenance, Navy'', and ``Operation and 
     Maintenance, Air Force'' may be transferred by the military 
     department concerned to its central fund established for 
     Fisher Houses and Suites pursuant to section 2493(d) of title 
     10, United States Code.

                     (including transfer of funds)

       Sec. 1187.  Not to exceed $500,000,000 appropriated by this 
     Act for operation and maintenance may be available for the 
     purpose of making remittances and transfer to the Defense 
     Acquisition Workforce Development Fund in accordance with 
     section 1705 of title 10, United States Code.
       Sec. 1188. (a) Any agency receiving funds made available in 
     this Act, shall, subject to subsections (b) and (c), post on 
     the public website of that agency any report required to be 
     submitted by the Congress in this or any other Act, upon the 
     determination by the head of the agency that it shall serve 
     the national interest.
       (b) Subsection (a) shall not apply to a report if--
       (1) the public posting of the report compromises national 
     security; or
       (2) the report contains proprietary information.
       (c) The head of the agency posting such report shall do so 
     only after such report has been made available to the 
     requesting Committee or Committees of Congress for no less 
     than 45 days.
       Sec. 1189. (a) None of the funds appropriated or otherwise 
     made available by this Act may be expended for any Federal 
     contract for an amount in excess of $1,000,000, unless the 
     contractor agrees not to--
       (1) enter into any agreement with any of its employees or 
     independent contractors that requires, as a condition of 
     employment, that the employee or independent contractor agree 
     to resolve through arbitration any claim under title VII of 
     the Civil Rights Act of 1964 or any tort related to or 
     arising out of sexual assault or harassment, including 
     assault and battery, intentional infliction of emotional 
     distress, false imprisonment, or negligent hiring, 
     supervision, or retention; or
       (2) take any action to enforce any provision of an existing 
     agreement with an employee or independent contractor that 
     mandates that the employee or independent contractor resolve 
     through arbitration any claim under title VII of the Civil 
     Rights Act of 1964 or any tort related to or arising out of 
     sexual assault or harassment, including assault and battery, 
     intentional infliction of emotional distress, false 
     imprisonment, or negligent hiring, supervision, or retention.
       (b) None of the funds appropriated or otherwise made 
     available by this Act may be expended for any Federal 
     contract unless the contractor certifies that it requires 
     each covered subcontractor to agree not to enter into, and 
     not to take any action to enforce any provision of, any 
     agreement as described in paragraphs (1) and (2) of 
     subsection (a), with respect to any employee or independent 
     contractor performing work related to such subcontract. For 
     purposes of this subsection, a ``covered subcontractor'' is 
     an entity that has a subcontract in excess of $1,000,000 on a 
     contract subject to subsection (a).
       (c) The prohibitions in this section do not apply with 
     respect to a contractor's or subcontractor's agreements with 
     employees or independent contractors that may not be enforced 
     in a court of the United States.
       (d) The Secretary of Defense may waive the application of 
     subsection (a) or (b) to a particular contractor or 
     subcontractor for the purposes of a particular contract or 
     subcontract if the Secretary or the Deputy Secretary 
     personally determines that the waiver is necessary to avoid 
     harm to national security interests of the United States, and 
     that the term of the contract or subcontract is not longer 
     than necessary to avoid such harm. The determination shall 
     set forth with specificity the grounds for the waiver and for 
     the contract or subcontract term selected, and shall state 
     any alternatives considered in lieu of a waiver and the 
     reasons each such alternative would not avoid harm to 
     national security interests of the United States. The 
     Secretary of Defense shall transmit to Congress, and 
     simultaneously make public, any determination under this 
     subsection not less than 15 business days before the contract 
     or subcontract addressed in the determination may be awarded.

                     (including transfer of funds)

       Sec. 1190.  From within the funds appropriated for 
     operation and maintenance for the Defense Health Program in 
     this Act, up to $115,519,000, shall be available for transfer 
     to the Joint Department of Defense-Department of Veterans 
     Affairs Medical Facility Demonstration Fund in accordance 
     with the provisions of section 1704 of the National Defense 
     Authorization Act for Fiscal Year 2010, Public Law 111-84:  
     Provided, That for purposes of section 1704(b), the facility 
     operations funded are operations of the integrated Captain 
     James A. Lovell Federal Health Care Center, consisting of the 
     North Chicago Veterans Affairs Medical Center, the Navy 
     Ambulatory Care Center, and supporting facilities designated 
     as a combined Federal medical facility as described by 
     section 706 of Public Law 110-417:  Provided further, That 
     additional funds may be transferred from funds appropriated 
     for operation and maintenance for the Defense Health Program 
     to the Joint Department of Defense-

[[Page H847]]

     Department of Veterans Affairs Medical Facility Demonstration 
     Fund upon written notification by the Secretary of Defense to 
     the Committees on Appropriations of the House of 
     Representatives and the Senate.
       Sec. 1191.  None of the funds appropriated or otherwise 
     made available by this Act may be used by the Department of 
     Defense or a component thereof in contravention of the 
     provisions of section 130h of title 10, United States Code.
       Sec. 1192.  Appropriations available to the Department of 
     Defense may be used for the purchase of heavy and light 
     armored vehicles for the physical security of personnel or 
     for force protection purposes up to a limit of $450,000 per 
     vehicle, notwithstanding price or other limitations 
     applicable to the purchase of passenger carrying vehicles.

                     (including transfer of funds)

       Sec. 1193.  Upon a determination by the Director of 
     National Intelligence that such action is necessary and in 
     the national interest, the Director may, with the approval of 
     the Office of Management and Budget, transfer not to exceed 
     $1,500,000,000 of the funds made available in this Act for 
     the National Intelligence Program:  Provided, That such 
     authority to transfer may not be used unless for higher 
     priority items, based on unforeseen intelligence 
     requirements, than those for which originally appropriated 
     and in no case where the item for which funds are requested 
     has been denied by the Congress:  Provided further, That a 
     request for multiple reprogrammings of funds using authority 
     provided in this section shall be made prior to June 30, 
     2017.
       Sec. 1194.  None of the funds appropriated or otherwise 
     made available in this or any other Act may be used to 
     transfer, release, or assist in the transfer or release to or 
     within the United States, its territories, or possessions 
     Khalid Sheikh Mohammed or any other detainee who--
       (1) is not a United States citizen or a member of the Armed 
     Forces of the United States; and
       (2) is or was held on or after June 24, 2009, at United 
     States Naval Station, Guantanamo Bay, Cuba, by the Department 
     of Defense.
       Sec. 1195. (a) None of the funds appropriated or otherwise 
     made available in this or any other Act may be used to 
     construct, acquire, or modify any facility in the United 
     States, its territories, or possessions to house any 
     individual described in subsection (c) for the purposes of 
     detention or imprisonment in the custody or under the 
     effective control of the Department of Defense.
       (b) The prohibition in subsection (a) shall not apply to 
     any modification of facilities at United States Naval 
     Station, Guantanamo Bay, Cuba.
       (c) An individual described in this subsection is any 
     individual who, as of June 24, 2009, is located at United 
     States Naval Station, Guantanamo Bay, Cuba, and who--
       (1) is not a citizen of the United States or a member of 
     the Armed Forces of the United States; and
       (2) is--
       (A) in the custody or under the effective control of the 
     Department of Defense; or
       (B) otherwise under detention at United States Naval 
     Station, Guantanamo Bay, Cuba.
       Sec. 1196.  None of the funds appropriated or otherwise 
     made available in this Act may be used to transfer any 
     individual detained at United States Naval Station Guantanamo 
     Bay, Cuba, to the custody or control of the individual's 
     country of origin, any other foreign country, or any other 
     foreign entity except in accordance with section 1034 of the 
     National Defense Authorization Act for Fiscal Year 2016 
     (Public Law 114-92) and section 1034 of the National Defense 
     Authorization Act for Fiscal Year 2017 (Public Law 114-328).
       Sec. 1197.  None of the funds made available by this Act 
     may be used in contravention of the War Powers Resolution (50 
     U.S.C. 1541 et seq.).
       Sec. 1198. (a) None of the funds appropriated or otherwise 
     made available by this or any other Act may be used by the 
     Secretary of Defense, or any other official or officer of the 
     Department of Defense, to enter into a contract, memorandum 
     of understanding, or cooperative agreement with, or make a 
     grant to, or provide a loan or loan guarantee to 
     Rosoboronexport or any subsidiary of Rosoboronexport.
       (b) The Secretary of Defense may waive the limitation in 
     subsection (a) if the Secretary, in consultation with the 
     Secretary of State and the Director of National Intelligence, 
     determines that it is in the vital national security interest 
     of the United States to do so, and certifies in writing to 
     the congressional defense committees that, to the best of the 
     Secretary's knowledge:
       (1) Rosoboronexport has ceased the transfer of lethal 
     military equipment to, and the maintenance of existing lethal 
     military equipment for, the Government of the Syrian Arab 
     Republic;
       (2) The armed forces of the Russian Federation have 
     withdrawn from Crimea, other than armed forces present on 
     military bases subject to agreements in force between the 
     Government of the Russian Federation and the Government of 
     Ukraine; and
       (3) Agents of the Russian Federation have ceased taking 
     active measures to destabilize the control of the Government 
     of Ukraine over eastern Ukraine.
       (c) The Inspector General of the Department of Defense 
     shall conduct a review of any action involving 
     Rosoboronexport with respect to a waiver issued by the 
     Secretary of Defense pursuant to subsection (b), and not 
     later than 90 days after the date on which such a waiver is 
     issued by the Secretary of Defense, the Inspector General 
     shall submit to the congressional defense committees a report 
     containing the results of the review conducted with respect 
     to such waiver.
       Sec. 1199.  None of the funds made available in this Act 
     may be used for the purchase or manufacture of a flag of the 
     United States unless such flags are treated as covered items 
     under section 2533a(b) of title 10, United States Code.
       Sec. 1200. (a) Of the funds appropriated in this Act for 
     the Department of Defense, amounts may be made available, 
     under such regulations as the Secretary of Defense may 
     prescribe, to local military commanders appointed by the 
     Secretary, or by an officer or employee designated by the 
     Secretary, to provide at their discretion ex gratia payments 
     in amounts consistent with subsection (d) of this section for 
     damage, personal injury, or death that is incident to combat 
     operations of the Armed Forces in a foreign country.
       (b) An ex gratia payment under this section may be provided 
     only if--
       (1) the prospective foreign civilian recipient is 
     determined by the local military commander to be friendly to 
     the United States;
       (2) a claim for damages would not be compensable under 
     chapter 163 of title 10, United States Code (commonly known 
     as the ``Foreign Claims Act''); and
       (3) the property damage, personal injury, or death was not 
     caused by action by an enemy.
       (c) Nature of Payments.--Any payments provided under a 
     program under subsection (a) shall not be considered an 
     admission or acknowledgement of any legal obligation to 
     compensate for any damage, personal injury, or death.
       (d) Amount of Payments.--If the Secretary of Defense 
     determines a program under subsection (a) to be appropriate 
     in a particular setting, the amounts of payments, if any, to 
     be provided to civilians determined to have suffered harm 
     incident to combat operations of the Armed Forces under the 
     program should be determined pursuant to regulations 
     prescribed by the Secretary and based on an assessment, which 
     should include such factors as cultural appropriateness and 
     prevailing economic conditions.
       (e) Legal Advice.--Local military commanders shall receive 
     legal advice before making ex gratia payments under this 
     subsection. The legal advisor, under regulations of the 
     Department of Defense, shall advise on whether an ex gratia 
     payment is proper under this section and applicable 
     Department of Defense regulations.
       (f) Written Record.--A written record of any ex gratia 
     payment offered or denied shall be kept by the local 
     commander and on a timely basis submitted to the appropriate 
     office in the Department of Defense as determined by the 
     Secretary of Defense.
       (g) Report.--The Secretary of Defense shall report to the 
     congressional defense committees on an annual basis the 
     efficacy of the ex gratia payment program including the 
     number of types of cases considered, amounts offered, the 
     response from ex gratia payment recipients, and any 
     recommended modifications to the program.
       Sec. 1201.  None of the funds available in this Act to the 
     Department of Defense, other than appropriations made for 
     necessary or routine refurbishments, upgrades or maintenance 
     activities, shall be used to reduce or to prepare to reduce 
     the number of deployed and non-deployed strategic delivery 
     vehicles and launchers below the levels set forth in the 
     report submitted to Congress in accordance with section 1042 
     of the National Defense Authorization Act for Fiscal Year 
     2012.
       Sec. 1202.  The Secretary of Defense shall post grant 
     awards on a public Website in a searchable format.
       Sec. 1203.  None of the funds made available by this Act 
     may be used to fund the performance of a flight demonstration 
     team at a location outside of the United States:  Provided, 
     That this prohibition applies only if a performance of a 
     flight demonstration team at a location within the United 
     States was canceled during the current fiscal year due to 
     insufficient funding.
       Sec. 1204.  None of the funds made available by this Act 
     may be used by the National Security Agency to--
       (1) conduct an acquisition pursuant to section 702 of the 
     Foreign Intelligence Surveillance Act of 1978 for the purpose 
     of targeting a United States person; or
       (2) acquire, monitor, or store the contents (as such term 
     is defined in section 2510(8) of title 18, United States 
     Code) of any electronic communication of a United States 
     person from a provider of electronic communication services 
     to the public pursuant to section 501 of the Foreign 
     Intelligence Surveillance Act of 1978.
       Sec. 1205.  None of the funds made available by this Act 
     may be obligated or expended to implement the Arms Trade 
     Treaty until the Senate approves a resolution of ratification 
     for the Treaty.
       Sec. 1206.  None of the funds made available in this or any 
     other Act may be used to pay the salary of any officer or 
     employee of any agency funded by this Act who approves or 
     implements the transfer of administrative responsibilities or 
     budgetary resources of any program, project, or activity 
     financed by this Act to the jurisdiction of another Federal 
     agency not financed by this Act unless explicity provided for 
     in a Defense Appropriations Act:  Provided, That this 
     limitation

[[Page H848]]

     shall not apply to transfers of funds expressly provided for 
     in Defense Appropriations Acts, or provisions of Acts 
     providing supplemental appropriations for the Department of 
     Defense.
       Sec. 1207.  None of the funds made available in this Act 
     may be obligated for activities authorized under section 1208 
     of the Ronald W. Reagan National Defense Authorization Act 
     for Fiscal Year 2005 (Public Law 112-81; 125 Stat. 1621) to 
     initiate support for, or expand support to, foreign forces, 
     irregular forces, groups, or individuals unless the 
     congressional defense committees are notified in accordance 
     with the direction contained in the classified annex 
     accompanying this Act, not less than 15 days before 
     initiating such support:  Provided, That none of the funds 
     made available in this Act may be used under section 1208 for 
     any activity that is not in support of an ongoing military 
     operation being conducted by United States Special Operations 
     Forces to combat terrorism:  Provided further, That the 
     Secretary of Defense may waive the prohibitions in this 
     section if the Secretary determines that such waiver is 
     required by extraordinary circumstances and, by not later 
     than 72 hours after making such waiver, notifies the 
     congressional defense committees of such waiver.
       Sec. 1208.  None of the funds made available by this Act 
     may be used with respect to Iraq in contravention of the War 
     Powers Resolution (50 U.S.C. 1541 et seq.), including for the 
     introduction of United States armed forces into hostilities 
     in Iraq, into situations in Iraq where imminent involvement 
     in hostilities is clearly indicated by the circumstances, or 
     into Iraqi territory, airspace, or waters while equipped for 
     combat, in contravention of the congressional consultation 
     and reporting requirements of sections 3 and 4 of such 
     Resolution (50 U.S.C. 1542 and 1543).
       Sec. 1209.  None of the funds provided in this Act for the 
     T-AO Fleet Oiler or the Towing, Salvage, and Rescue Ship 
     programs shall be used to award a new contract that provides 
     for the acquisition of the following components unless those 
     components are manufactured in the United States: Auxiliary 
     equipment (including pumps) for shipboard services; 
     propulsion equipment (including engines, reduction gears, and 
     propellers); shipboard cranes; and spreaders for shipboard 
     cranes.
       Sec. 1210.  The amount appropriated in title II of this Act 
     for ``Operation and Maintenance, Army'' is hereby reduced by 
     $75,000,000 to reflect excess cash balances in Department of 
     Defense Working Capital Funds.
       Sec. 1211.  Notwithstanding any other provision of this 
     Act, to reflect savings due to lower than anticipated fuel 
     costs, the total amount appropriated in title II of this Act 
     is hereby reduced by $1,007,267,000.
       Sec. 1212.  None of the funds made available by this Act 
     may be used for Government Travel Charge Card expenses by 
     military or civilian personnel of the Department of Defense 
     for gaming, or for entertainment that includes topless or 
     nude entertainers or participants, as prohibited by 
     Department of Defense FMR, Volume 9, Chapter 3 and Department 
     of Defense Instruction 1015.10 (enclosure 3, 14a and 14b).
       Sec. 1213.  None of the funds made available by this Act 
     may be used to propose, plan for, or execute a new or 
     additional Base Realignment and Closure (BRAC) round.
       Sec. 1214.  Of the amounts appropriated in this Act for 
     ``Operation and Maintenance, Navy'', $289,255,000, to remain 
     available until expended, may be used for any purposes 
     related to the National Defense Reserve Fleet established 
     under section 11 of the Merchant Ship Sales Act of 1946 (50 
     U.S.C. 4405):  Provided, That such amounts are available for 
     reimbursements to the Ready Reserve Force, Maritime 
     Administration account of the United States Department of 
     Transportation for programs, projects, activities, and 
     expenses related to the National Defense Reserve Fleet.
       Sec. 1215.  None of the funds made available by this Act 
     for the Joint Surveillance Target Attack Radar System 
     recapitalization program may be obligated or expended for 
     pre-milestone B activities after March 31, 2018, except for 
     source selection and other activities necessary to enter the 
     engineering and manufacturing development phase.
       Sec. 1216.  None of the funds made available by this Act 
     may be used to carry out the closure or realignment of the 
     United States Naval Station, Guantanamo Bay, Cuba.

                     (including transfer of funds)

       Sec. 1217.  Additional readiness funds made available in 
     title II of this Act for ``Operation and Maintenance, Army'', 
     ``Operation and Maintenance, Navy'', ``Operation and 
     Maintenance, Marine Corps'', and ``Operation and Maintenance, 
     Air Force'' may be transferred to and merged with any 
     appropriation of the Department of Defense for activities 
     related to the Zika virus in order to provide health support 
     for the full range of military operations and sustain the 
     health of the members of the Armed Forces, civilian employees 
     of the Department of Defense, and their families, to include: 
     research and development, disease surveillance, vaccine 
     development, rapid detection, vector controls and 
     surveillance, training, and outbreak response:  Provided, 
     That the authority provided in this section is subject to the 
     same terms and conditions as the authority provided in 
     section 8005 of this Act.
       Sec. 1218. (a) None of the funds made available in this Act 
     may be used to maintain or establish a computer network 
     unless such network is designed to block access to 
     pornography websites.
       (b) Nothing in subsection (a) shall limit the use of funds 
     necessary for any Federal, State, tribal, or local law 
     enforcement agency or any other entity carrying out criminal 
     investigations, prosecution, or adjudication activities, or 
     for any activity necessary for the national defense, 
     including intelligence activities.
       Sec. 1219.  Notwithstanding any other provision of law, any 
     transfer of funds appropriated or otherwise made available by 
     this Act to the Global Engagement Center pursuant to section 
     1287 of the National Defense Authorization Act for Fiscal 
     Year 2017 (Public Law 114-328) shall be made in accordance 
     with section 8005 or 9002 of this Act, as applicable.
       Sec. 1220.  No amounts credited or otherwise made available 
     in this or any other Act to the Department of Defense 
     Acquisition Workforce Development Fund may be transferred to:
       (1) the Rapid Prototyping Fund established under section 
     804(d) of the National Defense Authorization Act for Fiscal 
     Year 2016 (10 U.S.C. 2302 note); or
       (2) credited to a military-department specific fund 
     established under section 804(d)(2) of the National Defense 
     Authorization Act for Fiscal Year 2016 (as amended by section 
     897 of the National Defense Authorization Act for Fiscal Year 
     2017).

                       (including transfer fund)

       Sec. 1221.  In addition to amounts provided elsewhere in 
     this Act for military personnel pay, including active duty, 
     reserve and National Guard personnel, $206,400,000 is hereby 
     appropriated to the Department of Defense and made available 
     for transfer only to military personnel accounts: Provided, 
     That the transfer authority provided under this heading is in 
     addition to any other transfer authority provided elsewhere 
     in this Act.
       Sec. 1222.  In addition to amounts provided elsewhere in 
     this Act, there is appropriated $235,000,000, for an 
     additional amount for ``Operation and Maintenance, Defense-
     Wide'', to remain available until expended: Provided, That 
     such funds shall only be available to the Secretary of 
     Defense, acting through the Office of Economic Adjustment of 
     the Department of Defense, or for transfer to the Secretary 
     of Education, notwithstanding any other provision of law, to 
     make grants, conclude cooperative agreements, or supplement 
     other Federal funds to construct, renovate, repair, or expand 
     elementary and secondary public schools on military 
     installations in order to address capacity or facility 
     condition deficiencies at such schools: Provided further, 
     That in making such funds available, the Office of Economic 
     Adjustment or the Secretary of Education shall give priority 
     consideration to those military installations with schools 
     having the most serious capacity or facility condition 
     deficiencies as determined by the Secretary of Defense: 
     Provided further, That as a condition of receiving funds 
     under this section a local educational agency or State shall 
     provide a matching share as described in the notice titled 
     ``Department of Defense Program for Construction, Renovation, 
     Repair or Expansion of Public Schools Located on Military 
     Installations'' published by the Department of Defense in the 
     Federal Register on September 9, 2011 (76 Fed. Reg. 55883 et 
     seq.): Provided further, That these provisions apply to funds 
     provided under this section, and to funds previously provided 
     by Congress to construct, renovate, repair, or expand 
     elementary and secondary public schools on military 
     installations in order to address capacity or facility 
     condition deficiencies at such schools to the extent such 
     funds remain unobligated on the date of enactment of this 
     section.
       Sec. 1223.  None of the funds made available by this Act 
     may be used to carry out the changes to the Joint Travel 
     Regulations of the Department of Defense described in the 
     memorandum of the Per Diem Travel and Transportation 
     Allowance Committee titled ``UTD/CTD for MAP 118-13/CAP 118-
     13 - Flat Rate Per Diem for Long Term TDY'' and dated October 
     1, 2014.
       Sec. 1224.  In carrying out the program described in the 
     memorandum on the subject of ``Policy for Assisted 
     Reproductive Services for the Benefit of Seriously or 
     Severely Ill/Injured (Category II or III) Active Duty Service 
     Members'' issued by the Assistant Secretary of Defense for 
     Health Affairs on April 3, 2012, and the guidance issued to 
     implement such memorandum, the Secretary of Defense shall 
     apply such policy and guidance, except that--
       (1) the limitation on periods regarding embryo 
     cryopreservation and storage set forth in part III(G) and in 
     part IV(H) of such memorandum shall not apply; and
       (2) the term ``assisted reproductive technology'' shall 
     include embryo cryopreservation and storage without 
     limitation on the duration of such cryopreservation and 
     storage.

                                TITLE IX

        OVERSEAS CONTINGENCY OPERATIONS/GLOBAL WAR ON TERRORISM

                           MILITARY PERSONNEL

                        Military Personnel, Army

       For an additional amount for ``Military Personnel, Army'', 
     $2,635,317,000:  Provided, That such amount is designated by 
     the Congress for Overseas Contingency Operations/Global War 
     on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

[[Page H849]]

  


                        Military Personnel, Navy

       For an additional amount for ``Military Personnel, Navy'', 
     $377,857,000:  Provided, That such amount is designated by 
     the Congress for Overseas Contingency Operations/Global War 
     on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                    Military Personnel, Marine Corps

       For an additional amount for ``Military Personnel, Marine 
     Corps'', $103,800,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                     Military Personnel, Air Force

       For an additional amount for ``Military Personnel, Air 
     Force'', $912,779,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                        Reserve Personnel, Army

       For an additional amount for ``Reserve Personnel, Army'', 
     $24,942,000:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                        Reserve Personnel, Navy

       For an additional amount for ``Reserve Personnel, Navy'', 
     $9,091,000:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                    Reserve Personnel, Marine Corps

       For an additional amount for ``Reserve Personnel, Marine 
     Corps'', $2,328,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                      Reserve Personnel, Air Force

       For an additional amount for ``Reserve Personnel, Air 
     Force'', $20,569,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                     National Guard Personnel, Army

       For an additional amount for ``National Guard Personnel, 
     Army'', $184,589,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                  National Guard Personnel, Air Force

       For an additional amount for ``National Guard Personnel, 
     Air Force'', $5,004,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

         Military Personnel, National Defense Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $1,000,000,000, for the ``Military 
     Personnel, National Defense Restoration Fund'': Provided, 
     That such funds provided under this heading shall only be 
     available for programs, projects and activities necessary to 
     implement the 2018 National Defense Strategy: Provided 
     further, That such funds shall not be available for transfer 
     until 30 days after the Secretary has submitted, and the 
     congressional defense committees have approved, the proposed 
     allocation plan for the use of such funds to implement such 
     strategy: Provided further, That such allocation plan shall 
     include a detailed justification for the use of such funds 
     and a description of how such investments are necessary to 
     implement the strategy: Provided further, That the Secretary 
     of Defense may transfer these funds only to military 
     personnel accounts: Provided further, That the funds 
     transferred shall be merged with and shall be available for 
     the same purposes and for the same time period, as the 
     appropriation to which transferred: Provided further, That 
     none of the funds made available under this heading may be 
     transferred to any program, project, or activity specifically 
     limited or denied by this Act: Provided further, That the 
     transfer authority provided under this heading is in addition 
     to any other transfer authority available to the Department 
     of Defense: Provided further, That such amount is designated 
     by the Congress for Overseas Contingency Operations/Global 
     War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                       OPERATION AND MAINTENANCE

                    Operation and Maintenance, Army

       For an additional amount for ``Operation and Maintenance, 
     Army'', $16,126,403,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                    Operation and Maintenance, Navy

       For an additional amount for ``Operation and Maintenance, 
     Navy'', $5,875,015,000, of which up to $161,885,000 may be 
     transferred to the Coast Guard ``Operating Expenses'' 
     account:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                Operation and Maintenance, Marine Corps

       For an additional amount for ``Operation and Maintenance, 
     Marine Corps'', $1,116,640,000:  Provided, That such amount 
     is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                  Operation and Maintenance, Air Force

       For an additional amount for ``Operation and Maintenance, 
     Air Force'', $10,266,295,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                Operation and Maintenance, Defense-Wide

       For an additional amount for ``Operation and Maintenance, 
     Defense-Wide'', $6,944,201,000:  Provided, That of the funds 
     provided under this heading, not to exceed $900,000,000, to 
     remain available until September 30, 2019, shall be for 
     payments to reimburse key cooperating nations for logistical, 
     military, and other support, including access, provided to 
     United States military and stability operations in 
     Afghanistan and to counter the Islamic State of Iraq and the 
     Levant: Provided further, That such reimbursement payments 
     may be made in such amounts as the Secretary of Defense, with 
     the concurrence of the Secretary of State, and in 
     consultation with the Director of the Office of Management 
     and Budget, may determine, based on documentation determined 
     by the Secretary of Defense to adequately account for the 
     support provided, and such determination is final and 
     conclusive upon the accounting officers of the United States, 
     and 15 days following notification to the appropriate 
     congressional committees: Provided further, That funds 
     provided under this heading may be used for the purpose of 
     providing specialized training and procuring supplies and 
     specialized equipment and providing such supplies and loaning 
     such equipment on a non-reimbursable basis to coalition 
     forces supporting United States military and stability 
     operations in Afghanistan and to counter the Islamic State of 
     Iraq and the Levant, and 15 days following notification to 
     the appropriate congressional committees:  Provided further, 
     That funds provided under this heading may be used to support 
     the Government of Jordan, in such amounts as the Secretary of 
     Defense may determine, to enhance the ability of the armed 
     forces of Jordan to increase or sustain security along its 
     borders, upon 15 days prior written notification to the 
     congressional defense committees outlining the amounts 
     intended to be provided and the nature of the expenses 
     incurred: Provided further, That of the funds provided under 
     this heading, not to exceed $750,000,000, to remain available 
     until September 30, 2019, shall be available to provide 
     support and assistance to foreign security forces or other 
     groups or individuals to conduct, support, or facilitate 
     counterterrorism, crisis response, or other Department of 
     Defense security cooperation programs: Provided further, That 
     such amount is designated by the Congress for Overseas 
     Contingency Operations/Global War on Terrorism pursuant to 
     section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 
     Deficit Control Act of 1985.

                Operation and Maintenance, Army Reserve

       For an additional amount for ``Operation and Maintenance, 
     Army Reserve'', $24,699,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                Operation and Maintenance, Navy Reserve

       For an additional amount for ``Operation and Maintenance, 
     Navy Reserve'', $23,980,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

            Operation and Maintenance, Marine Corps Reserve

       For an additional amount for ``Operation and Maintenance, 
     Marine Corps Reserve'', $3,367,000:  Provided, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

              Operation and Maintenance, Air Force Reserve

       For an additional amount for ``Operation and Maintenance, 
     Air Force Reserve'', $58,523,000:  Provided, That such amount 
     is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of

[[Page H850]]

     the Balanced Budget and Emergency Deficit Control Act of 
     1985.

             Operation and Maintenance, Army National Guard

       For an additional amount for ``Operation and Maintenance, 
     Army National Guard'', $108,111,000:  Provided, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

             Operation and Maintenance, Air National Guard

       For an additional amount for ``Operation and Maintenance, 
     Air National Guard'', $15,400,000:  Provided, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

      Operation and Maintenance, National Defense Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $2,000,000,000, for the ``Operation and 
     Maintenance, National Defense Restoration Fund'': Provided, 
     That such funds provided under this heading shall only be 
     available for programs, projects and activities necessary to 
     implement the 2018 National Defense Strategy: Provided 
     further, That such funds shall not be available for transfer 
     until 30 days after the Secretary has submitted, and the 
     congressional defense committees have approved, the proposed 
     allocation plan for the use of such funds to implement such 
     strategy: Provided further, That such allocation plan shall 
     include a detailed justification for the use of such funds 
     and a description of how such investments are necessary to 
     implement the strategy: Provided further, That the Secretary 
     of Defense may transfer these funds only to operation and 
     maintenance accounts: Provided further, That the funds 
     transferred shall be merged with and shall be available for 
     the same purposes and for the same time period, as the 
     appropriation to which transferred: Provided further, That 
     none of the funds made available under this heading may be 
     transferred to any program, project, or activity specifically 
     limited or denied by this Act: Provided further, That the 
     transfer authority provided under this heading is in addition 
     to any other transfer authority available to the Department 
     of Defense: Provided further, That such amount is designated 
     by the Congress for Overseas Contingency Operations/Global 
     War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                    Afghanistan Security Forces Fund

       For the ``Afghanistan Security Forces Fund'', 
     $4,937,515,000 (reduced by $12,000,000), to remain available 
     until September 30, 2019:  Provided, That such funds shall be 
     available to the Secretary of Defense, notwithstanding any 
     other provision of law, for the purpose of allowing the 
     Commander, Combined Security Transition Command--Afghanistan, 
     or the Secretary's designee, to provide assistance, with the 
     concurrence of the Secretary of State, to the security forces 
     of Afghanistan, including the provision of equipment, 
     supplies, services, training, facility and infrastructure 
     repair, renovation, construction, and funding:  Provided 
     further, That the Secretary of Defense may obligate and 
     expend funds made available to the Department of Defense in 
     this title for additional costs associated with existing 
     projects previously funded with amounts provided under the 
     heading ``Afghanistan Infrastructure Fund'' in prior Acts:  
     Provided further, That such costs shall be limited to 
     contract changes resulting from inflation, market 
     fluctuation, rate adjustments, and other necessary contract 
     actions to complete existing projects, and associated 
     supervision and administration costs and costs for design 
     during construction:  Provided further, That the Secretary 
     may not use more than $50,000,000 under the authority 
     provided in this section:  Provided further, That the 
     Secretary shall notify in advance such contract changes and 
     adjustments in annual reports to the congressional defense 
     committees:  Provided further, That the authority to provide 
     assistance under this heading is in addition to any other 
     authority to provide assistance to foreign nations:  Provided 
     further, That contributions of funds for the purposes 
     provided herein from any person, foreign government, or 
     international organization may be credited to this Fund, to 
     remain available until expended, and used for such purposes:  
     Provided further, That the Secretary of Defense shall notify 
     the congressional defense committees in writing upon the 
     receipt and upon the obligation of any contribution, 
     delineating the sources and amounts of the funds received and 
     the specific use of such contributions:  Provided further, 
     That the Secretary of Defense shall, not fewer than 15 days 
     prior to obligating from this appropriation account, notify 
     the congressional defense committees in writing of the 
     details of any such obligation:  Provided further, That the 
     Secretary of Defense shall notify the congressional defense 
     committees of any proposed new projects or transfer of funds 
     between budget sub-activity groups in excess of $20,000,000:  
     Provided further, That the United States may accept equipment 
     procured using funds provided under this heading in this or 
     prior Acts that was transferred to the security forces of 
     Afghanistan and returned by such forces to the United States: 
      Provided further, That equipment procured using funds 
     provided under this heading in this or prior Acts, and not 
     yet transferred to the security forces of Afghanistan or 
     transferred to the security forces of Afghanistan and 
     returned by such forces to the United States, may be treated 
     as stocks of the Department of Defense upon written 
     notification to the congressional defense committees:  
     Provided further, That of the funds provided under this 
     heading, not less than $10,000,000 shall be for recruitment 
     and retention of women in the Afghanistan National Security 
     Forces, and the recruitment and training of female security 
     personnel:  Provided further, That such amount is designated 
     by the Congress for Overseas Contingency Operations/Global 
     War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                   Counter-ISIL Train and Equip Fund

       For the ``Counter-Islamic State of Iraq and the Levant 
     Train and Equip Fund'', $1,769,000,000, to remain available 
     until September 30, 2019: Provided, That such funds shall be 
     available to the Secretary of Defense in coordination with 
     the Secretary of State, to provide assistance, including 
     training; equipment; logistics support, supplies, and 
     services; stipends; infrastructure repair and renovation; and 
     sustainment, to foreign security forces, irregular forces, 
     groups, or individuals participating, or preparing to 
     participate in activities to counter the Islamic State of 
     Iraq and the Levant, and their affiliated or associated 
     groups: Provided further, That these funds may be used in 
     such amounts as the Secretary of Defense may determine to 
     enhance the border security of nations adjacent to conflict 
     areas including Jordan, Lebanon, Egypt, and Tunisia resulting 
     from actions of the Islamic State of Iraq and the Levant: 
     Provided further, That amounts made available under this 
     heading shall be available to provide assistance only for 
     activities in a country designated by the Secretary of 
     Defense, in coordination with the Secretary of State, as 
     having a security mission to counter the Islamic State of 
     Iraq and the Levant, and following written notification to 
     the congressional defense committees of such designation:  
     Provided further, That the Secretary of Defense shall ensure 
     that prior to providing assistance to elements of any forces 
     or individuals, such elements or individuals are 
     appropriately vetted, including at a minimum, assessing such 
     elements for associations with terrorist groups or groups 
     associated with the Government of Iran; and receiving 
     commitments from such elements to promote respect for human 
     rights and the rule of law: Provided further, That the 
     Secretary of Defense shall, not fewer than 15 days prior to 
     obligating from this appropriation account, notify the 
     congressional defense committees in writing of the details of 
     any such obligation: Provided further, That the Secretary of 
     Defense may accept and retain contributions, including 
     assistance in-kind, from foreign governments, including the 
     Government of Iraq and other entities, to carry out 
     assistance authorized under this heading: Provided further, 
     That contributions of funds for the purposes provided herein 
     from any foreign government or other entity may be credited 
     to this Fund, to remain available until expended, and used 
     for such purposes: Provided further, That the Secretary of 
     Defense may waive a provision of law relating to the 
     acquisition of items and support services or sections 40 and 
     40A of the Arms Export Control Act (22 U.S.C. 2780 and 2785) 
     if the Secretary determines that such provision of law would 
     prohibit, restrict, delay or otherwise limit the provision of 
     such assistance and a notice of and justification for such 
     waiver is submitted to the congressional defense committees, 
     the Committees on Appropriations and Foreign Relations of the 
     Senate and the Committees on Appropriations and Foreign 
     Affairs of the House of Representatives: Provided further, 
     That the United States may accept equipment procured using 
     funds provided under this heading, or under the heading, 
     ``Iraq Train and Equip Fund'' in prior Acts, that was 
     transferred to security forces, irregular forces, or groups 
     participating, or preparing to participate in activities to 
     counter the Islamic State of Iraq and the Levant and returned 
     by such forces or groups to the United States, may be treated 
     as stocks of the Department of Defense upon written 
     notification to the congressional defense committees: 
     Provided further, That equipment procured using funds 
     provided under this heading, or under the heading, ``Iraq 
     Train and Equip Fund'' in prior Acts, and not yet transferred 
     to security forces, irregular forces, or groups 
     participating, or preparing to participate in activities to 
     counter the Islamic State of Iraq and the Levant may be 
     treated as stocks of the Department of Defense when 
     determined by the Secretary to no longer be required for 
     transfer to such forces or groups and upon written 
     notification to the congressional defense committees: 
     Provided further, That the Secretary of Defense shall provide 
     quarterly reports to the congressional defense committees on 
     the use of funds provided under this heading, including, but 
     not limited to, the number of individuals trained, the nature 
     and scope of support and sustainment provided to each group 
     or individual, the area of operations for each group, and the 
     contributions of other countries, groups, or individuals: 
     Provided further, That such amount is

[[Page H851]]

     designated by the Congress for Overseas Contingency 
     Operations/ Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                              PROCUREMENT

                       Aircraft Procurement, Army

       For an additional amount for ``Aircraft Procurement, 
     Army'', $424,686,000, to remain available until September 30, 
     2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                       Missile Procurement, Army

       For an additional amount for ``Missile Procurement, Army'', 
     $557,583,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

        Procurement of Weapons and Tracked Combat Vehicles, Army

       For an additional amount for ``Procurement of Weapons and 
     Tracked Combat Vehicles, Army'', $1,191,139,000, to remain 
     available until September 30, 2020:  Provided, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                    Procurement of Ammunition, Army

       For an additional amount for ``Procurement of Ammunition, 
     Army'', $193,436,000, to remain available until September 30, 
     2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                        Other Procurement, Army

       For an additional amount for ``Other Procurement, Army'', 
     $405,575,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

                       Aircraft Procurement, Navy

       For an additional amount for ``Aircraft Procurement, 
     Navy'', $157,300,000, to remain available until September 30, 
     2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                       Weapons Procurement, Navy

       For an additional amount for ``Weapons Procurement, Navy'', 
     $130,994,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

            Procurement of Ammunition, Navy and Marine Corps

       For an additional amount for ``Procurement of Ammunition, 
     Navy and Marine Corps'', $223,843,000, to remain available 
     until September 30, 2020:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                        Other Procurement, Navy

       For an additional amount for ``Other Procurement, Navy'', 
     $207,984,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

                       Procurement, Marine Corps

       For an additional amount for ``Procurement, Marine Corps'', 
     $64,071,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

                    Aircraft Procurement, Air Force

       For an additional amount for ``Aircraft Procurement, Air 
     Force'', $510,836,000, to remain available until September 
     30, 2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                     Missile Procurement, Air Force

       For an additional amount for ``Missile Procurement, Air 
     Force'', $381,700,000, to remain available until September 
     30, 2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                      Space Procurement, Air Force

       For an additional amount for ``Space Procurement, Air 
     Force'', $2,256,000, to remain available until September 30, 
     2020: Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                  Procurement of Ammunition, Air Force

       For an additional amount for ``Procurement of Ammunition, 
     Air Force'', $501,509,000, to remain available until 
     September 30, 2020:  Provided, That such amount is designated 
     by the Congress for Overseas Contingency Operations/Global 
     War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                      Other Procurement, Air Force

       For an additional amount for ``Other Procurement, Air 
     Force'', $3,998,887,000, to remain available until September 
     30, 2020:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                       Procurement, Defense-Wide

       For an additional amount for ``Procurement, Defense-Wide'', 
     $510,741,000, to remain available until September 30, 2020:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

              National Guard and Reserve Equipment Account

       For procurement of rotary-wing aircraft; combat, tactical 
     and support vehicles; other weapons; and other procurement 
     items for the reserve components of the Armed Forces, 
     $1,000,000,000, to remain available for obligation until 
     September 30, 2020:  Provided, That the Chiefs of National 
     Guard and Reserve components shall, not later than 30 days 
     after enactment of this Act, individually submit to the 
     congressional defense committees the modernization priority 
     assessment for their respective National Guard or Reserve 
     component:  Provided further, That none of the funds made 
     available by this paragraph may be used to procure manned 
     fixed wing aircraft, or procure or modify missiles, 
     munitions, or ammunition:  Provided further, That such amount 
     is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

             Procurement, National Defense Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $6,000,000,000, for the ``Procurement, 
     National Defense Restoration Fund'': Provided, That such 
     funds provided under this heading shall only be available for 
     programs, projects and activities necessary to implement the 
     2018 National Defense Strategy: Provided further, That such 
     funds shall not be available for transfer until 30 days after 
     the Secretary has submitted, and the congressional defense 
     committees have approved, the proposed allocation plan for 
     the use of such funds to implement such strategy: Provided 
     further, That such allocation plan shall include a detailed 
     justification for the use of such funds and a description of 
     how such investments are necessary to implement the strategy: 
     Provided further, That the Secretary of Defense may transfer 
     these funds only to procurement accounts: Provided further, 
     That the funds transferred shall be merged with and shall be 
     available for the same purposes and for the same time period, 
     as the appropriation to which transferred: Provided further, 
     That none of the funds made available under this heading may 
     be transferred to any program, project, or activity 
     specifically limited or denied by this Act: Provided further, 
     That the transfer authority provided under this heading is in 
     addition to any other transfer authority available to the 
     Department of Defense: Provided further, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

               RESEARCH, DEVELOPMENT, TEST AND EVALUATION

            Research, Development, Test and Evaluation, Army

       For an additional amount for ``Research, Development, Test 
     and Evaluation, Army'', $119,368,000 (increased by 
     $6,000,000), to remain available until September 30, 2019:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

            Research, Development, Test and Evaluation, Navy

       For an additional amount for ``Research, Development, Test 
     and Evaluation, Navy'', $124,865,000, to remain available 
     until September 30, 2019:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

         Research, Development, Test and Evaluation, Air Force

       For an additional amount for ``Research, Development, Test 
     and Evaluation, Air

[[Page H852]]

     Force'', $144,508,000, to remain available until September 
     30, 2019:  Provided, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

        Research, Development, Test and Evaluation, Defense-Wide

       For an additional amount for ``Research, Development, Test 
     and Evaluation, Defense-Wide'', $226,096,000, to remain 
     available until September 30, 2019:  Provided, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

     Research, Development, Test and Evaluation, National Defense 
                            Restoration Fund

                     (including transfer of funds)

       In addition to amounts provided elsewhere in this Act, 
     there is appropriated $1,000,000,000, for the ``Research, 
     Development, Test and Evaluation, National Defense 
     Restoration Fund'': Provided, That such funds provided under 
     this heading shall only be available for programs, projects 
     and activities necessary to implement the 2018 National 
     Defense Strategy: Provided further, That such funds shall not 
     be available for transfer until 30 days after the Secretary 
     has submitted, and the congressional defense committees have 
     approved, the proposed allocation plan for the use of such 
     funds to implement such strategy: Provided further, That such 
     allocation plan shall include a detailed justification for 
     the use of such funds and a description of how such 
     investments are necessary to implement the strategy: Provided 
     further, That the Secretary of Defense may transfer these 
     funds only to research, development, test and evaluation 
     accounts: Provided further, That the funds transferred shall 
     be merged with and shall be available for the same purposes 
     and for the same time period, as the appropriation to which 
     transferred: Provided further, That none of the funds made 
     available under this heading may be transferred to any 
     program, project, or activity specifically limited or denied 
     by this Act: Provided further, That the transfer authority 
     provided under this heading is in addition to any other 
     transfer authority available to the Department of Defense: 
     Provided further, That such amount is designated by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985.

                     REVOLVING AND MANAGEMENT FUNDS

                     Defense Working Capital Funds

       For an additional amount for ``Defense Working Capital 
     Funds'', $148,956,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                  OTHER DEPARTMENT OF DEFENSE PROGRAMS

                         Defense Health Program

       For an additional amount for ``Defense Health Program'', 
     $395,805,000, which shall be for operation and maintenance:  
     Provided, That such amount is designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985.

         Drug Interdiction and Counter-Drug Activities, Defense

       For an additional amount for ``Drug Interdiction and 
     Counter-Drug Activities, Defense'', $196,300,000:  Provided, 
     That such amount is designated by the Congress for Overseas 
     Contingency Operations/Global War on Terrorism pursuant to 
     section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 
     Deficit Control Act of 1985.

                  Joint Improvised-Threat Defeat Fund

                     (including transfer of funds)

       For the ``Joint Improvised-Threat Defeat Fund'', 
     $483,058,000, to remain available until September 30, 2020:  
     Provided, That such funds shall be available to the Secretary 
     of Defense, notwithstanding any other provision of law, for 
     the purpose of allowing the Director of the Joint Improvised-
     Threat Defeat Organization to investigate, develop and 
     provide equipment, supplies, services, training, facilities, 
     personnel and funds to assist United States forces in the 
     defeat of improvised explosive devices:  Provided further, 
     That the Secretary of Defense may transfer funds provided 
     herein to appropriations for military personnel; operation 
     and maintenance; procurement; research, development, test and 
     evaluation; and defense working capital funds to accomplish 
     the purpose provided herein:  Provided further, That this 
     transfer authority is in addition to any other transfer 
     authority available to the Department of Defense:  Provided 
     further, That the Secretary of Defense shall, not fewer than 
     5 days prior to making transfers from this appropriation, 
     notify the congressional defense committees in writing of the 
     details of any such transfer:  Provided further, That such 
     amount is designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                    Office of the Inspector General

       For an additional amount for the ``Office of the Inspector 
     General'', $24,692,000:  Provided, That such amount is 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                     GENERAL PROVISIONS--THIS TITLE

       Sec. 1301.  Notwithstanding any other provision of law, 
     funds made available in this title are in addition to amounts 
     appropriated or otherwise made available for the Department 
     of Defense for fiscal year 2018.

                     (including transfer of funds)

       Sec. 1302.  Upon the determination of the Secretary of 
     Defense that such action is necessary in the national 
     interest, the Secretary may, with the approval of the Office 
     of Management and Budget, transfer up to $2,500,000,000 
     between the appropriations or funds made available to the 
     Department of Defense in this title:  Provided, That the 
     Secretary shall notify the Congress promptly of each transfer 
     made pursuant to the authority in this section:  Provided 
     further, That the authority provided in this section is in 
     addition to any other transfer authority available to the 
     Department of Defense and is subject to the same terms and 
     conditions as the authority provided in section 8005 of this 
     Act.
       Sec. 1303.  Supervision and administration costs and costs 
     for design during construction associated with a construction 
     project funded with appropriations available for operation 
     and maintenance or the ``Afghanistan Security Forces Fund'' 
     provided in this Act and executed in direct support of 
     overseas contingency operations in Afghanistan, may be 
     obligated at the time a construction contract is awarded:  
     Provided, That, for the purpose of this section, supervision 
     and administration costs and costs for design during 
     construction include all in-house Government costs.
       Sec. 1304.  From funds made available in this title, the 
     Secretary of Defense may purchase for use by military and 
     civilian employees of the Department of Defense in the United 
     States Central Command area of responsibility:
       (1) passenger motor vehicles up to a limit of $75,000 per 
     vehicle; and
       (2) heavy and light armored vehicles for the physical 
     security of personnel or for force protection purposes up to 
     a limit of $450,000 per vehicle, notwithstanding price or 
     other limitations applicable to the purchase of passenger 
     carrying vehicles.
       Sec. 1305.  Not to exceed $5,000,000 of the amounts 
     appropriated by this title under the heading ``Operation and 
     Maintenance, Army'' may be used, notwithstanding any other 
     provision of law, to fund the Commanders' Emergency Response 
     Program (CERP), for the purpose of enabling military 
     commanders in Afghanistan to respond to urgent, small-scale, 
     humanitarian relief and reconstruction requirements within 
     their areas of responsibility:  Provided, That each project 
     (including any ancillary or related elements in connection 
     with such project) executed under this authority shall not 
     exceed $2,000,000:  Provided further, That not later than 45 
     days after the end of each 6 months of the fiscal year, the 
     Secretary of Defense shall submit to the congressional 
     defense committees a report regarding the source of funds and 
     the allocation and use of funds during that 6-month period 
     that were made available pursuant to the authority provided 
     in this section or under any other provision of law for the 
     purposes described herein:  Provided further, That, not later 
     than 30 days after the end of each fiscal year quarter, the 
     Army shall submit to the congressional defense committees 
     quarterly commitment, obligation, and expenditure data for 
     the CERP in Afghanistan:  Provided further, That, not less 
     than 15 days before making funds available pursuant to the 
     authority provided in this section or under any other 
     provision of law for the purposes described herein for a 
     project with a total anticipated cost for completion of 
     $500,000 or more, the Secretary shall submit to the 
     congressional defense committees a written notice containing 
     each of the following:
       (1) The location, nature and purpose of the proposed 
     project, including how the project is intended to advance the 
     military campaign plan for the country in which it is to be 
     carried out.
       (2) The budget, implementation timeline with milestones, 
     and completion date for the proposed project, including any 
     other CERP funding that has been or is anticipated to be 
     contributed to the completion of the project.
       (3) A plan for the sustainment of the proposed project, 
     including the agreement with either the host nation, a non-
     Department of Defense agency of the United States Government 
     or a third-party contributor to finance the sustainment of 
     the activities and maintenance of any equipment or facilities 
     to be provided through the proposed project.
       Sec. 1306.  Funds available to the Department of Defense 
     for operation and maintenance may be used, notwithstanding 
     any other provision of law, to provide supplies, services, 
     transportation, including airlift and sealift, and other 
     logistical support to allied forces participating in a 
     combined operation with the armed forces of the United States 
     and coalition forces supporting military and stability 
     operations in Afghanistan and to counter the Islamic State of 
     Iraq and the Levant:  Provided, That the Secretary of Defense 
     shall provide quarterly reports to the congressional defense 
     committees regarding support provided under this section.
       Sec. 1307.  None of the funds appropriated or otherwise 
     made available by this or any

[[Page H853]]

     other Act shall be obligated or expended by the United States 
     Government for a purpose as follows:
       (1) To establish any military installation or base for the 
     purpose of providing for the permanent stationing of United 
     States Armed Forces in Iraq.
       (2) To exercise United States control over any oil resource 
     of Iraq.
       (3) To establish any military installation or base for the 
     purpose of providing for the permanent stationing of United 
     States Armed Forces in Afghanistan.
       Sec. 1308.  None of the funds made available in this Act 
     may be used in contravention of the following laws enacted or 
     regulations promulgated to implement the United Nations 
     Convention Against Torture and Other Cruel, Inhuman or 
     Degrading Treatment or Punishment (done at New York on 
     December 10, 1984):
       (1) Section 2340A of title 18, United States Code.
       (2) Section 2242 of the Foreign Affairs Reform and 
     Restructuring Act of 1998 (division G of Public Law 105-277; 
     112 Stat. 2681-822; 8 U.S.C. 1231 note) and regulations 
     prescribed thereto, including regulations under part 208 of 
     title 8, Code of Federal Regulations, and part 95 of title 
     22, Code of Federal Regulations.
       (3) Sections 1002 and 1003 of the Department of Defense, 
     Emergency Supplemental Appropriations to Address Hurricanes 
     in the Gulf of Mexico, and Pandemic Influenza Act, 2006 
     (Public Law 109-148).
       Sec. 1309.  None of the funds provided for the 
     ``Afghanistan Security Forces Fund'' (ASFF) may be obligated 
     prior to the approval of a financial and activity plan by the 
     Afghanistan Resources Oversight Council (AROC) of the 
     Department of Defense:  Provided, That the AROC must approve 
     the requirement and acquisition plan for any service 
     requirements in excess of $50,000,000 annually and any non-
     standard equipment requirements in excess of $100,000,000 
     using ASFF:  Provided further, That the Department of Defense 
     must certify to the congressional defense committees that the 
     AROC has convened and approved a process for ensuring 
     compliance with the requirements in the preceding proviso and 
     accompanying report language for the ASFF.
       Sec. 1310.  Funds made available in this title to the 
     Department of Defense for operation and maintenance may be 
     used to purchase items having an investment unit cost of not 
     more than $250,000:  Provided, That, upon determination by 
     the Secretary of Defense that such action is necessary to 
     meet the operational requirements of a Commander of a 
     Combatant Command engaged in contingency operations overseas, 
     such funds may be used to purchase items having an investment 
     item unit cost of not more than $500,000.
       Sec. 1311.  Up to $500,000,000 of funds appropriated by 
     this Act for the Defense Security Cooperation Agency in 
     ``Operation and Maintenance, Defense-Wide'' may be used to 
     provide assistance to the Government of Jordan to support the 
     armed forces of Jordan and to enhance security along its 
     borders.
       Sec. 1312.  None of the funds made available by this Act 
     under the heading ``Counter-ISIL Train and Equip Fund'' may 
     be used to procure or transfer man-portable air defense 
     systems.
       Sec. 1313.  For the ``Ukraine Security Assistance 
     Initiative'', $150,000,000 is hereby appropriated, to remain 
     available until September 30, 2018:  Provided, That such 
     funds shall be available to the Secretary of Defense, in 
     coordination with the Secretary of State, to provide 
     assistance, including training; equipment; lethal weapons of 
     a defensive nature; logistics support, supplies and services; 
     sustainment; and intelligence support to the military and 
     national security forces of Ukraine, and for replacement of 
     any weapons or defensive articles provided to the Government 
     of Ukraine from the inventory of the United States:  Provided 
     further, That the Secretary of Defense shall, not less than 
     15 days prior to obligating funds provided under this 
     heading, notify the congressional defense committees in 
     writing of the details of any such obligation:  Provided 
     further, That the United States may accept equipment procured 
     using funds provided under this heading in this or prior Acts 
     that was transferred to the security forces of Ukraine and 
     returned by such forces to the United States:  Provided 
     further, That equipment procured using funds provided under 
     this heading in this or prior Acts, and not yet transferred 
     to the military or National Security Forces of Ukraine or 
     returned by such forces to the United States, may be treated 
     as stocks of the Department of Defense upon written 
     notification to the congressional defense committees:  
     Provided further, That amounts made available by this section 
     are designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.
       Sec. 1314.  Funds appropriated in this title shall be 
     available for replacement of funds for items provided to the 
     Government of Ukraine from the inventory of the United States 
     to the extent specifically provided for in section 9013 of 
     this Act.
       Sec. 1315.  None of the funds made available by this Act 
     under section 9013 for ``Assistance and Sustainment to the 
     Military and National Security Forces of Ukraine'' may be 
     used to procure or transfer man-portable air defense systems.
       Sec. 1316. (a) None of the funds appropriated or otherwise 
     made available by this Act under the heading ``Operation and 
     Maintenance, Defense-Wide'' for payments under section 1233 
     of Public Law 110-181 for reimbursement to the Government of 
     Pakistan may be made available unless the Secretary of 
     Defense, in coordination with the Secretary of State, 
     certifies to the congressional defense committees that the 
     Government of Pakistan is--
       (1) cooperating with the United States in counterterrorism 
     efforts against the Haqqani Network, the Quetta Shura 
     Taliban, Lashkar e-Tayyiba, Jaish-e-Mohammed, Al Qaeda, and 
     other domestic and foreign terrorist organizations, including 
     taking steps to end support for such groups and prevent them 
     from basing and operating in Pakistan and carrying out cross 
     border attacks into neighboring countries;
       (2) not supporting terrorist activities against United 
     States or coalition forces in Afghanistan, and Pakistan's 
     military and intelligence agencies are not intervening extra-
     judicially into political and judicial processes in Pakistan;
       (3) dismantling improvised explosive device (IED) networks 
     and interdicting precursor chemicals used in the manufacture 
     of IEDs;
       (4) preventing the proliferation of nuclear-related 
     material and expertise;
       (5) implementing policies to protect judicial independence 
     and due process of law;
       (6) issuing visas in a timely manner for United States 
     visitors engaged in counterterrorism efforts and assistance 
     programs in Pakistan; and
       (7) providing humanitarian organizations access to 
     detainees, internally displaced persons, and other Pakistani 
     civilians affected by the conflict.
       (b) The Secretary of Defense, in coordination with the 
     Secretary of State, may waive the restriction in subsection 
     (a) on a case-by-case basis by certifying in writing to the 
     congressional defense committees that it is in the national 
     security interest to do so:  Provided, That if the Secretary 
     of Defense, in coordination with the Secretary of State, 
     exercises such waiver authority, the Secretaries shall report 
     to the congressional defense committees on both the 
     justification for the waiver and on the requirements of this 
     section that the Government of Pakistan was not able to meet: 
      Provided further, That such report may be submitted in 
     classified form if necessary.

                     (including transfer of funds)

       Sec. 1317.  In addition to amounts otherwise made available 
     in this Act, $500,000,000 is hereby appropriated to the 
     Department of Defense and made available for transfer only to 
     the operation and maintenance, military personnel, and 
     procurement accounts, to improve the intelligence, 
     surveillance, and reconnaissance capabilities of the 
     Department of Defense:  Provided, That the transfer authority 
     provided in this section is in addition to any other transfer 
     authority provided elsewhere in this Act:  Provided further, 
     That not later than 30 days prior to exercising the transfer 
     authority provided in this section, the Secretary of Defense 
     shall submit a report to the congressional defense committees 
     on the proposed uses of these funds:  Provided further, That 
     the funds provided in this section may not be transferred to 
     any program, project, or activity specifically limited or 
     denied by this Act:  Provided further, That amounts made 
     available by this section are designated by the Congress for 
     Overseas Contingency Operations/Global War on Terrorism 
     pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
     and Emergency Deficit Control Act of 1985:  Provided further, 
     That the authority to provide funding under this section 
     shall terminate on September 30, 2018.
       Sec. 1318.  None of the funds made available by this Act 
     may be used with respect to Syria in contravention of the War 
     Powers Resolution (50 U.S.C. 1541 et seq.), including for the 
     introduction of United States armed or military forces into 
     hostilities in Syria, into situations in Syria where imminent 
     involvement in hostilities is clearly indicated by the 
     circumstances, or into Syrian territory, airspace, or waters 
     while equipped for combat, in contravention of the 
     congressional consultation and reporting requirements of 
     sections 3 and 4 of that law (50 U.S.C. 1542 and 1543).

                             (rescissions)

       Sec. 1319.  Of the funds appropriated in Department of 
     Defense Appropriations Acts, the following funds are hereby 
     rescinded from the following accounts and programs in the 
     specified amounts:  Provided, That such amounts are 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985:
       ``Other Procurement, Air Force'', 2017/2019, $25,100,000;
       ``Afghanistan Security Forces Fund'', 2017/2018, 
     $100,000,000; and
       ``Counter-ISIL Train and Equip Fund'', 2017/2018, 
     $112,513,000.
       ``Operation and Maintenance, Defense-Wide, DSCA Coalition 
     Support Fund'', 2017/2018, $350,000,000.
       Sec. 1320.  Each amount designated in this Act by the 
     Congress for Overseas Contingency Operations/Global War on 
     Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
     Balanced Budget and Emergency Deficit Control Act of 1985 
     shall be available only if the President subsequently so 
     designates all such amounts and transmits such designations 
     to the Congress.

[[Page H854]]

       Sec. 1321. (a) Not later than 30 days after the date of the 
     enactment of this Act, the President shall submit to Congress 
     a report on the United States strategy to defeat Al-Qaeda, 
     the Taliban, the Islamic State of Iraq and Syria (ISIS), and 
     their associated forces and co-belligerents.
       (b) The report required under subsection (a) shall include 
     the following:
       (1) An analysis of the adequacy of the existing legal 
     framework to accomplish the strategy described in subsection 
     (a), particularly with respect to the Authorization for Use 
     of Military Force (Public Law 107-40; 50 U.S.C. 1541 note) 
     and the Authorization for Use of Military Force Against Iraq 
     Resolution of 2002 (Public Law 107-243; 50 U.S.C. 1541 note).
       (2) An analysis of the budgetary resources necessary to 
     accomplish the strategy described in subsection (a).
       (c) Not later than 30 days after the date on which the 
     President submits to the appropriate congressional committees 
     the report required by subsection (a), the Secretary of State 
     and the Secretary of Defense shall testify at any hearing 
     held by any of the appropriate congressional committees on 
     the report and to which the Secretary is invited.
       (d) In this section, the term ``appropriate congressional 
     committees'' means--
       (1) the Committee on Foreign Relations and the Committee on 
     Armed Services of the Senate; and
       (2) the Committee on Foreign Affairs and the Committee on 
     Armed Services of the House of Representatives.
       Sec. 1322. (a) In addition to amounts provided elsewhere in 
     this Act, there is hereby appropriated $1,184,112,000, for 
     the following accounts and programs in the specified amounts 
     for costs associated with Operation Freedom's Sentinel:
       (1) ``Military Personnel, Army'', $48,377,000;
       (2) ``Military Personnel, Marine Corps'', $179,000;
       (3) ``Military Personnel, Air Force'', $1,340,000;
       (4) ``Operation and Maintenance, Army'', $872,491,000;
       (5) ``Operation and Maintenance, Navy'', $76,274,000;
       (6) ``Operation and Maintenance, Marine Corps'', 
     $24,734,000;
       (7) ``Operation and Maintenance, Defense-Wide'', 
     $81,164,000;
       (8) ``Procurement of Ammunition, Navy and Marine Corps'', 
     $10,853,000, to remain available until September 30, 2020;
       (9) ``Other Procurement, Navy'', $31,500,000, to remain 
     available until September 30, 2020; and
       (10) ``Research, Development, Test and Evaluation, Navy'', 
     $37,200,000, to remain available until September 30, 2019.
       (b) Amounts provided pursuant to this section are hereby 
     designated by the Congress for Overseas Contingency 
     Operations/Global War on Terrorism pursuant to section 
     251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
     Control Act of 1985.

                 TITLE X--ADDITIONAL GENERAL PROVISIONS

                          references to report

       Sec. 1401.  Any reference to a ``report accompanying this 
     Act'' contained in this Act shall be treated as a reference 
     to House Report 115-219. Such report shall apply for purposes 
     of determining the allocation of funds provided by, and the 
     implementation of, this Act.

                       spending reduction account

       Sec. 1402.  $0.
       Sec. 1403.  None of the funds appropriated or otherwise 
     made available under the heading ``Afghanistan Security 
     Forces Fund'' may be used to procure uniforms for the Afghan 
     National Army.
       Sec. 1404.  None of the funds made available in this Act 
     may be used for the closure of a biosafety level 4 
     laboratory.
       Sec. 1405.  None of the funds made available by this Act 
     may be used to provide arms, training, or other assistance to 
     the Azov Battalion.
       Sec. 1406.  None of the finds made available by this Act 
     may be used to purchase heavy water from Iran.
       Sec. 1407.  None of the funds appropriated by this Act may 
     be used to plan for, begin, continue, complete, process, or 
     approve a public-private competition under the Office of 
     Management and Budget Circular A-76.
       Sec. 1408.  Notwithstanding any other provision of law, 
     with respect to the revised security category (as that term 
     is defined in section 250(c)(4)(D) of the Balanced Budget and 
     Emergency Deficit Control Act of 1985), any sequestration 
     order issued under such Act for fiscal year 2018 shall have 
     no force or effect.
       This division may be cited as the ``Department of Defense 
     Appropriations Act, 2018''.

                       DIVISION D--MISCELLANEOUS

       Sec. 1501. (a) Section 1240B of the Food Security Act of 
     1985 (16 U.S.C. 3839aa-2) is amended by striking subsection 
     (a) and inserting the following:
       ``(a) Establishment.--During each of the 2002 through 2019 
     fiscal years, the Secretary shall provide payments to 
     producers that enter into contracts with the Secretary under 
     the program.''.
       (b) Section 1241 of the Food Security Act of 1985 (16 
     U.S.C. 3841) is amended--
       (1) in subsection (a)--
       (A) in the matter preceding paragraph (1), by striking 
     ``2018'' and inserting ``2018 (and fiscal year 2019 in the 
     case of the program specified in paragraph (5))''; and
       (B) in paragraph (5)(E), by striking ``fiscal year 2018'' 
     and inserting ``each of fiscal years 2018 through 2019''; and
       (2) in subsection (b), by striking ``2018'' and inserting 
     ``2018 (and fiscal year 2019 in the case of the program 
     specified in subsection (a)(5))''.

                        DIVISION E--TAX MATTERS

     SEC. 1601. REPEAL OF SHIFT IN TIME OF PAYMENT OF CORPORATE 
                   ESTIMATED TAXES.

       The Trade Preferences Extension Act of 2015 is amended by 
     striking section 803 (relating to time for payment of 
     corporate estimated taxes).

                     DIVISION F--HEALTH PROVISIONS

     SEC. 2100. SHORT TITLE.

       This division may be cited as the ``Strengthening and 
     Underpinning the Safety-net to Aid Individuals Needing Care 
     Act of 2018'' or the ``SUSTAIN Care Act of 2018''.

            TITLE I--MEDICARE EXTENDERS AND RELATED POLICIES

                      Subtitle A--Medicare Part A

     SEC. 2101. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) 
                   PROGRAM.

       (a) In General.--Section 1886(d)(5)(G) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended--
       (1) in clause (i), by striking ``October 1, 2017'' and 
     inserting ``October 1, 2019'';
       (2) in clause (ii)(II), by striking ``October 1, 2017'' and 
     inserting ``October 1, 2019''; and
       (3) in clause (iv)--
       (A) by amending subclause (I) to read as follows:

       ``(I) that--

       ``(aa) is located in a rural area; or
       ``(bb) for discharges occurring on or after October 1, 
     2017, is located in a State with no rural area (as defined in 
     paragraph (2)(D)) and satisfies any of the criteria in 
     subclause (I), (II), (III), or (IV) of paragraph 
     (8)(E)(ii),''; and
       (B) by adding at the end, after and below subclause (IV), 
     the following flush sentence:
     ``For purposes of applying subclause (II) of paragraph 
     (8)(E)(ii) under subclause (I)(bb), such subclause (II) shall 
     be applied by inserting `as of January 1, 2018,' after `such 
     State' each place it appears.''.
       (b) Conforming Amendments.--
       (1) Extension of target amount.--Section 1886(b)(3)(D) of 
     the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
     amended--
       (A) in the matter preceding clause (i), by striking 
     ``October 1, 2017'' and inserting ``October 1, 2019''; and
       (B) in clause (iv), by striking ``through fiscal year 
     2017'' and inserting ``through fiscal year 2019''.
       (2) Permitting hospitals to decline reclassification.--
     Section 13501(e)(2) of the Omnibus Budget Reconciliation Act 
     of 1993 (42 U.S.C. 1395ww note) is amended by striking 
     ``through fiscal year 2017'' and inserting ``through fiscal 
     year 2019''.

     SEC. 2102. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT 
                   ADJUSTMENT FOR CERTAIN LOW-VOLUME HOSPITALS.

       Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
     1395ww(d)(12)) is amended--
       (1) in subparagraph (B), in the matter preceding clause 
     (i), by striking ``fiscal year 2018'' and inserting ``fiscal 
     year 2020'';
       (2) in subparagraph (C)(i), by striking ``fiscal years 2011 
     through 2017'' and inserting ``fiscal years 2011 through 
     2019'' each place it appears; and
       (3) in subparagraph (D), by striking ``fiscal years 2011 
     through 2017'' and inserting ``fiscal years 2011 through 
     2019''.

     SEC. 2103. STUDIES RELATING TO HOSPITAL PROGRAMS PAID OUTSIDE 
                   OF PROSPECTIVE PAYMENT SYSTEMS.

       (a) MedPAC Report.--Using data from hospital programs with 
     respect to which hospitals receive payment outside of the 
     prospective payment systems under sections 1833 and 1886 of 
     the Social Security Act (42 U.S.C. 1395l; 42 U.S.C. 1395ww) 
     (such programs referred to in this subsection as ``PPS carve-
     out programs'') or other data, as available, not later than 
     June 30, 2019, the Medicare Payment Advisory Commission shall 
     submit to Congress a report that evaluates and recommends 
     changes to PPS carve-out programs, including with respect to 
     amendments made by sections 2101 and 2102 of this Act, 
     sections 1814, 1820, 1886(d)(5)(D)(iii), and 1115(A) of the 
     Social Security Act, and such other sections of title XVIII 
     of the Social Security Act deemed appropriate. To the extent 
     feasible, such report shall make recommendations on a payment 
     methodology under the Medicare program for hospital payments, 
     including with respect to PPS carve-out programs, that 
     differs from the payment methodology applicable to such 
     programs as of September 30, 2017.
       (b) MedPAC Recommendations for Possible Alternative 
     Payments.--Not later than 2 years after the date by which the 
     Secretary of Health and Human Services has collected 2 years 
     of data under sections 1886(d)(5)(G) and 1886(d)(12) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(5)(G); 42 U.S.C. 
     1395ww(d)(12)), as extended pursuant to sections 2101 and 
     2102 of this Act, the Medicare Payment Advisory Commission 
     shall submit to Congress a report, including--
       (1) recommendations on payments, including a technical 
     prototype for payments for PPS carve-out programs, if 
     warranted;

[[Page H855]]

       (2) recommendations, if any, on which Medicare fee-for-
     service regulations for hospital payments under title XVIII 
     of the Social Security Act should be altered (such as the 
     critical access hospital 96-hour rule);
       (3) an analysis of the impact of the recommended payments 
     described in paragraph (1) on Medicare beneficiary cost-
     sharing, access to care, and choice of setting;
       (4) a projection of any potential reduction in expenditures 
     under title XVIII of the Social Security Act that may be 
     attributable to the application of the recommended payments 
     described in paragraph (1);
       (5) a review of the value of hospitals participating in PPS 
     carve-out programs collecting and reporting to the Secretary 
     standardized patient assessment data with respect to 
     inpatient hospital services;
       (6) the types of rural hospital classifications and payment 
     methodologies under the Medicare program, including 
     information on each special payment structure such as 
     eligibility criteria, and any areas of overlap between such 
     special payment programs;
       (7) Medicare spending on each PPS carve-out program;
       (8) the financial aspects of hospitals participating in 
     such PPS carve-out programs, such as the share of discharges 
     under the Medicare and Medicaid programs; and
       (9) whether such payment programs are empirically justified 
     to support Medicare beneficiary access to care.

     SEC. 2104. EXTENSION OF HOME HEALTH RURAL ADD-ON.

       (a) Extension.--
       (1) In general.--Section 421 of the Medicare Prescription 
     Drug, Improvement, and Modernization Act of 2003 (Public Law 
     108-173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended 
     by section 5201(b) of the Deficit Reduction Act of 2005 
     (Public Law 109-171; 120 Stat. 46), section 3131(c) of the 
     Patient Protection and Affordable Care Act (Public Law 111-
     148; 124 Stat. 428), and section 210 of the Medicare Access 
     and CHIP Reauthorization Act of 2015 (Public Law 114-10; 129 
     Stat. 151) is amended--
       (A) in subsection (a), by striking ``January 1, 2018'' and 
     inserting ``January 1, 2019'' each place it appears;
       (B) by redesignating subsections (b) and (c) as subsections 
     (c) and (d), respectively;
       (C) in each of subsections (c) and (d), as so redesignated, 
     by striking ``subsection (a)'' and inserting ``subsection (a) 
     or (b)''; and
       (D) by inserting after subsection (a) the following new 
     subsection:
       ``(b) Subsequent Temporary Increase.--
       ``(1) In general.--The Secretary shall increase the payment 
     amount otherwise made under such section 1895 for home health 
     services furnished in a county (or equivalent area) in a 
     rural area (as defined in such section 1886(d)(2)(D)) that, 
     as determined by the Secretary--
       ``(A) is in the highest quartile of all counties (or 
     equivalent areas) based on the number of Medicare home health 
     episodes furnished per 100 individuals who are entitled to, 
     or enrolled for, benefits under part A of title XVIII of the 
     Social Security Act or enrolled for benefits under part B of 
     such title (but not enrolled in a plan under part C of such 
     title)--
       ``(i) in the case of episodes and visits ending during 
     2019, by 1.5 percent; and
       ``(ii) in the case of episodes and visits ending during 
     2020, by 0.5 percent;
       ``(B) has a population density of 6 individuals or fewer 
     per square mile of land area and is not described in 
     subparagraph (A)--
       ``(i) in the case of episodes and visits ending during 
     2019, by 4 percent;
       ``(ii) in the case of episodes and visits ending during 
     2020, by 3 percent;
       ``(iii) in the case of episodes and visits ending during 
     2021, by 2 percent; and
       ``(iv) in the case of episodes and visits ending during 
     2022, by 1 percent; and
       ``(C) is not described in either subparagraph (A) or (B)--
       ``(i) in the case of episodes and visits ending during 
     2019, by 3 percent;
       ``(ii) in the case of episodes and visits ending during 
     2020, by 2 percent; and
       ``(iii) in the case of episodes and visits ending during 
     2021, by 1 percent.
       ``(2) Rules for determinations.--
       ``(A) No switching.--For purposes of this subsection, the 
     determination by the Secretary as to which subparagraph of 
     paragraph (1) applies to a county (or equivalent area) shall 
     be made a single time and shall apply for the duration of the 
     period to which this subsection applies.
       ``(B) Utilization.--In determining which counties (or 
     equivalent areas) are in the highest quartile under paragraph 
     (1)(A), the following rules shall apply:
       ``(i) The Secretary shall use data from 2015.
       ``(ii) The Secretary shall exclude data from the 
     territories (and the territories shall not be described in 
     such paragraph).
       ``(iii) The Secretary may exclude data from counties (or 
     equivalent areas) in rural areas with a low volume of home 
     health episodes (and if data is so excluded with respect to a 
     county (or equivalent area), such county (or equivalent area) 
     shall not be described in such paragraph).
       ``(C) Population density.--In determining population 
     density under paragraph (1)(B), the Secretary shall use data 
     from the 2010 decennial Census.
       ``(3) Limitations on review.--There shall be no 
     administrative or judicial review under section 1869, section 
     1878, or otherwise of determinations under paragraph (1).''.
       (2) Requirement to submit county data on claim form.--
     Section 1895(c) of the Social Security Act (42 U.S.C. 
     1395fff(c)) is amended--
       (A) in paragraph (1), by striking ``and'' at the end;
       (B) in paragraph (2), by striking the period at the end and 
     inserting ``; and''; and
       (C) by adding at the end the following new paragraph:
       ``(3) in the case of home health services furnished on or 
     after January 1, 2019, the claim contains the code for the 
     county (or equivalent area) in which the home health service 
     was furnished.''.
       (b) OIG Review.--The Office of the Inspector General shall 
     submit to Congress, not later than January 1, 2020, and 
     annually thereafter through January 1, 2024, a report 
     containing--
       (1) an analysis of payments made under section 1895 of the 
     Social Security Act (42 U.S.C. 1395fff) increased under 
     section 421 of the Medicare Prescription Drug, Improvement, 
     and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2283; 42 U.S.C. 1395fff note), as amended by section 5201(b) 
     of the Deficit Reduction Act of 2005 (Public Law 109-171; 120 
     Stat. 46), section 3131(c) of the Patient Protection and 
     Affordable Care Act (Public Law 111-148; 124 Stat. 428), 
     section 210 of the Medicare Access and CHIP Reauthorization 
     Act of 2015 (Public Law 114-10; 129 Stat. 151), and 
     subsection (a); and
       (2) a recommendation on whether such payments should 
     continue to be made based on county data.

                      Subtitle B--Medicare Part B

     SEC. 2111. GROUND AMBULANCE SERVICES COST REPORTING 
                   REQUIREMENT.

       (a) In General.--Section 1121 of the Social Security Act 
     (42 U.S.C. 1320a) is amended--
       (1) in subsection (a)--
       (A) by striking ``For the purposes of'' and inserting 
     ``Subject to subsection (d), for the purposes of'';
       (B) by inserting ``suppliers of ground ambulance 
     services,'' after ``health maintenance organizations,''; and
       (C) in the matter following paragraph (5), by adding the 
     following new sentence: ``Not later than December 31, 2019, 
     the Secretary shall modify the uniform reporting systems for 
     providers of services with respect to ground ambulance 
     services to ensure that such systems contain information 
     similar (as determined by the Secretary) to information 
     required under the uniform reporting system for suppliers of 
     ground ambulance services.''; and
       (2) by adding at the end the following new subsection:
       ``(d) In the case of a provider or supplier of ground 
     ambulance services, the Secretary may modify the requirements 
     for the inclusion of any data element specified in subsection 
     (a) in reports made in accordance with the uniform reporting 
     system established under this section with respect to such 
     services for such provider or supplier.''.
       (b) Suspension of Payment for Ground Ambulance Services; 
     Deeming Certain Payments Overpayments.--Section 1834(l) of 
     the Social Security Act (42 U.S.C. 1395m(l)) is amended by 
     adding at the end the following new paragraph:
       ``(17) Requirement to submit cost report and authority to 
     suspend payments and deem certain payments overpayments for 
     ground ambulance services.--
       ``(A) In general.--With respect to ground ambulance 
     services furnished by a supplier of such services during cost 
     reporting periods (as defined in subparagraph (I)) beginning 
     on or after January 1, 2020, such supplier shall make reports 
     to the Secretary of information described in section 1121(a) 
     in accordance with the uniform reporting system established 
     under such section for such suppliers and, as may be required 
     by the Secretary, of any of the information described in 
     subparagraph (B).
       ``(B) Additional information.--The Secretary may, with 
     respect to a supplier of ground ambulance services, require 
     the following information (to be reported to the extent 
     practicable under the uniform reporting system established 
     under section 1121(a) for such suppliers):
       ``(i) Whether the supplier is part of an emergency services 
     department, a governmental organization, or another type of 
     entity (as described by the Secretary).
       ``(ii) The number of hours in a week during which the 
     supplier is available for furnishing ground ambulance 
     services.
       ``(iii) The average number of volunteer hours a week used 
     by the supplier.
       ``(C) Suspension of payment.--Subject to subparagraph (E), 
     in the case that the Secretary determines that a supplier of 
     ground ambulance services has not made to the Secretary a 
     timely report described in subparagraph (A) with respect to a 
     cost reporting period beginning on or after January 1, 2020, 
     and before January 1, 2022, the Secretary may suspend 
     payments made under this subsection, in whole or in part, to 
     such supplier until the Secretary determines that such 
     supplier has made such a report.
       ``(D) Deeming certain payments overpayments.--Subject to 
     subparagraphs (E) and (F), in the case that the Secretary 
     determines that a supplier of ground ambulance services has 
     not made to the Secretary a complete, accurate, and timely 
     report described in subparagraph (A) with respect to a cost 
     reporting period beginning on or after January 1, 2022, the 
     Secretary may either--
       ``(i) deem payments made under this subsection to such 
     supplier for such period to be

[[Page H856]]

     overpayments and recoup such overpayments; or
       ``(ii) suspend payments made under this subsection to such 
     supplier for such period.
       ``(E) Hardship delay.--The Secretary shall establish a 
     process whereby a supplier of ground ambulance services may 
     request a delay in making a report described in subparagraph 
     (A) with respect to a cost reporting period for reason of 
     significant hardship (as determined by the Secretary).
       ``(F) Authority to modify cost reporting elements and 
     enforcement.--Not earlier than January 1, 2024, the Secretary 
     may provide that subparagraph (D) no longer applies to 
     suppliers of ground ambulance services or a category of such 
     suppliers after--
       ``(i) taking into account the recommendation of the 
     Medicare Payment Advisory Commission in the most recent 
     report available to the Secretary submitted under section 
     2111(g) of the SUSTAIN Care Act of 2018 whether cost reports 
     made by suppliers or a category of suppliers (as specified 
     for purposes of the report submitted under such section) of 
     ground ambulance services should be required or modified; and
       ``(ii) undertaking notice and comment rulemaking.
       ``(G) Audit of cost reports.--The Secretary shall audit 
     reports described in subparagraph (A) made with respect to 
     cost reporting periods beginning on or after January 1, 2021.
       ``(H) Appeals.--The Secretary shall establish a process 
     whereby a supplier of ground ambulance services may appeal a 
     determination described in subparagraph (C) or (D) made with 
     respect to a cost report required to be made by such supplier 
     under subparagraph (A).
       ``(I) Definition.--In this paragraph, the term `cost 
     reporting period' means, with respect to a year, the 12-month 
     period beginning on January 1 of such year.''.
       (c) Stakeholder Feedback.--
       (1) In general.--The Secretary of Health and Human Services 
     shall implement the provisions of this section, including the 
     amendments made by this section, through notice and comment 
     rulemaking and seek input from stakeholders.
       (2) Nonapplication of paperwork reduction act.--Chapter 35 
     of title 44, United States Code, shall not apply with respect 
     to--
       (A) the development and implementation of the uniform 
     reporting system required under section 1121(a) of the Social 
     Security Act (42 U.S.C. 1320a(a)) for suppliers of ground 
     ambulance services and reports required to be made under 
     section 1834(l)(17) of such Act (42 U.S.C. 1395m(l)(17)); and
       (B) the modification of the uniform reporting systems under 
     such section 1121(a) of such Act for providers of such 
     services and reports required to be made under section 
     1861(v)(1)(F) of such Act (42 U.S.C. 1395x(v)(1)(F)).
       (d) Implementation Resources.--In addition to funds 
     otherwise available, there are appropriated to the Centers 
     for Medicare & Medicaid Services Program Management Account 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 of the Social Security Act (42 U.S.C. 1395i) $8,000,000 
     and from the Federal Supplementary Medical Insurance Trust 
     Fund under section 1841 of such Act (42 U.S.C. 1395t) 
     $137,000,000 (of which not less than $15,000,000 shall be 
     used to fulfill the auditing requirement under section 
     1834(l)(17)(G) of such Act, as added by subsection (b) of 
     this section) to carry out the provisions of this section, 
     including the amendments made by this section, to remain 
     available through December 31, 2022. Of the amounts 
     appropriated under the previous sentence, the Secretary shall 
     use such sums as may be necessary to hire not less than 2 
     full-time employees for purposes of carrying out such 
     provisions, including such amendments.
       (e) Extension of Rural Add-on Payments.--Section 1834(l) of 
     the Social Security Act (42. U.S.C. 1395m(l)) is amended--
       (1) in paragraph (12)(A), by striking ``2018'' and 
     inserting ``2023''; and
       (2) in paragraph (13)(A), by striking ``2018'' each place 
     it appears and inserting ``2023''.
       (f) Sense of Congress.--It is the sense of Congress that--
       (1) a cost report made by a supplier of ground ambulance 
     services with respect to a cost reporting period beginning 
     before January 1, 2022, may not contain complete and accurate 
     information on ground ambulance services furnished during 
     such a period by the supplier; and
       (2) the Secretary should take into account only the 
     timeliness of such a report made with respect to such a 
     period when determining whether to suspend payments to a 
     supplier under section 1834(l) of the Social Security Act (42 
     U.S.C. 1395m(l)).
       (g) Ground Ambulance Services Cost Reporting Study.--
       (1) In general.--Not later than March 15, 2023, and as 
     determined necessary by the Medicare Payment Advisory 
     Commission thereafter, such Commission shall assess and 
     submit to Congress a report on cost reports of suppliers and 
     providers of ground ambulance services carried out in 
     accordance with sections 1121(a) and 1834(l) of the Social 
     Security Act (42 U.S.C. 1320a(a), 1395m(l)), the adequacy of 
     payments for such services made under section 1834(l) of such 
     Act, and geographic variations in the cost of providing such 
     services.
       (2) Contents.--The report described in paragraph (1) shall 
     contain the following:
       (A) An analysis of cost report data submitted in accordance 
     with such sections.
       (B) An analysis of any burden on providers and suppliers of 
     such services associated with reporting such data.
       (C) A recommendation on whether or not cost reports of 
     ground ambulance services made by suppliers or a category of 
     suppliers (as specified by the Secretary) of such services, 
     or the ground ambulance portion of cost reports made by 
     providers of such services, should be required or modified, 
     taking into account the analyses described in subparagraphs 
     (A) and (B).

     SEC. 2112. EXTENSION OF WORK GPCI FLOOR.

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

     SEC. 2113. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY 
                   SERVICES; REPLACEMENT WITH LIMITATION TO ENSURE 
                   APPROPRIATE THERAPY.

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

[[Page H857]]

       ``(iv) Funding.--For purposes of carrying out this 
     subparagraph, the Secretary shall provide for the transfer, 
     from the Federal Supplementary Medical Insurance Trust Fund 
     under section 1841 to the Centers for Medicare & Medicaid 
     Services Program Management Account, of $5,000,000 for each 
     fiscal year beginning with fiscal year 2018, to remain 
     available until expended. Such funds may not be used by a 
     contractor under section 1893(h) for medical reviews under 
     this subparagraph.''.

                       Subtitle C--Miscellaneous

     SEC. 2121. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE 
                   SPECIAL NEEDS PLANS FOR VULNERABLE POPULATIONS.

       (a) Extension.--Section 1859(f)(1) of the Social Security 
     Act (42 U.S.C. 1395w-28(f)(1)) is amended by striking ``and 
     for periods before January 1, 2019''.
       (b) Increased Integration of Dual SNPs.--
       (1) In general.--Section 1859(f) of the Social Security Act 
     (42 U.S.C. 1395w-28(f)) is amended--
       (A) in paragraph (3), by adding at the end the following 
     new subparagraph:
       ``(F) The plan meets the requirements applicable under 
     paragraph (8).''; and
       (B) by adding at the end the following new paragraph:
       ``(8) Increased integration of dual snps.--
       ``(A) Designated contact.--The Secretary, acting through 
     the Federal Coordinated Health Care Office established under 
     section 2602 of Public Law 111-148, shall serve as a 
     dedicated point of contact for States to address 
     misalignments that arise with the integration of specialized 
     MA plans for special needs individuals described in 
     subsection (b)(6)(B)(ii) under this paragraph and, consistent 
     with such role, shall establish--
       ``(i) a uniform process for disseminating to State Medicaid 
     agencies information under this title impacting contracts 
     between such agencies and such plans under this subsection; 
     and
       ``(ii) basic resources for States interested in exploring 
     such plans as a platform for integration, such as a model 
     contract or other tools to achieve those goals.
       ``(B) Unified grievances and appeals process.--
       ``(i) In general.--Not later than April 1, 2020, the 
     Secretary shall establish procedures, to the extent feasible 
     as determined by the Secretary, unifying grievances and 
     appeals procedures under sections 1852(f), 1852(g), 
     1902(a)(3), 1902(a)(5), and 1932(b)(4) for items and services 
     provided by specialized MA plans for special needs 
     individuals described in subsection (b)(6)(B)(ii) under this 
     title and title XIX. With respect to items and services 
     described in the preceding sentence, procedures established 
     under this clause shall apply in place of otherwise 
     applicable grievances and appeals procedures. The Secretary 
     shall solicit comment in developing such procedures from 
     States, plans, beneficiaries and their representatives, and 
     other relevant stakeholders.
       ``(ii) Procedures.--The procedures established under clause 
     (i) shall be included in the plan contract under paragraph 
     (3)(D) and shall--

       ``(I) adopt the provisions for the enrollee that are most 
     protective for the enrollee and, to the extent feasible as 
     determined by the Secretary, are compatible with unified 
     timeframes and consolidated access to external review under 
     an integrated process;
       ``(II) take into account differences in State plans under 
     title XIX to the extent necessary;
       ``(III) be easily navigable by an enrollee; and
       ``(IV) include the elements described in clause (iii), as 
     applicable.

       ``(iii) Elements described.--Both unified appeals and 
     unified grievance procedures shall include, as applicable, 
     the following elements described in this clause:

       ``(I) Single written notification of all applicable 
     grievances and appeal rights under this title and title XIX. 
     For purposes of this subparagraph, the Secretary may waive 
     the requirements under section 1852(g)(1)(B) when the 
     specialized MA plan covers items or services under this part 
     or under title XIX.
       ``(II) Single pathways for resolution of any grievance or 
     appeal related to a particular item or service provided by 
     specialized MA plans for special needs individuals described 
     in subsection (b)(6)(B)(ii) under this title and title XIX.
       ``(III) Notices written in plain language and available in 
     a language and format that is accessible to the enrollee, 
     including in non-English languages that are prevalent in the 
     service area of the specialized MA plan.
       ``(IV) Unified timeframes for grievances and appeals 
     processes, such as an individual's filing of a grievance or 
     appeal, a plan's acknowledgment and resolution of a grievance 
     or appeal, and notification of decisions with respect to a 
     grievance or appeal.
       ``(V) Requirements for how the plan must process, track, 
     and resolve grievances and appeals, to ensure beneficiaries 
     are notified on a timely basis of decisions that are made 
     throughout the grievance or appeals process and are able to 
     easily determine the status of a grievance or appeal.

       ``(iv) Continuation of benefits pending appeal.--The 
     unified procedures under clause (i) shall, with respect to 
     all benefits under parts A and B and title XIX subject to 
     appeal under such procedures, incorporate provisions under 
     current law and implementing regulations that provide 
     continuation of benefits pending appeal under this title and 
     title XIX.
       ``(C) Requirement for unified grievances and appeals.--For 
     2021 and subsequent years, the contract of a specialized MA 
     plan for special needs individuals described in subsection 
     (b)(6)(B)(ii) with a State Medicaid agency under paragraph 
     (3)(D) shall require the use of unified grievances and 
     appeals procedures as described in subparagraph (B).
       ``(D) Requirements for integration.--
       ``(i) In general.--For 2021 and subsequent years, a 
     specialized MA plan for special needs individuals described 
     in subsection (b)(6)(B)(ii) shall meet one or more of the 
     following requirements, to the extent permitted under State 
     law, for integration of benefits under this title and title 
     XIX:

       ``(I) The specialized MA plan must meet the requirements of 
     contracting with the State Medicaid agency described in 
     paragraph (3)(D) in addition to coordinating long-term 
     services and supports or behavioral health services, or both, 
     by meeting an additional minimum set of requirements 
     determined by the Secretary through the Federal Coordinated 
     Health Care Office established under section 2602 of the 
     Patient Protection and Affordable Care Act based on input 
     from stakeholders, such as notifying the State in a timely 
     manner of hospitalizations, emergency room visits, and 
     hospital or nursing home discharges of enrollees, assigning 
     one primary care provider for each enrollee, or sharing data 
     that would benefit the coordination of items and services 
     under this title and the State plan under title XIX. Such 
     minimum set of requirements must be included in the contract 
     of the specialized MA plan with the State Medicaid agency 
     under such paragraph.
       ``(II) The specialized MA plan must meet the requirements 
     of a fully integrated plan described in section 
     1853(a)(1)(B)(iv)(II) (other than the requirement that the 
     plan have similar average levels of frailty, as determined by 
     the Secretary, as the PACE program), or enter into a 
     capitated contract with the State Medicaid agency to provide 
     long-term services and supports or behavioral health 
     services, or both.
       ``(III) In the case of a specialized MA plan that is 
     offered by a parent organization that is also the parent 
     organization of a Medicaid managed care organization 
     providing long term services and supports or behavioral 
     services under a contract under section 1903(m), the parent 
     organization must assume clinical and financial 
     responsibility for benefits provided under this title and 
     title XIX with respect to any individual who is enrolled in 
     both the specialized MA plan and the Medicaid managed care 
     organization.

       ``(ii) Suspension of enrollment for failure to meet 
     requirements during initial period.--During the period of 
     plan years 2021 through 2025, if the Secretary determines 
     that a specialized MA plan for special needs individuals 
     described in subsection (b)(6)(B)(ii) has failed to comply 
     with clause (i), the Secretary may provide for the 
     application against the Medicare Advantage organization 
     offering the plan of the remedy described in section 
     1857(g)(2)(B) in the same manner as the Secretary may apply 
     such remedy, and in accordance with the same procedures as 
     would apply, in the case of an MA organization determined by 
     the Secretary to have engaged in conduct described in section 
     1857(g)(1). If the Secretary applies such remedy to a 
     Medicare Advantage organization under the preceding sentence, 
     the organization shall submit to the Secretary (at a time, 
     and in a form and manner, specified by the Secretary) 
     information describing how the plan will come into compliance 
     with clause (i).
       ``(E) Study and report to congress.--
       ``(i) In general.--Not later than January 1, 2022, and, 
     subject to clause (iii), biennially thereafter through 2032, 
     the Medicare Payment Advisory Commission established under 
     section 1805, in consultation with the Medicaid and CHIP 
     Payment and Access Commission established under section 1900, 
     shall conduct (and submit to the Secretary and the Committees 
     on Ways and Means and Energy and Commerce of the House of 
     Representatives and the Committee on Finance of the Senate a 
     report on) a study to determine how specialized MA plans for 
     special needs individuals described in subsection 
     (b)(6)(B)(ii) perform among each other based on data from 
     Healthcare Effectiveness Data and Information Set (HEDIS) 
     quality measures, reported on the plan level, as required 
     under section 1852(e)(3) (or such other measures or data 
     sources that are available and appropriate, such as encounter 
     data and Consumer Assessment of Healthcare Providers and 
     Systems data, as specified by such Commissions as enabling an 
     accurate evaluation under this subparagraph). Such study 
     shall include, as feasible, the following comparison groups 
     of specialized MA plans for special needs individuals 
     described in subsection (b)(6)(B)(ii):

       ``(I) A comparison group of such plans that are described 
     in subparagraph (D)(i)(I).
       ``(II) A comparison group of such plans that are described 
     in subparagraph (D)(i)(II).
       ``(III) A comparison group of such plans operating within 
     the Financial Alignment Initiative demonstration for the 
     period for which such plan is so operating and the 
     demonstration is in effect, and, in the case that an 
     integration option that is not with respect to specialized MA 
     plans for special needs individuals is established after the 
     conclusion of the demonstration involved.

[[Page H858]]

       ``(IV) A comparison group of such plans that are described 
     in subparagraph (D)(i)(III).
       ``(V) A comparison group of MA plans, as feasible, not 
     described in a previous subclause of this clause, with 
     respect to the performance of such plans for enrollees who 
     are special needs individuals described in subsection 
     (b)(6)(B)(ii).

       ``(ii) Discretionary additional reports.--Beginning with 
     2033 and every five years thereafter, the Medicare Payment 
     Advisory Commission, in consultation with the Medicaid and 
     CHIP Payment and Access Commission shall, at the discretion 
     of the Secretary, conduct a study described in clause (i).''.
       (2) Conforming amendment to responsibilities of federal 
     coordinated health care office.--Section 2602(d) of Public 
     Law 111-148 (42 U.S.C. 1315b(d)) is amended by adding at the 
     end the following new paragraphs:
       ``(6) To act as a designated contact for States under 
     subsection (f)(8)(A) of section 1859 of the Social Security 
     Act (42 U.S.C. 1395w-28) with respect to the integration of 
     specialized MA plans for special needs individuals described 
     in subsection (b)(6)(B)(ii) of such section.
       ``(7) To be responsible, subject to the final approval of 
     the Secretary, for developing regulations and guidance 
     related to the implementation of a unified grievance and 
     appeals process as described in subparagraphs (B) and (C) of 
     section 1859(f)(8) of the Social Security Act (42 U.S.C. 
     1395w-28(f)(8)).
       ``(8) To be responsible, subject to the final approval of 
     the Secretary, for developing regulations and guidance 
     related to the integration or alignment of policy and 
     oversight under the Medicare program under title XVIII of 
     such Act and the Medicaid program under title XIX of such Act 
     regarding specialized MA plans for special needs individuals 
     described in subsection (b)(6)(B)(ii) of such section 
     1859.''.
       (c) Improvements to Severe or Disabling Chronic Condition 
     SNPs.--
       (1) Care management requirements.--Section 1859(f)(5) of 
     the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is 
     amended--
       (A) by striking ``all snps.--The requirements'' and 
     inserting ``all snps.--
       ``(A) In general.--Subject to subparagraph (B), the 
     requirements'';
       (B) by redesignating subparagraphs (A) and (B) as clauses 
     (i) and (ii), respectively, and indenting appropriately; and
       (C) in clause (ii), as redesignated by subparagraph (B), by 
     redesignating clauses (i) through (iii) as subclauses (I) 
     through (III), respectively, and indenting appropriately; and
       (D) by adding at the end the following new subparagraph:
       ``(B) Improvements to care management requirements for 
     severe or disabling chronic condition snps.--For 2020 and 
     subsequent years, in the case of a specialized MA plan for 
     special needs individuals described in subsection 
     (b)(6)(B)(iii), the requirements described in this paragraph 
     include the following:
       ``(i) The interdisciplinary team under subparagraph 
     (A)(ii)(III) includes a team of providers with demonstrated 
     expertise, including training in an applicable specialty, in 
     treating individuals similar to the targeted population of 
     the plan.
       ``(ii) Requirements developed by the Secretary to provide 
     face-to-face encounters with individuals enrolled in the plan 
     not less frequently than on an annual basis.
       ``(iii) As part of the model of care under clause (i) of 
     subparagraph (A), the results of the initial assessment and 
     annual reassessment under clause (ii)(I) of such subparagraph 
     of each individual enrolled in the plan are addressed in the 
     individual's individualized care plan under clause (ii)(II) 
     of such subparagraph.
       ``(iv) As part of the annual evaluation and approval of 
     such model of care, the Secretary shall take into account 
     whether the plan fulfilled the previous year's goals (as 
     required under the model of care).
       ``(v) The Secretary shall establish a minimum benchmark for 
     each element of the model of care of a plan. The Secretary 
     shall only approve a plan's model of care under this 
     paragraph if each element of the model of care meets the 
     minimum benchmark applicable under the preceding sentence.''.
       (2) Revisions to the definition of a severe or disabling 
     chronic conditions specialized needs individual.--
       (A) In general.--Section 1859(b)(6)(B)(iii) of the Social 
     Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) is amended--
       (i) by striking ``who have'' and inserting ``who--

       ``(I) before January 1, 2022, have'';

       (ii) in subclause (I), as added by clause (i), by striking 
     the period at the end and inserting ``; and''; and
       (iii) by adding at the end the following new subclause:

       ``(II) on or after January 1, 2022, have one or more 
     comorbid and medically complex chronic conditions that is 
     life threatening or significantly limits overall health or 
     function, have a high risk of hospitalization or other 
     adverse health outcomes, and require intensive care 
     coordination and that is listed under subsection 
     (f)(9)(A).''.

       (B) Panel of clinical advisors.--Section 1859(f) of the 
     Social Security Act (42 U.S.C. 1395w-28(f)), as amended by 
     subsection (b), is amended by adding at the end the following 
     new paragraph:
       ``(9) List of conditions for clarification of the 
     definition of a severe or disabling chronic conditions 
     specialized needs individual.--
       ``(A) In general.--Not later than December 31, 2020, and 
     every 5 years thereafter, subject to subparagraphs (B) and 
     (C), the Secretary shall convene a panel of clinical advisors 
     to establish and update a list of conditions that meet each 
     of the following criteria:
       ``(i) Conditions that meet the definition of a severe or 
     disabling chronic condition under subsection (b)(6)(B)(iii) 
     on or after January 1, 2022.
       ``(ii) Conditions that require prescription drugs, 
     providers, and models of care that are unique to the specific 
     population of enrollees in a specialized MA plan for special 
     needs individuals described in such subsection on or after 
     such date and--

       ``(I) as a result of access to, and enrollment in, such a 
     specialized MA plan for special needs individuals, 
     individuals with such condition would have a reasonable 
     expectation of slowing or halting the progression of the 
     disease, improving health outcomes and decreasing overall 
     costs for individuals diagnosed with such condition compared 
     to available options of care other than through such a 
     specialized MA plan for special needs individuals; or
       ``(II) have a low prevalence in the general population of 
     beneficiaries under this title or a disproportionally high 
     per-beneficiary cost under this title.

       ``(B) Inclusion of certain conditions.--The conditions 
     listed under subparagraph (A) shall include HIV/AIDS, end 
     stage renal disease, and chronic and disabling mental 
     illness.
       ``(C) Requirement.--In establishing and updating the list 
     under subparagraph (A), the panel shall take into account the 
     availability of varied benefits, cost-sharing, and 
     supplemental benefits under the model described in paragraph 
     (2) of section 1859(h), including the expansion under 
     paragraph (1) of such section.''.
       (d) Quality Measurement at the Plan Level for SNPs and 
     Determination of Feasability of Quality Measurement at the 
     Plan Level for All MA Plans.--Section 1853(o) of the Social 
     Security Act (42 U.S.C. 1395w-23(o)) is amended by adding at 
     the end the following new paragraphs:
       ``(6) Quality measurement at the plan level for snps.--
       ``(A) In general.--Subject to subparagraph (B), the 
     Secretary may require reporting of data under section 1852(e) 
     for, and apply under this subsection, quality measures at the 
     plan level for specialized MA plans for special needs 
     individuals instead of at the contract level.
       ``(B) Considerations.--Prior to applying quality 
     measurement at the plan level under this paragraph, the 
     Secretary shall--
       ``(i) take into consideration the minimum number of 
     enrollees in a specialized MA plan for special needs 
     individuals in order to determine if a statistically 
     significant or valid measurement of quality at the plan level 
     is possible under this paragraph;
       ``(ii) take into consideration the impact of such 
     application on plans that serve a disproportionate number of 
     individuals dually eligible for benefits under this title and 
     under title XIX;
       ``(iii) if quality measures are reported at the plan level, 
     ensure that MA plans are not required to provide duplicative 
     information; and
       ``(iv) ensure that such reporting does not interfere with 
     the collection of encounter data submitted by MA 
     organizations or the administration of any changes to the 
     program under this part as a result of the collection of such 
     data.
       ``(C) Application.--If the Secretary applies quality 
     measurement at the plan level under this paragraph--
       ``(i) such quality measurement may include Medicare Health 
     Outcomes Survey (HOS), Healthcare Effectiveness Data and 
     Information Set (HEDIS), Consumer Assessment of Healthcare 
     Providers and Systems (CAHPS) measures and quality measures 
     under part D; and
       ``(ii) the Secretary shall consider applying administrative 
     actions, such as remedies described in section 1857(g)(2), at 
     the plan level.
       ``(7) Determination of feasibility of quality measurement 
     at the plan level for all ma plans.--
       ``(A) Determination of feasibility.--The Secretary shall 
     determine the feasibility of requiring reporting of data 
     under section 1852(e) for, and applying under this 
     subsection, quality measures at the plan level for all MA 
     plans under this part.
       ``(B) Consideration of change.--After making a 
     determination under subparagraph (A), the Secretary shall 
     consider requiring such reporting and applying such quality 
     measures at the plan level as described in such 
     subparagraph''.
       (e) GAO Study and Report on State-Level Integration Between 
     Dual SNPs and Medicaid.--
       (1) Study.--The Comptroller General of the United States 
     (in this subsection referred to as the ``Comptroller 
     General'') shall conduct a study on State-level integration 
     between specialized MA plans for special needs individuals 
     described in subsection (b)(6) (B)(ii) of section 1859 of the 
     Social Security Act (42 U.S.C. 1395w-28) and the Medicaid 
     program under title XIX of such Act (42 U.S.C. 1396 et seq.). 
     Such study shall include an analysis of the following:
       (A) The characteristics of States in which the State agency 
     responsible for administering the State plan under such title 
     XIX

[[Page H859]]

     has a contract with such a specialized MA plan and that 
     delivers long-term services and supports under the State plan 
     under such title XIX through a managed care program, 
     including the requirements under such State plan with respect 
     to long-term services and supports.
       (B) The types of such specialized MA plans, which may 
     include the following:
       (i) A plan described in section 1853(a)(1)(B)(iv)(II) of 
     such Act (42 U.S.C. 1395w-23(a)(1)(B)(iv)(II)).
       (ii) A plan that meets the requirements described in 
     subsection (f)(3)(D) of such section 1859.
       (iii) A plan described in clause (ii) that also meets 
     additional requirements established by the State.
       (C) The characteristics of individuals enrolled in such 
     specialized MA plans.
       (D) As practicable, the following with respect to State 
     programs for the delivery of long-term services and supports 
     under such title XIX through a managed care program:
       (i) Which populations of individuals are eligible to 
     receive such services and supports.
       (ii) Whether all such services and supports are provided on 
     a capitated basis or if any of such services and supports are 
     carved out and provided through fee-forservice.
       (E) As practicable, how the availability and variation of 
     integration arrangements of such specialized MA plans offered 
     in States affects spending, service delivery options, access 
     to community-based care, and utilization of care.
       (F) The efforts of State Medicaid programs to transition 
     dually-eligible beneficiaries receiving long-term services 
     and supports (LTSS) from institutional settings to home and 
     community-based settings and related financial impacts of 
     such transitions.
       (G) Barriers and opportunities for making further progress 
     on dual integration, as well as recommendations for 
     legislation or administrative action to expedite or refine 
     pathways toward fully integrated care.
       (2) Report.--Not later than 2 years after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under paragraph (1), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.

     SEC. 2122. EXTENSION OF CERTAIN MIPPA FUNDING PROVISIONS; 
                   STATE HEALTH INSURANCE ASSISTANCE PROGRAM 
                   REPORTING REQUIREMENTS.

       (a) Funding Extensions.--Section 119 of the Medicare 
     Improvements for Patients and Providers Act of 2008 (42 
     U.S.C. 1395b-3 note) is amended--
       (1) in subsection (a)(1)(B)--
       (A) in clause (vi), by striking ``and'' at the end;
       (B) in clause (vii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by inserting after clause (vii) the following new 
     clause:
       ``(viii) for each of fiscal years 2018 and 2019, of 
     $13,000,000.'';
       (2) in subsection (b)(1)(B)--
       (A) in clause (vi), by striking ``and'' at the end;
       (B) in clause (vii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by inserting after clause (vii) the following new 
     clause:
       ``(viii) for each of fiscal years 2018 and 2019, of 
     $7,500,000.'';
       (3) in subsection (c)(1)(B)--
       (A) in clause (vi), by striking ``and'' at the end;
       (B) in clause (vii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by inserting after clause (vii) the following new 
     clause:
       ``(viii) for each of fiscal years 2018 and 2019, of 
     $5,000,000.''; and
       (4) in subsection (d)(2)--
       (A) in clause (vi), by striking ``and'' at the end;
       (B) in clause (vii), by striking the period at the end and 
     inserting ``; and''; and
       (C) by inserting after clause (vii) the following new 
     clause:
       ``(viii) for each of fiscal years 2018 and 2019, of 
     $12,000,000.''.
       (b) State Health Insurance Assistance Program Reporting 
     Requirements.--Beginning not later than April 1, 2019, and 
     biennially thereafter, the Agency for Community Living shall 
     electronically post on its website the following information, 
     with respect to grants to States for State health insurance 
     assistance programs, (such information to be presented by 
     State and by entity receiving funds from the State to carry 
     out such a program funded by such grant):
       (1) The amount of Federal funding provided to each such 
     State for such program for the period involved and the amount 
     of Federal funding provided by each such State for such 
     program to each such entity for the period involved.
       (2) Information as the Secretary may specify, with respect 
     to such programs carried out through such grants, consistent 
     with the terms and conditions for receipt of such grants.

     SEC. 2123. EXTENSION OF FUNDING FOR QUALITY MEASURE 
                   ENDORSEMENT, INPUT, AND SELECTION; REPORTING 
                   REQUIREMENTS.

       (a) In General.--Section 1890(d) of the Social Security Act 
     (42 U.S.C. 1395aaa(d)) is amended--
       (1) in paragraph (2), by adding at the end the following 
     new sentence: ``Any of such amounts remaining available as of 
     the date of the enactment of the SUSTAIN Care Act of 2018 
     shall be used only for purposes under this section that are 
     purposes other than funding a contract entered into under 
     subsection (a).''; and
       (2) by adding at the end the following new paragraph:
       ``(3) For purposes of carrying out this section, the 
     Secretary shall provide for the transfer, from the Federal 
     Hospital Insurance Trust Fund under section 1817 and the 
     Federal Supplemental Medical Insurance Trust Fund under 1841, 
     in such proportion as Secretary deems appropriate, to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account of $7,500,000 for each of fiscal years 2018 and 2019. 
     Of the amount transferred under the previous sentence for a 
     fiscal year, there shall be used for the purpose of funding a 
     contract entered into under subsection (a) with respect to 
     carrying out section 1890A (other than subsections (e) and 
     (f)) for such fiscal year an amount that is not less than the 
     amount used for such purpose for fiscal year 2017.''.
       (b) Annual Report by Secretary to Congress.--Section 1890 
     of the Social Security Act (42 U.S.C. 1395aaa) is amended by 
     adding at the end the following new subsection:
       ``(e) Annual Report by Secretary to Congress.--By not later 
     than March 1 of each year (beginning with 2018), the 
     Secretary shall submit to Congress a report containing the 
     following:
       ``(1) A comprehensive plan that identifies the quality 
     measurement needs of programs and initiatives of the 
     Secretary and provides a strategy for using the work 
     performed by the entity with a contract under subsection (a) 
     and the work of any other entity the Secretary has contracted 
     with to perform work associated with this section or section 
     1890A to help meet those needs, specifically with respect to 
     the programs under this title and title XIX.
       ``(2) The amount of mandatory funding provided under 
     subsection (d) for purposes of carrying out this section and 
     section 1890A that has been obligated by the Secretary, the 
     amount of funding provided that has been expended, and the 
     amount of funding provided that remains unobligated.
       ``(3) A description of how the funds provided that are 
     obligated have been allocated, including how much of that 
     funding has been allocated for work performed by the 
     Secretary, the entity with a contract under subsection (a), 
     and any other entity the Secretary has contracted with to 
     perform work related to this section or section 1890A, 
     respectively.
       ``(4) A description of the activities for which the 
     obligated funds have been or will be used, including any 
     activities performed by the Secretary, task orders, specific 
     projects, and activities assigned to the entity with a 
     contract under subsection (a), and task orders, specific 
     projects, and activities assigned to any other entity the 
     Secretary has contracted with to perform work related to 
     carrying out this section or section 1890A.
       ``(5) The amount of funding allocated to each of the 
     activities described in paragraph (4).
       ``(6) Estimates for, and descriptions of, obligations and 
     expenditures that the Secretary anticipates will be needed in 
     the succeeding two year period to carry out each of the 
     quality measurement activities required under this section 
     and section 1890A, including any obligations that will 
     require funds to be expended in a future year.''.
       (c) Revisions to Annual Report From Consensus-based Entity 
     to Congress and the Secretary.--
       (1) In general.--Section 1890(b)(5)(A) of the Social 
     Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended--
       (A) by redesignating clauses (i) through (vi) as subclauses 
     (I) through (VI), respectively, and moving the margins 
     accordingly;
       (B) in the matter preceding subclause (I), as redesignated 
     by clause (i), by striking ``containing a description of--'' 
     and inserting ``containing the following:
       ``(i) A description of--''; and
       (C) by adding at the end the following new clauses:
       ``(ii) An itemization of financial information for the 
     fiscal year ending September 30 of the preceding year, 
     including--

       ``(I) annual revenues of the entity (including any 
     government funding, private sector contributions, grants, 
     membership revenues, and investment revenue);
       ``(II) annual expenses of the entity (including grants 
     paid, benefits paid, salaries or other compensation, 
     fundraising expenses, and overhead costs); and
       ``(III) a breakdown of the amount awarded per contracted 
     task order and the specific projects funded in each task 
     order assigned to the entity.

       ``(iii) Any updates or modifications of internal policies 
     and procedures of the entity as they relate to the duties of 
     the entity under this section, including--

       ``(I) specifically identifying any modifications to the 
     disclosure of interests and conflicts of interests for 
     committees, work groups, task forces, and advisory panels of 
     the entity; and
       ``(II) information on external stakeholder participation in 
     the duties of the entity under this section (including 
     complete rosters for all committees, work groups, task 
     forces, and advisory panels funded through government 
     contracts, descriptions of relevant interests and any 
     conflicts of interest for members of all committees, work 
     groups, task forces, and advisory panels, and the total 
     percentage by health care sector of all

[[Page H860]]

     convened committees, work groups, task forces, and advisory 
     panels.''.

       (2) Effective date.--The amendments made by this subsection 
     shall apply to reports submitted for years beginning with 
     2018.
       (d) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     shall conduct a study on health care quality measurement 
     efforts funded under sections 1890 and 1890A of the Social 
     Security Act (42 U.S.C. 1395aaa; 1395aaa-1). Such study shall 
     include an examination of the following:
       (A) The extent to which the Secretary of Health and Human 
     Services (in this subsection referred to as the 
     ``Secretary'') has set and prioritized objectives to be 
     achieved for each of the quality measurement activities 
     required under such sections 1890 and 1890A.
       (B) The efforts that the Secretary has undertaken to meet 
     quality measurement objectives associated with such sections 
     1890 and 1890A, including division of responsibilities for 
     those efforts within the Department of Health and Human 
     Services and through contracts with a consensus-based entity 
     under subsection (a) of such section 1890 (in this subsection 
     referred to as the ``consensus-based entity'') and other 
     entities, and the extent of any overlap among the work 
     performed by the Secretary, the consensus-based entity, the 
     Measure Application Partnership (MAP) convened by such entity 
     to provide input to the Secretary on the selection of quality 
     and efficiency measures, and any other entities the Secretary 
     has contracted with to perform work related to carrying out 
     such sections 1890 and 1890A.
       (C) The total amount of mandatory funding provided to the 
     Secretary for purposes of carrying out such sections 1890 and 
     1890A, the amount of such funding that has been obligated by 
     the Secretary, and the amount of such funding that remains 
     unobligated.
       (D) How the obligated funds have been allocated, including 
     how much of the obligated funding has been allocated for work 
     performed by the Secretary, the consensus-based entity, and 
     any other entity the Secretary has contracted with to perform 
     work related to carrying out such sections 1890 and 1890A, 
     respectively, and descriptions of such work.
       (E) The extent to which the Secretary has developed a 
     comprehensive and long-term plan to ensure that it can 
     achieve quality measurement objectives related to carrying 
     out such sections 1890 and 1890A in a timely manner and with 
     efficient use of available resources, including the roles of 
     the consensus-based entity, the Measure Application 
     Partnership (MAP), and any other entity the Secretary has 
     contracted with to perform work related to such sections 1890 
     and 1890A in helping the Secretary achieve those objectives.
       (2) Report.--Not later than 18 months after the date of 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to Congress a report containing the 
     results of the study conducted under paragraph (1), together 
     with recommendations for such legislation and administrative 
     action as the Comptroller General determines appropriate.

      TITLE II--ADDITIONAL MEDICARE POLICIES RELATING TO EXTENDERS

     SEC. 2201. HOME HEALTH PAYMENT REFORM.

       (a) Budget Neutral Transition to a 30-day Unit of Payment 
     for Home Health Services.--Section 1895(b) of the Social 
     Security Act (42 U.S.C. 1395fff(b)) is amended--
       (1) in paragraph (2)--
       (A) by striking ``payment.--In defining'' and inserting 
     ``payment.--
       ``(A) In general.--In defining''; and
       (B) by adding at the end the following new subparagraph:
       ``(B) 30-day unit of service.--For purposes of implementing 
     the prospective payment system with respect to home health 
     units of service furnished during a year beginning with 2020, 
     the Secretary shall apply a 30-day unit of service as the 
     unit of service applied under this paragraph.'';
       (2) in paragraph (3)--
       (A) in subparagraph (A), by adding at the end the following 
     new clause:
       ``(iv) Budget neutrality for 2020.--With respect to 
     payments for home health units of service furnished that end 
     during the 12-month period beginning January 1, 2020, the 
     Secretary shall calculate a standard prospective payment 
     amount (or amounts) for 30-day units of service (as described 
     in paragraph (2)(B)) for the prospective payment system under 
     this subsection. Such standard prospective payment amount (or 
     amounts) shall be calculated in a manner such that the 
     estimated aggregate amount of expenditures under the system 
     during such period with application of paragraph (2)(B) is 
     equal to the estimated aggregate amount of expenditures that 
     otherwise would have been made under the system during such 
     period if paragraph (2)(B) had not been enacted. The previous 
     sentence shall be applied before (and not affect the 
     application of) paragraph (3)(B). In calculating such amount 
     (or amounts), the Secretary shall make assumptions about 
     behavior changes that could occur as a result of the 
     implementation of paragraph (2)(B) and the case-mix 
     adjustment factors established under paragraph (4)(B) and 
     shall provide a description of such assumptions in the notice 
     and comment rulemaking used to implement this clause.''; and
       (B) by adding at the end the following new subparagraph:
       ``(D) Behavior assumptions and adjustments.--
       ``(i) In general.--The Secretary shall annually determine 
     the impact of differences between assumed behavior changes 
     (as described in paragraph (3)(A)(iv)) and actual behavior 
     changes on estimated aggregate expenditures under this 
     subsection with respect to years beginning with 2020 and 
     ending with 2026.
       ``(ii) Permanent adjustments.--The Secretary shall, at a 
     time and in a manner determined appropriate, through notice 
     and comment rulemaking, provide for one or more permanent 
     increases or decreases to the standard prospective payment 
     amount (or amounts) for applicable years, on a prospective 
     basis, to offset for such increases or decreases in estimated 
     aggregate expenditures (as determined under clause (i)).
       ``(iii) Temporary adjustments for retrospective behavior.--
     The Secretary shall, at a time and in a manner determined 
     appropriate, through notice and comment rulemaking, provide 
     for one or more temporary increases or decreases to the 
     payment amount for a unit of home health services (as 
     determined under paragraph (4)) for applicable years, on a 
     prospective basis, to offset for such increases or decreases 
     in estimated aggregate expenditures (as determined under 
     clause (i)). Such a temporary increase or decrease shall 
     apply only with respect to the year for which such temporary 
     increase or decrease is made, and the Secretary shall not 
     take into account such a temporary increase or decrease in 
     computing such amount under this subsection for a subsequent 
     year.''; and
       (3) in paragraph (4)(B)--
       (A) by striking ``Factors.--The Secretary'' and inserting 
     ``Factors.--
       ``(i) In general.--The Secretary''; and
       (B) by adding at the end the following new clause:
       ``(ii) Treatment of therapy thresholds.--For 2020 and 
     subsequent years, the Secretary shall eliminate the use of 
     therapy thresholds (established by the Secretary) in case mix 
     adjustment factors established under clause (i) for 
     calculating payments under the prospective payment system 
     under this subsection.''.
       (b) Technical Expert Panel.--
       (1) In general.--During the period beginning on January 1, 
     2018, and ending on December 31, 2018, the Secretary of 
     Health and Human Services shall hold at least one session of 
     a technical expert panel, the participants of which shall 
     include home health providers, patient representatives, and 
     other relevant stakeholders. The technical expert panel shall 
     identify and prioritize recommendations with respect to the 
     prospective payment system for home health services under 
     section 1895(b) of the Social Security Act (42 U.S.C. 
     1395fff(b)), on the following:
       (A) The Home Health Groupings Model, as described in the 
     proposed rule ``Medicare and Medicaid Programs; CY 2018 Home 
     Health Prospective Payment System Rate Update and Proposed CY 
     2019 Case-Mix Adjustment Methodology Refinements; Home Health 
     Value-Based Purchasing Model; and Home Health Quality 
     Reporting Requirements'' (82 Fed. Reg. 35294 through 35332 
     (July 28, 2017)).
       (B) Alternative case-mix models to the Home Health 
     Groupings Model that were submitted during 2017 as comments 
     in response to proposed rule making, including patient-
     focused factors that consider the risks of hospitalization 
     and readmission to a hospital, improvement or maintenance of 
     functionality of individuals to increase the capacity for 
     self-care, quality of care, and resource utilization.
       (2) Inapplicability of faca.--The provisions of the Federal 
     Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
     technical expert panel under paragraph (1).
       (3) Report.--Not later than April 1, 2019, the Secretary of 
     Health and Human Services shall submit to the Committee on 
     Ways and Means and the Committee on Energy and Commerce of 
     the House of Representatives and the Committee on Finance of 
     the Senate a report on the recommendations of such panel 
     described in such paragraph.
       (4) Notice and comment rulemaking.--Not later than December 
     31, 2019, the Secretary of Health and Human Services shall 
     pursue notice and comment rulemaking on a case-mix system 
     with respect to the prospective payment system for home 
     health services under section 1895(b) of the Social Security 
     Act (42 U.S.C. 1395fff(b)).
       (c) Reports.--
       (1) Interim report.--Not later than March 15, 2022, the 
     Medicare Payment Advisory Commission shall submit to Congress 
     an interim report on the application of a 30-day unit of 
     service as the unit of service applied under section 
     1895(b)(2) of the Social Security Act (42 U.S.C. 
     1395fff(b)(2)), as amended by subsection (a), including an 
     analysis of the level of payments provided to home health 
     agencies as compared to the cost of delivering home health 
     services, and any unintended consequences, including with 
     respect to behavioral changes and quality.
       (2) Final report.--Not later than March 15, 2026, such 
     Commission shall submit to Congress a final report on such 
     application and any such consequences.

     SEC. 2202. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE 
                   ELIGIBILITY FOR HOME HEALTH SERVICES.

       (a) Part A.--Section 1814(a) of the Social Security Act (42 
     U.S.C. 1395f(a)) is amended

[[Page H861]]

     by inserting before ``For purposes of paragraph (2)(C),'' the 
     following new sentence: ``For purposes of documentation for 
     physician certification and recertification made under 
     paragraph (2) on or after January 1, 2019, and made with 
     respect to home health services furnished by a home health 
     agency, in addition to using documentation in the medical 
     record of the physician who so certifies or the medical 
     record of the acute or post-acute care facility (in the case 
     that home health services were furnished to an individual who 
     was directly admitted to the home health agency from such a 
     facility), the Secretary may use documentation in the medical 
     record of the home health agency as supporting material, as 
     appropriate to the case involved.''.
       (b) Part B.--Section 1835(a) of the Social Security Act (42 
     U.S.C. 1395n(a)) is amended by inserting before ``For 
     purposes of paragraph (2)(A),'' the following new sentence: 
     ``For purposes of documentation for physician certification 
     and recertification made under paragraph (2) on or after 
     January 1, 2019, and made with respect to home health 
     services furnished by a home health agency, in addition to 
     using documentation in the medical record of the physician 
     who so certifies or the medical record of the acute or post-
     acute care facility (in the case that home health services 
     were furnished to an individual who was directly admitted to 
     the home health agency from such a facility), the Secretary 
     may use documentation in the medical record of the home 
     health agency as supporting material, as appropriate to the 
     case involved.''.

     SEC. 2203. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.

       (a) Settlement Process for Home Health Claims.--
       (1) In general.--Not later than one year after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall establish a settlement process under which a 
     home health agency entitled to an eligible administrative 
     appeal has the option to enter into a settlement with the 
     Secretary that is reached in a manner consistent with the 
     succeeding paragraphs of this subsection.
       (2) Process and consideration of home health claims.--A 
     settlement under paragraph (1) with a home health agency that 
     is with respect to an eligible administrative appeal may only 
     be reached in accordance with the following process:
       (A) A settlement under such paragraph with the home health 
     agency shall be with respect to all claims by such agency, 
     subject to paragraph (4), that, as of the date of such 
     settlement, are under an eligible administrative appeal.
       (B) For the duration of the settlement process with such 
     agency, an eligible administrative appeal that is with 
     respect to any such claim by such agency shall be suspended.
       (C) Under the settlement process, the Secretary shall 
     determine an aggregate amount to be paid to the home health 
     agency with respect to all claims by such agency that are 
     under an eligible administrative appeal in the following 
     manner:
       (i) The Secretary shall, for purposes of applying clause 
     (ii) with respect to all settlements under paragraph (1), 
     select a percentage. In selecting such percentage, the 
     Secretary shall consider the percentage used under the 
     Centers for Medicare & Medicaid Services hospital appeals 
     settlement that began on August 29, 2014.
       (ii) The Secretary shall, with respect to each denied claim 
     for such agency that is under an eligible administrative 
     appeal, calculate an amount (referred to in this subparagraph 
     as an ``individual claim amount'') by multiplying the net 
     payable amount for such claim by the percentage selected 
     under clause (i).
       (iii) Such aggregate amount with respect to such agency 
     shall be determined by calculating the total sum of all the 
     individual claim amounts calculated under clause (ii) with 
     respect to such agency.
       (3) Effect of process.--
       (A) Effect of settlement.--
       (i) Further appeal.--As part of any settlement under 
     paragraph (1) between a home health agency and the Secretary, 
     such home health agency shall be required to forego the right 
     to an administrative appeal under section 1869 of the Social 
     Security Act (42 U.S.C. 1395ff) or section 1878 of such Act 
     (42 U.S.C. 1395oo) (including any redetermination, 
     reconsideration, hearing, or review) with respect to any 
     claims for home health services that are subject to the 
     settlement.
       (ii) Judicial review.--There shall be no administrative or 
     judicial review under such section 1869 or otherwise of a 
     settlement under paragraph (1) and the claims covered by the 
     settlement.
       (B) Effect of no settlement.--In the event that the process 
     described in paragraph (2) does not, with respect to a home 
     health agency, result in a settlement under paragraph (1) 
     with such agency, any appeal under such section 1869 that is 
     with respect to a claim by such agency that was suspended 
     pursuant to paragraph (2)(B) shall resume under such section.
       (4) Coordination with law enforcement.--The Secretary of 
     Health and Human Services shall establish a process to 
     coordinate with appropriate law enforcement agencies in order 
     to avoid the inadvertent settlement of cases that involve 
     fraud or other criminal activity.
       (b) No Entitlement to Settlement Process.--Nothing in this 
     section shall be construed as creating an entitlement to 
     enter into a settlement process established pursuant to 
     subsection (a).
       (c) Eligible Administrative Appeal Defined.--For purposes 
     of this section, the term ``eligible administrative appeal'' 
     means an appeal under section 1869 of the Social Security Act 
     (42 U.S.C. 1395ff) (including any redetermination, 
     reconsideration, hearing, or review)--
       (1) that is with respect to one or more claims that--
       (A) are for home health services that were furnished on or 
     after January 1, 2011, and before January 1, 2015; and
       (B) were timely filed consistent with section 1814(a)(1) of 
     such Act (42 U.S.C. 1395f(a)(1)) or sections 1835(a)(1) and 
     1842(b)(3) of such Act (42 U.S.C. 1395n(a)(1), 1395u(b)(3)); 
     and
       (2) either--
       (A) was timely filed consistent with section 1869 of such 
     Act (42 U.S.C. 1395ff) and is pending; or
       (B) for which the applicable time frame to file an appeal 
     has not expired.
       (d) Conforming Amendment.--Section 1869 of the Social 
     Security Act (42 U.S.C. 1395ff) is amended by adding at the 
     end the following new subsection:
       ``(j) Application With Respect to Certain Home Health 
     Claims.--For the application of the provisions of this 
     section with respect to certain claims for home health 
     services that were furnished on or after January 1, 2011, and 
     before January 1, 2015, see section 106 of the Healthcare 
     Extension, Reauthorization, and Opportunities Act of 2017.''.

     SEC. 2204. EXTENSION OF ENFORCEMENT INSTRUCTION ON MEDICARE 
                   SUPERVISION REQUIREMENTS FOR OUTPATIENT 
                   THERAPEUTIC SERVICES IN CRITICAL ACCESS AND 
                   SMALL RURAL HOSPITALS.

       Section 1834 of the Social Security Act (42 U.S.C. 1395m) 
     is amended by adding at the end the following new subsection:
       ``(v) Extension of Enforcement Instruction on Supervision 
     Requirements for Outpatient Therapeutic Services in Critical 
     Access and Small Rural Hospitals.--For calendar year 2017, 
     the Secretary shall continue to apply the enforcement 
     instruction described in the notice of the Centers for 
     Medicare & Medicaid Services entitled `Enforcement 
     Instruction on Supervision Requirements for Outpatient 
     Therapeutic Services in Critical Access and Small Rural 
     Hospitals for CY 2013', dated November 1, 2012 (providing for 
     an exception to the restatement and clarification under the 
     final rulemaking changes to the Medicare hospital outpatient 
     prospective payment system and calendar year 2009 payment 
     rates (published in the Federal Register on November 18, 
     2008, 73 Fed. Reg. 68702 through 68704) with respect to 
     requirements for direct supervision by physicians for 
     therapeutic hospital outpatient services), as previously 
     extended under section 1 of Public Law 113-198, as amended by 
     section 1 of Public Law 114-112 and section 16004(a) of the 
     21st Century Cures Act (Public Law 114-255).''.

     SEC. 2205. TECHNICAL AMENDMENTS TO PUBLIC LAW 114-10.

       (a) MIPS Transition.--Section 1848 of the Social Security 
     Act (42 U.S.C. 1395w-4) is amended--
       (1) in subsection (q)--
       (A) in paragraph (1)--
       (i) in subparagraph (B), by striking ``items and services'' 
     and inserting ``covered professional services (as defined in 
     subsection (k)(3)(A))''; and
       (ii) in subparagraph (C)(iv)--

       (I) by amending subclause (I) to read as follows:
       ``(I) The minimum number (as determined by the Secretary) 
     of--

       ``(aa) for performance periods beginning before January 1, 
     2018, individuals enrolled under this part who are treated by 
     the eligible professional for the performance period 
     involved; and
       ``(bb) for performance periods beginning on or after 
     January 1, 2018, individuals enrolled under this part who are 
     furnished covered professional services (as defined in 
     subsection (k)(3)(A)) by the eligible professional for the 
     performance period involved.'';

       (II) in subclause (II), by striking ``items and services'' 
     and inserting ``covered professional services (as defined in 
     subsection (k)(3)(A))''; and
       (III) by amending subclause (III) to read as follows:
       ``(III) The minimum amount (as determined by the Secretary) 
     of--

       ``(aa) for performance periods beginning before January 1, 
     2018, allowed charges billed by such professional under this 
     part for such performance period; and
       ``(bb) for performance periods beginning on or after 
     January 1, 2018, allowed charges for covered professional 
     services (as defined in subsection (k)(3)(A)) billed by such 
     professional for such performance period.'';
       (B) in paragraph (5)(D)--
       (i) in clause (i)(I), by inserting ``subject to clause 
     (iii),'' after ``clauses (i) and (ii) of paragraph (2)(A),''; 
     and
       (ii) by adding at the end the following new clause:
       ``(iii) Transition years.--For each of the second, third, 
     fourth, and fifth years for which the MIPS applies to 
     payments, the

[[Page H862]]

     performance score for the performance category described in 
     paragraph (2)(A)(ii) shall not take into account the 
     improvement of the professional involved.'';
       (C) in paragraph (5)(E)--
       (i) in clause (i)(I)(bb)--

       (I) in the heading by striking ``First 2 years'' and 
     inserting ``First 5 years''; and
       (II) by striking ``the first and second years'' and 
     inserting ``each of the first through fifth years'';

       (ii) in clause (i)(II)(bb)--

       (I) in the heading, by striking ``2 years'' and inserting 
     ``5 years''; and
       (II) by striking the second sentence and inserting the 
     following new sentences: ``For each of the second, third, 
     fourth, and fifth years for which the MIPS applies to 
     payments, not less than 10 percent and not more than 30 
     percent of such score shall be based on performance with 
     respect to the category described in clause (ii) of paragraph 
     (2)(A). Nothing in the previous sentence shall be construed, 
     with respect to a performance period for a year described in 
     the previous sentence, as preventing the Secretary from 
     basing 30 percent of such score for such year with respect to 
     the category described in such clause (ii), if the Secretary 
     determines, based on information posted under subsection 
     (r)(2)(I) that sufficient resource use measures are ready for 
     adoption for use under the performance category under 
     paragraph (2)(A)(ii) for such performance period.'';

       (D) in paragraph (6)(D)--
       (i) in clause (i), in the second sentence, by striking 
     ``Such performance threshold'' and inserting ``Subject to 
     clauses (iii) and (iv), such performance threshold'';
       (ii) in clause (ii)--

       (I) in the first sentence, by inserting ``(beginning with 
     2019 and ending with 2024)'' after ``for each year of the 
     MIPS''; and
       (II) in the second sentence, by inserting ``subject to 
     clause (iii),'' after ``For each such year,'';

       (iii) in clause (iii)--

       (I) in the heading, by striking ``2'' and inserting ``5''; 
     and
       (II) in the first sentence, by striking ``two years'' and 
     inserting ``five years''; and

       (iv) by adding at the end the following new clause:
       ``(iv) Additional special rule for third, fourth and fifth 
     years of mips.--For purposes of determining MIPS adjustment 
     factors under subparagraph (A), in addition to the 
     requirements specified in clause (iii), the Secretary shall 
     increase the performance threshold with respect to each of 
     the third, fourth, and fifth years to which the MIPS applies 
     to ensure a gradual and incremental transition to the 
     performance threshold described in clause (i) (as estimated 
     by the Secretary) with respect to the sixth year to which the 
     MIPS applies.'';
       (E) in paragraph (6)(E)--
       (i) by striking ``In the case of items and services'' and 
     inserting ``In the case of covered professional services (as 
     defined in subsection (k)(3)(A))''; and
       (ii) by striking ``under this part with respect to such 
     items and services'' and inserting ``under this part with 
     respect to such covered professional services''; and
       (F) in paragraph (7), in the first sentence, by striking 
     ``items and services'' and inserting ``covered professional 
     services (as defined in subsection (k)(3)(A))'';
       (2) in subsection (r)(2), by adding at the end the 
     following new subparagraph:
       ``(I) Information.--The Secretary shall, not later than 
     December 31st of each year (beginning with 2018), post on the 
     Internet website of the Centers for Medicare & Medicaid 
     Services information on resource use measures in use under 
     subsection (q), resource use measures under development and 
     the time-frame for such development, potential future 
     resource use measure topics, a description of stakeholder 
     engagement, and the percent of expenditures under part A and 
     this part that are covered by resource use measures.''; and
       (3) in subsection (s)(5)(B), by striking ``section 
     1833(z)(2)(C)'' and inserting ``section 1833(z)(3)(D)''.
       (b) Physician-focused Payment Model Technical Advisory 
     Committee Provision of Initial Proposal Feedback.--Section 
     1868(c)(2)(C) of the Social Security Act (42 U.S.C. 
     1395ee(c)(2)(C)) is amended to read as follows:
       ``(C) Committee review of models submitted.--The Committee, 
     on a periodic basis--
       ``(i) shall review models submitted under subparagraph (B);
       ``(ii) may provide individuals and stakeholder entities who 
     submitted such models with--

       ``(I) initial feedback on such models regarding the extent 
     to which such models meet the criteria described in 
     subparagraph (A); and
       ``(II) an explanation of the basis for the feedback 
     provided under subclause (I); and

       ``(iii) shall prepare comments and recommendations 
     regarding whether such models meet the criteria described in 
     subparagraph (A) and submit such comments and recommendations 
     to the Secretary.''.

     SEC. 2206. REVISED REQUIREMENTS FOR MEDICARE INTENSIVE 
                   CARDIAC REHABILITATION PROGRAMS.

       (a) In General.--Section 1861(eee)(4)(B) of the Social 
     Security Act (42 U.S.C. 1395x(eee)(4)(B)) is amended--
       (1) in clause (v), by striking ``or'' at the end;
       (2) in clause (vi), by striking the period at the end and 
     inserting a semicolon; and
       (3) by adding at the end the following new clauses:
       ``(vii) stable, chronic heart failure (defined as patients 
     with left ventricular ejection fraction of 35 percent or less 
     and New York Heart Association (NYHA) class II to IV symptoms 
     despite being on optimal heart failure therapy for at least 6 
     weeks); or
       ``(viii) any additional condition for which the Secretary 
     has determined that a cardiac rehabilitation program shall be 
     covered, unless the Secretary determines, using the same 
     process used to determine that the condition is covered for a 
     cardiac rehabilitation program, that such coverage is not 
     supported by the clinical evidence.''.
       (b) Ensuring Future Supervision Level Parity With Cardiac 
     Rehabilitation Programs.--Section 1861(eee)(4)(A) of the 
     Social Security Act (42 U.S.C. 1395x(eee)(4)(A)) is amended, 
     in the matter preceding clause (i), by striking ``physician-
     supervised program (as described in paragraph (2))'' and 
     inserting ``program (supervised as described in paragraph 
     (2))''.

  TITLE III--CREATING HIGH-QUALITY RESULTS AND OUTCOMES NECESSARY TO 
                     IMPROVE CHRONIC (CHRONIC) CARE

          Subtitle A--Receiving High Quality Care in the Home

     SEC. 2301. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRATION 
                   PROGRAM.

       (a) In General.--Section 1866E of the Social Security Act 
     (42 U.S.C. 1395cc-5) is amended--
       (1) in subsection (e)--
       (A) in paragraph (1)--
       (i) by striking ``An agreement'' and inserting 
     ``Agreements''; and
       (ii) by striking ``5-year'' and inserting ``7-year''; and
       (B) in paragraph (5)--
       (i) by striking ``10,000'' and inserting ``15,000''; and
       (ii) by adding at the end the following new sentence: ``An 
     applicable beneficiary that participates in the demonstration 
     program by reason of the increase from 10,000 to 15,000 in 
     the preceding sentence pursuant to the amendment made by 
     section 2301(a)(1)(B) of the SUSTAIN Care Act of 2018 shall 
     be considered in the spending target estimates under 
     paragraph (1) of subsection (c) and the incentive payment 
     calculations under paragraph (2) of such subsection for the 
     sixth and seventh years of such program.'';
       (2) in subsection (g), in the first sentence, by inserting 
     ``, including, to the extent practicable, with respect to the 
     use of electronic health information systems, as described in 
     subsection (b)(1)(A)(vi)'' after ``under the demonstration 
     program''; and
       (3) in subsection (i)(1)(A), by striking ``will not receive 
     an incentive payment for the second of 2'' and inserting 
     ``did not achieve savings for the third of 3''.
       (b) Effective Date.--The amendment made by subsection 
     (a)(3) shall take effect as if included in the enactment of 
     Public Law 111-148.

     SEC. 2302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.

       (a) In General.--Section 1881(b)(3) of the Social Security 
     Act (42 U.S.C. 1395rr(b)(3)) is amended--
       (1) by redesignating subparagraphs (A) and (B) as clauses 
     (i) and (ii), respectively;
       (2) in clause (ii), as redesignated by paragraph (1), by 
     striking ``on a comprehensive'' and insert ``subject to 
     subparagraph (B), on a comprehensive'';
       (3) by striking ``With respect to'' and inserting ``(A) 
     With respect to''; and
       (4) by adding at the end the following new subparagraph:
       ``(B)(i) For purposes of subparagraph (A)(ii), subject to 
     clause (ii), an individual determined to have end stage renal 
     disease receiving home dialysis may choose to receive monthly 
     end stage renal disease-related clinical assessments 
     furnished on or after January 1, 2019, via telehealth.
       ``(ii) Clause (i) shall apply to an individual only if the 
     individual receives a face-to-face clinical assessment, 
     without the use of telehealth--
       ``(I) in the case of the initial 3 months of home dialysis 
     of such individual, at least monthly; and
       ``(II) after such initial 3 months, at least once every 3 
     consecutive months.''.
       (b) Originating Site Requirements.--
       (1) In general.--Section 1834(m) of the Social Security Act 
     (42 U.S.C. 1395m(m)) is amended--
       (A) in paragraph (4)(C)(ii), by adding at the end the 
     following new subclauses:

       ``(IX) A renal dialysis facility, but only for purposes of 
     section 1881(b)(3)(B).
       ``(X) The home of an individual, but only for purposes of 
     section 1881(b)(3)(B).''; and

       (B) by adding at the end the following new paragraph:
       ``(5) Treatment of home dialysis monthly esrd-related 
     visit.--The geographic requirements described in paragraph 
     (4)(C)(i) shall not apply with respect to telehealth services 
     furnished on or after January 1, 2019, for purposes of 
     section 1881(b)(3)(B), at an originating site described in 
     subclause (VI), (IX), or (X) of paragraph (4)(C)(ii).''.
       (2) No facility fee if originating site for home dialysis 
     therapy is the home.--Section 1834(m)(2)(B) of the Social 
     Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
       (A) by redesignating clauses (i) and (ii) as subclauses (I) 
     and (II), and indenting appropriately;
       (B) in subclause (II), as redesignated by subparagraph (A), 
     by striking ``clause (i) or

[[Page H863]]

     this clause'' and inserting ``subclause (I) or this 
     subclause'';
       (C) by striking ``site.--With respect to'' and inserting 
     ``site.--
       ``(i) In general.--Subject to clause (ii), with respect 
     to''; and
       (D) by adding at the end the following new clause:
       ``(ii) No facility fee if originating site for home 
     dialysis therapy is the home.--No facility fee shall be paid 
     under this subparagraph to an originating site described in 
     paragraph (4)(C)(ii)(X).''.
       (c) Clarification Regarding Telehealth Provided to 
     Beneficiaries.--Section 1128A(i)(6) of the Social Security 
     Act (42 U.S.C. 1320a-7a(i)(6)) is amended--
       (1) in subparagraph (H), by striking ``or'' at the end;
       (2) in subparagraph (I), by striking the period at the end 
     and inserting ``; or''; and
       (3) by adding at the end the following new subparagraph:
       ``(J) the provision of telehealth technologies (as defined 
     by the Secretary) on or after January 1, 2019, by a provider 
     of services or a renal dialysis facility (as such terms are 
     defined for purposes of title XVIII) to an individual with 
     end stage renal disease who is receiving home dialysis for 
     which payment is being made under part B of such title, if--
       ``(i) the telehealth technologies are not offered as part 
     of any advertisement or solicitation;
       ``(ii) the telehealth technologies are provided for the 
     purpose of furnishing telehealth services related to the 
     individual's end stage renal disease; and
       ``(iii) the provision of the telehealth technologies meets 
     any other requirements set forth in regulations promulgated 
     by the Secretary.''.
       (d) Conforming Amendment.--Section 1881(b)(1) of the Social 
     Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking 
     ``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.

            Subtitle B--Expanding Innovation and Technology

     SEC. 2311. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY 
                   ILL MEDICARE ADVANTAGE ENROLLEES.

       Section 1859 of the Social Security Act (42 U.S.C. 1395w-
     28) is amended by adding at the end the following new 
     subsection:
       ``(h) National Testing of Medicare Advantage Value-Based 
     Insurance Design Model.--
       ``(1) In general.--In implementing the Medicare Advantage 
     Value-Based Insurance Design model that is being tested under 
     section 1115A(b), the Secretary shall revise the testing of 
     the model under such section to cover, effective not later 
     than January 1, 2020, all States.
       ``(2) Termination and modification provision not applicable 
     until january 1, 2022.--The provisions of section 
     1115A(b)(3)(B) shall apply to the Medicare Advantage Value-
     Based Insurance Design model, including such model as revised 
     under paragraph (1), beginning January 1, 2022, but shall not 
     apply to such model, as so revised, prior to such date.
       ``(3) Funding.--The Secretary shall allocate funds made 
     available under section 1115A(f)(1) to design, implement, and 
     evaluate the Medicare Advantage Value-Based Insurance Design 
     model, as revised under paragraph (1).''.

     SEC. 2312. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS 
                   OF CHRONICALLY ILL MEDICARE ADVANTAGE 
                   ENROLLEES.

       (a) In General.--Section 1852(a)(3) of the Social Security 
     Act (42 U.S.C. 1395w-22(a)(3)) is amended--
       (1) in subparagraph (A), by striking ``Each'' and inserting 
     ``Subject to subparagraph (D), each''; and
       (2) by adding at the end the following new subparagraph:
       ``(D) Expanding supplemental benefits to meet the needs of 
     chronically ill enrollees.--
       ``(i) In general.--For plan year 2020 and subsequent plan 
     years, in addition to any supplemental health care benefits 
     otherwise provided under this paragraph, an MA plan, 
     including a specialized MA plan for special needs individuals 
     (as defined in section 1859(b)(6)), may provide supplemental 
     benefits described in clause (ii) to a chronically ill 
     enrollee (as defined in clause (iii)).
       ``(ii) Supplemental benefits described.--

       ``(I) In general.--Supplemental benefits described in this 
     clause are supplemental benefits that, with respect to a 
     chronically ill enrollee, have a reasonable expectation of 
     improving or maintaining the health or overall function of 
     the chronically ill enrollee and may not be limited to being 
     primarily health related benefits.
       ``(II) Authority to waive uniformity requirements.--The 
     Secretary may, only with respect to supplemental benefits 
     provided to a chronically ill enrollee under this 
     subparagraph, waive the uniformity requirements under this 
     part, as determined appropriate by the Secretary.

       ``(iii) Chronically ill enrollee defined.--In this 
     subparagraph, the term `chronically ill enrollee' means an 
     enrollee in an MA plan that the Secretary determines--

       ``(I) has one or more comorbid and medically complex 
     chronic conditions that is life threatening or significantly 
     limits the overall health or function of the enrollee;
       ``(II) has a high risk of hospitalization or other adverse 
     health outcomes; and
       ``(III) requires intensive care coordination.''.

       (b) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     (in this subsection referred to as the ``Comptroller 
     General'') shall conduct a study on supplemental benefits 
     provided to enrollees in Medicare Advantage plans under part 
     C of title XVIII of the Social Security Act, including 
     specialized MA plans for special needs individuals (as 
     defined in section 1859(b)(6) of such Act (42 U.S.C. 1395w-
     28(b)(6))). To the extend data are available, such study 
     shall include an analysis of the following:
       (A) The type of supplemental benefits provided to such 
     enrollees, the total number of enrollees receiving each 
     supplemental benefit, and whether the supplemental benefit is 
     covered by the standard benchmark cost of the benefit or with 
     an additional premium.
       (B) The frequency in which supplemental benefits are 
     utilized by such enrollees.
       (C) The impact supplemental benefits have on--
       (i) indicators of the quality of care received by such 
     enrollees, including overall health and function of the 
     enrollees;
       (ii) the utilization of items and services for which 
     benefits are available under the original Medicare fee-for-
     service program option under parts A and B of such title 
     XVIII by such enrollees; and
       (iii) the amount of the bids submitted by Medicare 
     Advantage Organizations for Medicare Advantage plans under 
     such part C.
       (2) Consultation.--In conducting the study under paragraph 
     (1), the Comptroller General shall, as necessary, consult 
     with the Centers for Medicare & Medicaid Services and 
     Medicare Advantage organizations offering Medicare Advantage 
     plans.
       (3) Report.--Not later than 5 years after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under paragraph (1), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.

     SEC. 2313. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE 
                   ENROLLEES THROUGH TELEHEALTH.

       (a) In General.--Section 1852 of the Social Security Act 
     (42 U.S.C. 1395w-22) is amended--
       (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
     subsection (m),'' after ``means''; and
       (2) by adding at the end the following new subsection:
       ``(m) Provision of Additional Telehealth Benefits.--
       ``(1) MA plan option.--For plan year 2020 and subsequent 
     plan years, subject to the requirements of paragraph (3), an 
     MA plan may provide additional telehealth benefits (as 
     defined in paragraph (2)) to individuals enrolled under this 
     part.
       ``(2) Additional telehealth benefits defined.--
       ``(A) In general.--For purposes of this subsection and 
     section 1854:
       ``(i) Definition.--The term `additional telehealth 
     benefits' means services--

       ``(I) for which benefits are available under part B, 
     including services for which payment is not made under 
     section 1834(m) due to the conditions for payment under such 
     section; and
       ``(II) that are identified for the year involved by the 
     Secretary as clinically appropriate to furnish using 
     electronic information and telecommunications technology when 
     a physician (as defined in section 1861(r)) or practitioner 
     (described in section 1842(b)(18)(C)) providing the service 
     is not at the same location as the plan enrollee.

       ``(ii) Exclusion of capital and infrastructure costs and 
     investments.--The term `additional telehealth benefits' does 
     not include capital and infrastructure costs and investments 
     relating to such benefits.
       ``(B) Public comment.--Not later than November 30, 2018, 
     the Secretary shall solicit comments on--
       ``(i) what types of items and services (including those 
     provided through supplemental health care benefits, such as 
     remote patient monitoring, secure messaging, store and 
     forward technologies, and other non-face-to-face 
     communication) should be considered to be additional 
     telehealth benefits; and
       ``(ii) the requirements for the provision or furnishing of 
     such benefits (such as licensure, training, and coordination 
     requirements).
       ``(3) Requirements for additional telehealth benefits.--The 
     Secretary shall specify requirements for the provision or 
     furnishing of additional telehealth benefits, including with 
     respect to the following:
       ``(A) Physician or practitioner qualifications (other than 
     licensure) and other requirements such as specific training.
       ``(B) Factors necessary for the coordination of such 
     benefits with other items and services, including those 
     furnished in-person.
       ``(C) Such other areas as determined by the Secretary.
       ``(4) Enrollee choice.--If an MA plan provides a service as 
     an additional telehealth benefit (as defined in paragraph 
     (2))--
       ``(A) the MA plan shall also provide access to such benefit 
     through an in-person visit (and not only as an additional 
     telehealth benefit); and
       ``(B) an individual enrollee shall have discretion as to 
     whether to receive such service through the in-person visit 
     or as an additional telehealth benefit.

[[Page H864]]

       ``(5) Treatment under ma.--For purposes of this subsection 
     and section 1854, if a plan provides additional telehealth 
     benefits, such additional telehealth benefits shall be 
     treated as if they were benefits under the original Medicare 
     fee-for-service program option.
       ``(6) Construction.--Nothing in this subsection shall be 
     construed as affecting the requirement under subsection 
     (a)(1) that MA plans provide enrollees with items and 
     services (other than hospice care) for which benefits are 
     available under parts A and B, including benefits available 
     under section 1834(m).''.
       (b) Clarification Regarding Inclusion in Bid Amount.--
     Section 1854(a)(6)(A)(ii)(I) of the Social Security Act (42 
     U.S.C. 1395w-24(a)(6)(A)(ii)(I)) is amended by inserting ``, 
     including, for plan year 2020 and subsequent plan years, the 
     provision of additional telehealth benefits as described in 
     section 1852(m)'' before the semicolon at the end.

     SEC. 2314. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE 
                   ABILITY TO EXPAND THE USE OF TELEHEALTH.

       (a) In General.--Section 1899 of the Social Security Act 
     (42 U.S.C. 1395jjj) is amended by adding at the end the 
     following new subsection:
       ``(l) Providing ACOs the Ability To Expand the Use of 
     Telehealth Services.--
       ``(1) In general.--In the case of telehealth services for 
     which payment would otherwise be made under this title 
     furnished on or after January 1, 2020, for purposes of this 
     subsection only, the following shall apply with respect to 
     such services furnished by a physician or practitioner 
     participating in an applicable ACO (as defined in paragraph 
     (2)) to a Medicare fee-for-service beneficiary assigned to 
     the applicable ACO:
       ``(A) Inclusion of home as originating site.--Subject to 
     paragraph (3), the home of a beneficiary shall be treated as 
     an originating site described in section 1834(m)(4)(C)(ii).
       ``(B) No application of geographic limitation.--The 
     geographic limitation under section 1834(m)(4)(C)(i) shall 
     not apply with respect to an originating site described in 
     section 1834(m)(4)(C)(ii) (including the home of a 
     beneficiary under subparagraph (A)), subject to State 
     licensing requirements.
       ``(2) Definitions.--In this subsection:
       ``(A) Applicable aco.--The term `applicable ACO' means an 
     ACO participating in a model tested or expanded under section 
     1115A or under this section--
       ``(i) that operates under a two-sided model--

       ``(I) described in section 425.600(a) of title 42, Code of 
     Federal Regulations; or
       ``(II) tested or expanded under section 1115A; and

       ``(ii) for which Medicare fee-for-service beneficiaries are 
     assigned to the ACO using a prospective assignment method, as 
     determined appropriate by the Secretary.
       ``(B) Home.--The term `home' means, with respect to a 
     Medicare fee-for-service beneficiary, the place of residence 
     used as the home of the beneficiary.
       ``(3) Telehealth services received in the home.--In the 
     case of telehealth services described in paragraph (1) where 
     the home of a Medicare fee-for-service beneficiary is the 
     originating site, the following shall apply:
       ``(A) No facility fee.--There shall be no facility fee paid 
     to the originating site under section 1834(m)(2)(B).
       ``(B) Exclusion of certain services.--No payment may be 
     made for such services that are inappropriate to furnish in 
     the home setting such as services that are typically 
     furnished in inpatient settings such as a hospital.''.
       (b) Study and Report.--
       (1) Study.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     conduct a study on the implementation of section 1899(l) of 
     the Social Security Act, as added by subsection (a). Such 
     study shall include an analysis of the utilization of, and 
     expenditures for, telehealth services under such section.
       (B) Collection of data.--The Secretary may collect such 
     data as the Secretary determines necessary to carry out the 
     study under this paragraph.
       (2) Report.--Not later than January 1, 2026, the Secretary 
     shall submit to Congress a report containing the results of 
     the study conducted under paragraph (1), together with 
     recommendations for such legislation and administrative 
     action as the Secretary determines appropriate.

     SEC. 2315. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS 
                   WITH STROKE.

       Section 1834(m) of the Social Security Act (42 U.S.C. 
     1395m(m)), as amended by section 2302(b), is amended--
       (1) in paragraph (4)(C)(i), in the matter preceding 
     subclause (I), by striking ``The term'' and inserting 
     ``Except as provided in paragraph (6), the term''; and
       (2) by adding at the end the following new paragraph:
       ``(6) Treatment of stroke telehealth services.--
       ``(A) Non-application of originating site requirements.--
     The requirements described in paragraph (4)(C) shall not 
     apply with respect to telehealth services furnished on or 
     after January 1, 2021, for purposes of diagnosis, evaluation, 
     or treatment of symptoms of an acute stroke, as determined by 
     the Secretary.
       ``(B) Inclusion of certain sites.--With respect to 
     telehealth services described in subparagraph (A), the term 
     `originating site' shall include any hospital (as defined in 
     section 1861(e)) or critical access hospital (as defined in 
     section 1861(mm)(1)), any mobile stroke unit (as defined by 
     the Secretary), or any other site determined appropriate by 
     the Secretary, at which the eligible telehealth individual is 
     located at the time the service is furnished via a 
     telecommunications system.
       ``(C) No originating site facility fee for new sites.--No 
     facility fee shall be paid under paragraph (2)(B) to an 
     originating site with respect to a telehealth service 
     described in subparagraph (A) if the originating site does 
     not otherwise meet the requirements for an originating site 
     under paragraph (4)(C).''.

         Subtitle C--Identifying the Chronically Ill Population

     SEC. 2321. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART 
                   OF AN ACCOUNTABLE CARE ORGANIZATION.

       Section 1899(c) of the Social Security Act (42 U.S.C. 
     1395jjj(c)) is amended--
       (1) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), respectively, and indenting 
     appropriately;
       (2) by striking ``ACOs.--The Secretary'' and inserting 
     ``ACOs.--
       ``(1) In general.--Subject to paragraph (2), the 
     Secretary''; and
       (3) by adding at the end the following new paragraph:
       ``(2) Providing flexibility.--
       ``(A) Choice of prospective assignment.--For each agreement 
     period (effective for agreements entered into or renewed on 
     or after January 1, 2020), in the case where an ACO 
     established under the program is in a Track that provides for 
     the retrospective assignment of Medicare fee-for-service 
     beneficiaries to the ACO, the Secretary shall permit the ACO 
     to choose to have Medicare fee-for-service beneficiaries 
     assigned prospectively, rather than retrospectively, to the 
     ACO for an agreement period.
       ``(B) Assignment based on voluntary identification by 
     medicare fee-for-service beneficiaries.--
       ``(i) In general.--For performance year 2018 and each 
     subsequent performance year, if a system is available for 
     electronic designation, the Secretary shall permit a Medicare 
     fee-for-service beneficiary to voluntarily identify an ACO 
     professional as the primary care provider of the beneficiary 
     for purposes of assigning such beneficiary to an ACO, as 
     determined by the Secretary.
       ``(ii) Notification process.--The Secretary shall establish 
     a process under which a Medicare fee-for-service beneficiary 
     is--

       ``(I) notified of their ability to make an identification 
     described in clause (i); and
       ``(II) informed of the process by which they may make and 
     change such identification.

       ``(iii) Superseding claims-based assignment.--A voluntary 
     identification by a Medicare fee-for-service beneficiary 
     under this subparagraph shall supersede any claims-based 
     assignment otherwise determined by the Secretary.''.

   Subtitle D--Empowering Individuals and Caregivers in Care Delivery

     SEC. 2331. ELIMINATING BARRIERS TO CARE COORDINATION UNDER 
                   ACCOUNTABLE CARE ORGANIZATIONS.

       (a) In General.--Section 1899 of the Social Security Act 
     (42 U.S.C. 1395jjj), as amended by section 2314(a), is 
     amended--
       (1) in subsection (b)(2), by adding at the end the 
     following new subparagraph:
       ``(I) An ACO that seeks to operate an ACO Beneficiary 
     Incentive Program pursuant to subsection (m) shall apply to 
     the Secretary at such time, in such manner, and with such 
     information as the Secretary may require.'';
       (2) by adding at the end the following new subsection:
       ``(m) Authority To Provide Incentive Payments to 
     Beneficiaries With Respect to Qualifying Primary Care 
     Services.--
       ``(1) Program.--
       ``(A) In general.--In order to encourage Medicare fee-for-
     service beneficiaries to obtain medically necessary primary 
     care services, an ACO participating under this section under 
     a payment model described in clause (i) or (ii) of paragraph 
     (2)(B) may apply to establish an ACO Beneficiary Incentive 
     Program to provide incentive payments to such beneficiaries 
     who are furnished qualifying services in accordance with this 
     subsection. The Secretary shall permit such an ACO to 
     establish such a program at the Secretary's discretion and 
     subject to such requirements, including program integrity 
     requirements, as the Secretary determines necessary.
       ``(B) Implementation.--The Secretary shall implement this 
     subsection on a date determined appropriate by the Secretary. 
     Such date shall be no earlier than January 1, 2019, and no 
     later than January 1, 2020.
       ``(2) Conduct of program.--
       ``(A) Duration.--Subject to subparagraph (H), an ACO 
     Beneficiary Incentive Program established under this 
     subsection shall be conducted for such period (of not less 
     than 1 year) as the Secretary may approve.
       ``(B) Scope.--An ACO Beneficiary Incentive Program 
     established under this subsection shall provide incentive 
     payments to all of the following Medicare fee-for-service 
     beneficiaries who are furnished qualifying services by the 
     ACO:
       ``(i) With respect to the Track 2 and Track 3 payment 
     models described in section

[[Page H865]]

     425.600(a) of title 42, Code of Federal Regulations (or in 
     any successor regulation), Medicare fee-for-service 
     beneficiaries who are preliminarily prospectively or 
     prospectively assigned (or otherwise assigned, as determined 
     by the Secretary) to the ACO.
       ``(ii) With respect to any future payment models involving 
     two-sided risk, Medicare fee-for-service beneficiaries who 
     are assigned to the ACO, as determined by the Secretary.
       ``(C) Qualifying service.--For purposes of this subsection, 
     a qualifying service is a primary care service, as defined in 
     section 425.20 of title 42, Code of Federal Regulations (or 
     in any successor regulation), with respect to which 
     coinsurance applies under part B, furnished through an ACO 
     by--
       ``(i) an ACO professional described in subsection (h)(1)(A) 
     who has a primary care specialty designation included in the 
     definition of primary care physician under section 425.20 of 
     title 42, Code of Federal Regulations (or any successor 
     regulation);
       ``(ii) an ACO professional described in subsection 
     (h)(1)(B); or
       ``(iii) a Federally qualified health center or rural health 
     clinic (as such terms are defined in section 1861(aa)).
       ``(D) Incentive payments.--An incentive payment made by an 
     ACO pursuant to an ACO Beneficiary Incentive Program 
     established under this subsection shall be--
       ``(i) in an amount up to $20, with such maximum amount 
     updated annually by the percentage increase in the consumer 
     price index for all urban consumers (United States city 
     average) for the 12-month period ending with June of the 
     previous year;
       ``(ii) in the same amount for each Medicare fee-for-service 
     beneficiary described in clause (i) or (ii) of subparagraph 
     (B) without regard to enrollment of such a beneficiary in a 
     medicare supplemental policy (described in section 
     1882(g)(1)), in a State Medicaid plan under title XIX or a 
     waiver of such a plan, or in any other health insurance 
     policy or health benefit plan;
       ``(iii) made for each qualifying service furnished to such 
     a beneficiary described in clause (i) or (ii) of subparagraph 
     (B) during a period specified by the Secretary; and
       ``(iv) made no later than 30 days after a qualifying 
     service is furnished to such a beneficiary described in 
     clause (i) or (ii) of subparagraph (B).
       ``(E) No separate payments from the secretary.--The 
     Secretary shall not make any separate payment to an ACO for 
     the costs, including incentive payments, of carrying out an 
     ACO Beneficiary Incentive Program established under this 
     subsection. Nothing in this subparagraph shall be construed 
     as prohibiting an ACO from using shared savings received 
     under this section to carry out an ACO Beneficiary Incentive 
     Program.
       ``(F) No application to shared savings calculation.--
     Incentive payments made by an ACO under this subsection shall 
     be disregarded for purposes of calculating benchmarks, 
     estimated average per capita Medicare expenditures, and 
     shared savings under this section.
       ``(G) Reporting requirements.--An ACO conducting an ACO 
     Beneficiary Incentive Program under this subsection shall, at 
     such times and in such format as the Secretary may require, 
     report to the Secretary such information and retain such 
     documentation as the Secretary may require, including the 
     amount and frequency of incentive payments made and the 
     number of Medicare fee-for-service beneficiaries receiving 
     such payments.
       ``(H) Termination.--The Secretary may terminate an ACO 
     Beneficiary Incentive Program established under this 
     subsection at any time for reasons determined appropriate by 
     the Secretary.
       ``(3) Exclusion of incentive payments.--Any payment made 
     under an ACO Beneficiary Incentive Program established under 
     this subsection shall not be considered income or resources 
     or otherwise taken into account for purposes of--
       ``(A) determining eligibility for benefits or assistance 
     (or the amount or extent of benefits or assistance) under any 
     Federal program or under any State or local program financed 
     in whole or in part with Federal funds; or
       ``(B) any Federal or State laws relating to taxation.'';
       (3) in subsection (e), by inserting ``, including an ACO 
     Beneficiary Incentive Program under subsections (b)(2)(I) and 
     (m)'' after ``the program''; and
       (4) in subsection (g)(6), by inserting ``or of an ACO 
     Beneficiary Incentive Program under subsections (b)(2)(I) and 
     (m)'' after ``under subsection (d)(4)''.
       (b) Amendment to Section 1128B.--Section 1128B(b)(3) of the 
     Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
       (1) by striking ``and'' at the end of subparagraph (I);
       (2) by striking the period at the end of subparagraph (J) 
     and inserting ``; and''; and
       (3) by adding at the end the following new subparagraph:
       ``(K) an incentive payment made to a Medicare fee-for-
     service beneficiary by an ACO under an ACO Beneficiary 
     Incentive Program established under subsection (m) of section 
     1899, if the payment is made in accordance with the 
     requirements of such subsection and meets such other 
     conditions as the Secretary may establish.''.
       (c) Evaluation and Report.--
       (1) Evaluation.--The Secretary of Health and Human Services 
     (in this subsection referred to as the ``Secretary'') shall 
     conduct an evaluation of the ACO Beneficiary Incentive 
     Program established under subsections (b)(2)(I) and (m) of 
     section 1899 of the Social Security Act (42 U.S.C. 1395jjj), 
     as added by subsection (a). The evaluation shall include an 
     analysis of the impact of the implementation of the Program 
     on expenditures and beneficiary health outcomes under title 
     XVIII of the Social Security Act (42 U.S.C. 1395 et seq.).
       (2) Report.--Not later than October 1, 2023, the Secretary 
     shall submit to Congress a report containing the results of 
     the evaluation under paragraph (1), together with 
     recommendations for such legislation and administrative 
     action as the Secretary determines appropriate.

     SEC. 2332. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHENSIVE 
                   CARE PLANNING SERVICES UNDER MEDICARE PART B.

       (a) Study.--The Comptroller General shall conduct a study 
     on the establishment under part B of the Medicare program 
     under title XVIII of the Social Security Act of a payment 
     code for a visit for longitudinal comprehensive care planning 
     services. Such study shall include an analysis of the 
     following to the extent such information is available:
       (1) The frequency with which services similar to 
     longitudinal comprehensive care planning services are 
     furnished to Medicare beneficiaries, which providers of 
     services and suppliers are furnishing those services, whether 
     Medicare reimbursement is being received for those services, 
     and, if so, through which codes those services are being 
     reimbursed.
       (2) Whether, and the extent to which, longitudinal 
     comprehensive care planning services would overlap, and could 
     therefore result in duplicative payment, with services 
     covered under the hospice benefit as well as the chronic care 
     management code, evaluation and management codes, or other 
     codes that already exist under part B of the Medicare 
     program.
       (3) Any barriers to hospitals, skilled nursing facilities, 
     hospice programs, home health agencies, and other applicable 
     providers working with a Medicare beneficiary to engage in 
     the care planning process and complete the necessary 
     documentation to support the treatment and care plan of the 
     beneficiary and provide such documentation to other providers 
     and the beneficiary or the beneficiary's representative.
       (4) Any barriers to providers, other than the provider 
     furnishing longitudinal comprehensive care planning services, 
     accessing the care plan and associated documentation for use 
     related to the care of the Medicare beneficiary.
       (5) Potential options for ensuring that applicable 
     providers are notified of a patient's existing longitudinal 
     care plan and that applicable providers consider that plan in 
     making their treatment decisions, and what the challenges 
     might be in implementing such options.
       (6) Stakeholder's views on the need for the development of 
     quality metrics with respect to longitudinal comprehensive 
     care planning services, such as measures related to--
       (A) the process of eliciting input from the Medicare 
     beneficiary or from a legally authorized representative and 
     documenting in the medical record the patient-directed care 
     plan;
       (B) the effectiveness and patient-centeredness of the care 
     plan in organizing delivery of services consistent with the 
     plan;
       (C) the availability of the care plan and associated 
     documentation to other providers that care for the 
     beneficiary; and
       (D) the extent to which the beneficiary received services 
     and support that is free from discrimination based on 
     advanced age, disability status, or advanced illness.
       (7) Stakeholder's views on how such quality metrics would 
     provide information on--
       (A) the goals, values, and preferences of the beneficiary;
       (B) the documentation of the care plan;
       (C) services furnished to the beneficiary; and
       (D) outcomes of treatment.
       (8) Stakeholder's views on--
       (A) the type of training and education needed for 
     applicable providers, individuals, and caregivers in order to 
     facilitate longitudinal comprehensive care planning services;
       (B) the types of providers of services and suppliers that 
     should be included in the interdisciplinary team of an 
     applicable provider; and
       (C) the characteristics of Medicare beneficiaries that 
     would be most appropriate to receive longitudinal 
     comprehensive care planning services, such as individuals 
     with advanced disease and individuals who need assistance 
     with multiple activities of daily living.
       (9) Stakeholder's views on the frequency with which 
     longitudinal comprehensive care planning services should be 
     furnished.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     conducted under subsection (a), together with recommendations 
     for such legislation and administrative action as the 
     Comptroller General determines appropriate.
       (c) Definitions.--In this section:
       (1) Applicable provider.--The term ``applicable provider'' 
     means a hospice program (as defined in subsection (dd)(2) of 
     section 1861 of the Social Security Act (42 U.S.C. 1395ww)) 
     or other provider of services (as defined in subsection (u) 
     of such section) or supplier (as defined in subsection (d) of 
     such section) that--

[[Page H866]]

       (A) furnishes longitudinal comprehensive care planning 
     services through an interdisciplinary team; and
       (B) meets such other requirements as the Secretary may 
     determine to be appropriate.
       (2) Comptroller general.--The term ``Comptroller General'' 
     means the Comptroller General of the United States.
       (3) Interdisciplinary team.--The term ``interdisciplinary 
     team'' means a group that--
       (A) includes the personnel described in subsection 
     (dd)(2)(B)(i) of such section 1861;
       (B) may include a chaplain, minister, or other clergy; and
       (C) may include other direct care personnel.
       (4) Longitudinal comprehensive care planning services.--The 
     term ``longitudinal comprehensive care planning services'' 
     means a voluntary shared decisionmaking process that is 
     furnished by an applicable provider through an 
     interdisciplinary team and includes a conversation with 
     Medicare beneficiaries who have received a diagnosis of a 
     serious or life-threatening illness. The purpose of such 
     services is to discuss a longitudinal care plan that 
     addresses the progression of the disease, treatment options, 
     the goals, values, and preferences of the beneficiary, and 
     the availability of other resources and social supports that 
     may reduce the beneficiary's health risks and promote self-
     management and shared decisionmaking.
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

   Subtitle E--Other Policies to Improve Care for the Chronically Ill

     SEC. 2341. GAO STUDY AND REPORT ON IMPROVING MEDICATION 
                   SYNCHRONIZATION.

       (a) Study.--The Comptroller General of the United States 
     (in this section referred to as the ``Comptroller General'') 
     shall conduct a study on the extent to which Medicare 
     prescription drug plans (MA-PD plans and stand alone 
     prescription drug plans) under part D of title XVIII of the 
     Social Security Act and private payors use programs that 
     synchronize pharmacy dispensing so that individuals may 
     receive multiple prescriptions on the same day to facilitate 
     comprehensive counseling and promote medication adherence. 
     The study shall include a analysis of the following:
       (1) The extent to which pharmacies have adopted such 
     programs.
       (2) The common characteristics of such programs, including 
     how pharmacies structure counseling sessions under such 
     programs and the types of payment and other arrangements that 
     Medicare prescription drug plans and private payors employ 
     under such programs to support the efforts of pharmacies.
       (3) How such programs compare for Medicare prescription 
     drug plans and private payors.
       (4) What is known about how such programs affect patient 
     medication adherence and overall patient health outcomes, 
     including if adherence and outcomes vary by patient 
     subpopulations, such as disease state and socioeconomic 
     status.
       (5) What is known about overall patient satisfaction with 
     such programs and satisfaction with such programs, including 
     within patient subpopulations, such as disease state and 
     socioeconomic status.
       (6) The extent to which laws and regulations of the 
     Medicare program support such programs.
       (7) Barriers to the use of medication synchronization 
     programs by Medicare prescription drug plans.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     under subsection (a), together with recommendations for such 
     legislation and administrative action as the Comptroller 
     General determines appropriate.

     SEC. 2342. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS ON 
                   PATIENT HEALTH AND SPENDING.

       (a) Study.--The Comptroller General of the United States 
     (in this section referred to as the ``Comptroller General'') 
     shall, to the extent data are available, conduct a study on 
     the use of prescription drugs to manage the weight of obese 
     patients and the impact of coverage of such drugs on patient 
     health and on health care spending. Such study shall examine 
     the use and impact of these obesity drugs in the non-Medicare 
     population and for Medicare beneficiaries who have such drugs 
     covered through an MA-PD plan (as defined in section 1860D-
     1(a)(3)(C) of the Social Security Act (42 U.S.C. 1395w-
     101(a)(3)(C))) as a supplemental health care benefit. The 
     study shall include an analysis of the following:
       (1) The prevalence of obesity in the Medicare and non-
     Medicare population.
       (2) The utilization of obesity drugs.
       (3) The distribution of Body Mass Index by individuals 
     taking obesity drugs, to the extent practicable.
       (4) What is known about the use of obesity drugs in 
     conjunction with the receipt of other items or services, such 
     as behavioral counseling, and how these compare to items and 
     services received by obese individuals who do not take 
     obesity drugs.
       (5) Physician considerations and attitudes related to 
     prescribing obesity drugs.
       (6) The extent to which coverage policies cease or limit 
     coverage for individuals who fail to receive clinical 
     benefit.
       (7) What is known about the extent to which individuals who 
     take obesity drugs adhere to the prescribed regimen.
       (8) What is known about the extent to which individuals who 
     take obesity drugs maintain weight loss over time.
       (9) What is known about the subsequent impact such drugs 
     have on medical services that are directly related to 
     obesity, including with respect to subpopulations determined 
     based on the extent of obesity.
       (10) What is known about the spending associated with the 
     care of individuals who take obesity drugs, compared to the 
     spending associated with the care of individuals who do not 
     take such drugs.
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Comptroller General shall submit 
     to Congress a report containing the results of the study 
     under subsection (a), together with recommendations for such 
     legislation and administrative action as the Comptroller 
     General determines appropriate.

     SEC. 2343. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR 
                   CHRONIC CONDITIONS AMONG MEDICARE 
                   BENEFICIARIES.

       (a) Study.--The Secretary of Health and Human Services (in 
     this section referred to as the ``Secretary'') shall conduct 
     a study on long-term cost drivers to the Medicare program, 
     including obesity, tobacco use, mental health conditions, and 
     other factors that may contribute to the deterioration of 
     health conditions among individuals with chronic conditions 
     in the Medicare population. The study shall include an 
     analysis of any barriers to collecting and analyzing such 
     information and how to remove any such barriers (including 
     through legislation and administrative actions).
       (b) Report.--Not later than 18 months after the date of the 
     enactment of this Act, the Secretary shall submit to Congress 
     a report containing the results of the study under subsection 
     (a), together with recommendations for such legislation and 
     administrative action as the Secretary determines 
     appropriate. The Secretary shall also post such report on the 
     Internet website of the Department of Health and Human 
     Services.

            TITLE IV--MEDICARE PART B MISCELLANEOUS POLICIES

              Subtitle A--Medicare Part B Improvement Act

     SEC. 2401. HOME INFUSION THERAPY SERVICES TEMPORARY 
                   TRANSITIONAL PAYMENT.

       (a) In General.--Section 1834(u) of the Social Security Act 
     (42 U.S.C. 1395m(u)) is amended by adding at the end the 
     following new paragraph:
       ``(7) Home infusion therapy services temporary transitional 
     payment.--
       ``(A) Temporary transitional payment.--
       ``(i) In general.--The Secretary shall, in accordance with 
     the payment methodology described in subparagraph (B) and 
     subject to the provisions of this paragraph, provide a home 
     infusion therapy services temporary transitional payment 
     under this part to an eligible home infusion supplier (as 
     defined in subparagraph (F)) for items and services described 
     in subparagraphs (A) and (B) of section 1861(iii)(2)) 
     furnished during the period specified in clause (ii) by such 
     supplier in coordination with the furnishing of transitional 
     home infusion drugs (as defined in clause (iii)).
       ``(ii) Period specified.--For purposes of clause (i), the 
     period specified in this clause is the period beginning on 
     January 1, 2019, and ending on the day before the date of the 
     implementation of the payment system under paragraph (1)(A).
       ``(iii) Transitional home infusion drug defined.--For 
     purposes of this paragraph, the term `transitional home 
     infusion drug' has the meaning given to the term `home 
     infusion drug' under section 1861(iii)(3)(C)), except that 
     clause (ii) of such section shall not apply if a drug 
     described in such clause is identified in clauses (i), (ii), 
     (iii) or (iv) of subparagraph (C) as of the date of the 
     enactment of this paragraph.
       ``(B) Payment methodology.--For purposes of this paragraph, 
     the Secretary shall establish a payment methodology, with 
     respect to items and services described in subparagraph 
     (A)(i). Under such payment methodology the Secretary shall--
       ``(i) create the three payment categories described in 
     clauses (i), (ii), and (iii) of subparagraph (C);
       ``(ii) assign drugs to such categories, in accordance with 
     such clauses;
       ``(iii) assign appropriate Healthcare Common Procedure 
     Coding System (HCPCS) codes to each payment category; and
       ``(iv) establish a single payment amount for each such 
     payment category, in accordance with subparagraph (D), for 
     each infusion drug administration calendar day in the 
     individual's home for drugs assigned to such category.
       ``(C) Payment categories.--
       ``(i) Payment category 1.--The Secretary shall create a 
     payment category 1 and assign to such category drugs which 
     are covered under the Local Coverage Determination on 
     External Infusion Pumps (LCD number L33794) and billed with 
     the following HCPCS codes (as identified as of January 1, 
     2018, and as subsequently modified by the Secretary): J0133, 
     J0285, J0287, J0288, J0289, J0895, J1170, J1250, J1265, 
     J1325, J1455, J1457, J1570, J2175, J2260, J2270, J2274, 
     J2278, J3010, or J3285.
       ``(ii) Payment category 2.--The Secretary shall create a 
     payment category 2 and assign

[[Page H867]]

     to such category drugs which are covered under such local 
     coverage determination and billed with the following HCPCS 
     codes (as identified as of January 1, 2018, and as 
     subsequently modified by the Secretary): J1555 JB, J1559 JB, 
     J1561 JB, J1562 JB, J1569 JB, or J1575 JB.
       ``(iii) Payment category 3.--The Secretary shall create a 
     payment category 3 and assign to such category drugs which 
     are covered under such local coverage determination and 
     billed with the following HCPCS codes (as identified as of 
     January 1, 2018, and as subsequently modified by the 
     Secretary): J9000, J9039, J9040, J9065, J9100, J9190, J9200, 
     J9360, or J9370.
       ``(iv) Infusion drugs not otherwise included.--With respect 
     to drugs that are not included in payment category 1, 2, or 3 
     under clause (i), (ii), or (iii), respectively, the Secretary 
     shall assign to the most appropriate of such categories, as 
     determined by the Secretary, drugs which are--

       ``(I) covered under such local coverage determination and 
     billed under HCPCS codes J7799 or J7999 (as identified as of 
     July 1, 2017, and as subsequently modified by the Secretary); 
     or
       ``(II) billed under any code that is implemented after the 
     date of the enactment of this paragraph and included in such 
     local coverage determination or included in subregulatory 
     guidance as a home infusion drug described in subparagraph 
     (A)(i).

       ``(D) Payment amounts.--
       ``(i) In general.--Under the payment methodology, the 
     Secretary shall pay eligible home infusion suppliers, with 
     respect to items and services described in subparagraph 
     (A)(i) furnished during the period described in subparagraph 
     (A)(ii) by such supplier to an individual, at amounts equal 
     to the amounts determined under the physician fee schedule 
     established under section 1848 for services furnished during 
     the year for codes and units of such codes described in 
     clauses (ii), (iii), and (iv) with respect to drugs included 
     in the payment category under subparagraph (C) specified in 
     the respective clause, determined without application of the 
     geographic adjustment under subsection (e) of such section.
       ``(ii) Payment amount for category 1.--For purposes of 
     clause (i), the codes and units described in this clause, 
     with respect to drugs included in payment category 1 
     described in subparagraph (C)(i), are one unit of HCPCS code 
     96365 plus three units of HCPCS code 96366 (as identified as 
     of January 1, 2018, and as subsequently modified by the 
     Secretary).
       ``(iii) Payment amount for category 2.--For purposes of 
     clause (i), the codes and units described in this clause, 
     with respect to drugs included in payment category 2 
     described in subparagraph (C)(i), are one unit of HCPCS code 
     96369 plus three units of HCPCS code 96370 (as identified as 
     of January 1, 2018, and as subsequently modified by the 
     Secretary).
       ``(iv) Payment amount for category 3.--For purposes of 
     clause (i), the codes and units described in this clause, 
     with respect to drugs included in payment category 3 
     described in subparagraph (C)(i), are one unit of HCPCS code 
     96413 plus three units of HCPCS code 96415 (as identified as 
     of January 1, 2018, and as subsequently modified by the 
     Secretary).
       ``(E) Clarifications.--
       ``(i) Infusion drug administration day.--For purposes of 
     this subsection, with respect to the furnishing of 
     transitional home infusion drugs or home infusion drugs to an 
     individual by an eligible home infusion supplier or a 
     qualified home infusion therapy supplier, a reference to 
     payment to such supplier for an infusion drug administration 
     calendar day in the individual's home shall refer to payment 
     only for the date on which professional services (as 
     described in section 1861(iii)(2)(A)) were furnished to 
     administer such drugs to such individual. For purposes of the 
     previous sentence, an infusion drug administration calendar 
     day shall include all such drugs administered to such 
     individual on such day.
       ``(ii) Treatment of multiple drugs administered on same 
     infusion drug administration day.--In the case that an 
     eligible home infusion supplier, with respect to an infusion 
     drug administration calendar day in an individual's home, 
     furnishes to such individual transitional home infusion drugs 
     which are not all assigned to the same payment category under 
     subparagraph (C), payment to such supplier for such infusion 
     drug administration calendar day in the individual's home 
     shall be a single payment equal to the amount of payment 
     under this paragraph for the drug, among all such drugs so 
     furnished to such individual during such calendar day, for 
     which the highest payment would be made under this paragraph.
       ``(F) Eligible home infusion suppliers.--In this paragraph, 
     the term `eligible home infusion supplier' means a supplier 
     that is enrolled under this part as a pharmacy that provides 
     external infusion pumps and external infusion pump supplies 
     and that maintains all pharmacy licensure requirements in the 
     State in which the applicable infusion drugs are 
     administered.
       ``(G) Implementation.--Notwithstanding any other provision 
     of law, the Secretary may implement this paragraph by program 
     instruction or otherwise.''.
       (b) Conforming Amendment.--
       (1) Section 1842(b)(6)(I) of the Social Security Act (42 
     U.S.C. 1395u(b)(6)(I)) is amended by inserting ``or, in the 
     case of items and services described in clause (i) of section 
     1834(u)(7)(A) furnished to an individual during the period 
     described in clause (ii) of such section, payment shall be 
     made to the eligible home infusion therapy supplier'' after 
     ``payment shall be made to the qualified home infusion 
     therapy supplier''.
       (2) Section 5012(d) of the 21st Century Cures Act is 
     amended by inserting the following before the period at the 
     end the following: ``, except that the amendments made by 
     paragraphs (1) and (2) of subsection (c) shall apply to items 
     and services furnished on or after January 1, 2019''.

     SEC. 2402. ORTHOTIST'S AND PROSTHETIST'S CLINICAL NOTES AS 
                   PART OF THE PATIENT'S MEDICAL RECORD.

       Section 1834(h) of the Social Security Act (42 U.S.C. 
     1395m(h)) is amended by adding at the end the following new 
     paragraph:
       ``(5) Documentation created by orthotists and 
     prosthetists.--For purposes of determining the reasonableness 
     and medical necessity of orthotics and prosthetics, 
     documentation created by an orthotist or prosthetist shall be 
     considered part of the individual's medical record to support 
     documentation created by eligible professionals described in 
     section 1848(k)(3)(B).''.

     SEC. 2403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES 
                   AND ASSURANCE OF HIGH QUALITY SURVEYS.

       (a) Accreditation and Surveys.--
       (1) In general.--Section 1865 of the Social Security Act 
     (42 U.S.C. 1395bb) is amended--
       (A) in subsection (a)--
       (i) in paragraph (1), in the matter preceding subparagraph 
     (A), by striking ``or the conditions and requirements under 
     section 1881(b)''; and
       (ii) in paragraph (4), by inserting ``(including a renal 
     dialysis facility)'' after ``facility''; and
       (B) by adding at the end the following new subsection:
       ``(e) With respect to an accreditation body that has 
     received approval from the Secretary under subsection 
     (a)(3)(A) for accreditation of provider entities that are 
     required to meet the conditions and requirements under 
     section 1881(b), in addition to review and oversight 
     authorities otherwise applicable under this title, the 
     Secretary shall (as the Secretary determines appropriate) 
     conduct, with respect to such accreditation body and provider 
     entities, any or all of the following as frequently as is 
     otherwise required to be conducted under this title with 
     respect to other accreditation bodies or other provider 
     entities:
       ``(1) Validation surveys referred to in subsection (d).
       ``(2) Accreditation program reviews (as defined in section 
     488.8(c) of title 42 of the Code of Federal Regulations, or a 
     successor regulation).
       ``(3) Performance reviews (as defined in section 488.8(a) 
     of title 42 of the Code of Federal Regulations, or a 
     successor regulation).''.
       (2) Timing for acceptance of requests from accreditation 
     organizations.--Not later than 90 days after the date of 
     enactment of this Act, the Secretary of Health and Human 
     Services shall begin accepting requests from national 
     accreditation bodies for a finding described in section 
     1865(a)(3)(A) of the Social Security Act (42 U.S.C. 
     1395bb(a)(3)(A)) for purposes of accrediting provider 
     entities that are required to meet the conditions and 
     requirements under section 1881(b) of such Act (42 U.S.C. 
     1395rr(b)).
       (b) Requirement for Timing of Surveys of New Dialysis 
     Facilities.--Section 1881(b)(1) of the Social Security Act 
     (42 U.S.C. 1395rr(b)(1)) is amended by adding at the end the 
     following new sentence: ``Beginning 180 days after the date 
     of the enactment of this sentence, an initial survey of a 
     provider of services or a renal dialysis facility to 
     determine if the conditions and requirements under this 
     paragraph are met shall be initiated not later than 90 days 
     after such date on which both the provider enrollment form 
     (without regard to whether such form is submitted prior to or 
     after such date of enactment) has been determined by the 
     Secretary to be complete and the provider's enrollment status 
     indicates approval is pending the results of such survey.''.

     SEC. 2404. MODERNIZING THE APPLICATION OF THE STARK RULE 
                   UNDER MEDICARE.

       (a) Clarification of the Writing Requirement and Signature 
     Requirement for Arrangements Pursuant to the Stark Rule.--
       (1) Writing requirement.--Section 1877(h)(1) of the Social 
     Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding at 
     the end the following new subparagraph:
       ``(D) Written requirement clarified.--In the case of any 
     requirement pursuant to this section for a compensation 
     arrangement to be in writing, such requirement shall be 
     satisfied by such means as determined by the Secretary, 
     including by a collection of documents, including 
     contemporaneous documents evidencing the course of conduct 
     between the parties involved.''.
       (2) Signature requirement.--Section 1877(h)(1) of the 
     Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by 
     paragraph (1), is further amended by adding at the end the 
     following new subparagraph:
       ``(E) Special rule for signature requirements.--In the case 
     of any requirement pursuant to this section for a 
     compensation arrangement to be in writing and signed by the 
     parties, such signature requirement shall be met if--
       ``(i) not later than 90 consecutive calendar days 
     immediately following the date on

[[Page H868]]

     which the compensation arrangement became noncompliant, the 
     parties obtain the required signatures; and
       ``(ii) the compensation arrangement otherwise complies with 
     all criteria of the applicable exception.''.
       (b) Indefinite Holdover for Lease Arrangements and Personal 
     Services Arrangements Pursuant to the Stark Rule.--Section 
     1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) is 
     amended--
       (1) in paragraph (1), by adding at the end the following 
     new subparagraph:
       ``(C) Holdover lease arrangements.--In the case of a 
     holdover lease arrangement for the lease of office space or 
     equipment, which immediately follows a lease arrangement 
     described in subparagraph (A) for the use of such office 
     space or subparagraph (B) for the use of such equipment and 
     that expired after a term of at least 1 year, payments made 
     by the lessee to the lessor pursuant to such holdover lease 
     arrangement, if--
       ``(i) the lease arrangement met the conditions of 
     subparagraph (A) for the lease of office space or 
     subparagraph (B) for the use of equipment when the 
     arrangement expired;
       ``(ii) the holdover lease arrangement is on the same terms 
     and conditions as the immediately preceding arrangement; and
       ``(iii) the holdover arrangement continues to satisfy the 
     conditions of subparagraph (A) for the lease of office space 
     or subparagraph (B) for the use of equipment.''; and
       (2) in paragraph (3), by adding at the end the following 
     new subparagraph:
       ``(C) Holdover personal service arrangement.--In the case 
     of a holdover personal service arrangement, which immediately 
     follows an arrangement described in subparagraph (A) that 
     expired after a term of at least 1 year, remuneration from an 
     entity pursuant to such holdover personal service 
     arrangement, if--
       ``(i) the personal service arrangement met the conditions 
     of subparagraph (A) when the arrangement expired;
       ``(ii) the holdover personal service arrangement is on the 
     same terms and conditions as the immediately preceding 
     arrangement; and
       ``(iii) the holdover arrangement continues to satisfy the 
     conditions of subparagraph (A).''.

                   Subtitle B--Additional Provisions

     SEC. 2411. MAKING PERMANENT THE REMOVAL OF THE RENTAL CAP FOR 
                   DURABLE MEDICAL EQUIPMENT UNDER MEDICARE WITH 
                   RESPECT TO SPEECH GENERATING DEVICES.

       Section 1834(a)(2)(A)(iv) of the Social Security Act (42 
     U.S.C. 1395m(a)(2)(A)(iv)) is amended by striking ``and 
     before October 1, 2018,''.

     SEC. 2412. INCREASED CIVIL AND CRIMINAL PENALTIES AND 
                   INCREASED SENTENCES FOR FEDERAL HEALTH CARE 
                   PROGRAM FRAUD AND ABUSE.

       (a) Increased Civil Money Penalties and Criminal Fines.--
       (1) Increased civil money penalties.--Section 1128A of the 
     Social Security Act (42 U.S.C. 1320a-7a) is amended--
       (A) in subsection (a), in the matter following paragraph 
     (10)--
       (i) by striking ``$10,000'' and inserting ``$20,000'' each 
     place it appears;
       (ii) by striking ``$15,000'' and inserting ``$30,000''; and
       (iii) by striking ``$50,000'' and inserting ``$100,000'' 
     each place it appears; and
       (B) in subsection (b)--
       (i) in paragraph (1), in the flush text following 
     subparagraph (B), by striking ``$2,000'' and inserting 
     ``$5,000'';
       (ii) in paragraph (2), by striking ``$2,000'' and inserting 
     ``$5,000''; and
       (iii) in paragraph (3)(A)(i), by striking ``$5,000'' and 
     inserting ``$10,000''.
       (2) Increased criminal fines.--Section 1128B of such Act 
     (42 U.S.C. 1320a-7b) is amended--
       (A) in subsection (a), in the matter following paragraph 
     (6)--
       (i) by striking ``$25,000'' and inserting ``$100,000''; and
       (ii) by striking ``$10,000'' and inserting ``$20,000'';
       (B) in subsection (b)--
       (i) in paragraph (1), in the flush text following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000''; and
       (ii) in paragraph (2), in the flush text following 
     subparagraph (B), by striking ``$25,000'' and inserting 
     ``$100,000'';
       (C) in subsection (c), by striking ``$25,000'' and 
     inserting ``$100,000'';
       (D) in subsection (d), in the flush text following 
     paragraph (2), by striking ``$25,000'' and inserting 
     ``$100,000''; and
       (E) in subsection (e), by striking ``$2,000'' and inserting 
     ``$4,000''.
       (b) Increased Sentences for Felonies Involving Federal 
     Health Care Program Fraud and Abuse.--
       (1) False statements and representations.--Section 1128B(a) 
     of the Social Security Act (42 U.S.C. 1320a-7b(a)) is 
     amended, in the matter following paragraph (6), by striking 
     ``not more than five years or both, or (ii)'' and inserting 
     ``not more than 10 years or both, or (ii)''.
       (2) Antikickback.--Section 1128B(b) of such Act (42 U.S.C. 
     1320a-7b(b)) is amended--
       (A) in paragraph (1), in the flush text following 
     subparagraph (B), by striking ``not more than five years'' 
     and inserting ``not more than 10 years''; and
       (B) in paragraph (2), in the flush text following 
     subparagraph (B), by striking ``not more than five years'' 
     and inserting ``not more than 10 years''.
       (3) False statement or representation with respect to 
     conditions or operations of facilities.--Section 1128B(c) of 
     such Act (42 U.S.C. 1320a-7b(c)) is amended by striking ``not 
     more than five years'' and inserting ``not more than 10 
     years''.
       (4) Excess charges.--Section 1128B(d) of such Act (42 
     U.S.C. 1320a-7b(d)) is amended, in the flush text following 
     paragraph (2), by striking ``not more than five years'' and 
     inserting ``not more than 10 years''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to acts committed after the date of the enactment 
     of this Act.

     SEC. 2413. REDUCING THE VOLUME OF FUTURE EHR-RELATED 
                   SIGNIFICANT HARDSHIP REQUESTS.

       Section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 
     1395w-4(o)(2)(A)) and section 1886(n)(3)(A) of such Act (42 
     U.S.C. 1395ww(n)(3)(A)) are each amended in the last sentence 
     by striking ``by requiring'' and all that follows through 
     ``this paragraph''.

     SEC. 2414. COVERAGE OF CERTAIN DNA SPECIMEN PROVENANCE ASSAY 
                   TESTS UNDER MEDICARE.

       (a) Benefit.--
       (1) Coverage.--Section 1861 of the Social Security Act (42 
     U.S.C. 1395x) is amended--
       (A) in subsection (s)(2)--
       (i) in subparagraph (FF), by striking ``and'' at the end;
       (ii) in subparagraph (GG), by inserting ``and'' at the end; 
     and
       (iii) by adding at the end the following new subparagraph:
       ``(HH) a prostate cancer DNA Specimen Provenance Assay test 
     (DSPA test) (as defined in subsection (jjj)); and''; and
       (B) by adding at the end the following new subsection:
       ``(jjj) Prostate Cancer DNA Speciment Provenance Assay 
     Test.--The term `prostate cancer DNA Specimen Provenance 
     Assay Test' (DSPA test) means a test that, after a 
     determination of cancer in one or more prostate biopsy 
     specimens obtained from an individual, assesses the identity 
     of the DNA in such specimens by comparing such DNA with the 
     DNA that was separately taken from such individual at the 
     time of the biopsy.''.
       (2) Exclusion from coverage.--Section 1862(a)(1) of the 
     Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
       (A) in subparagraph (O), by striking ``and'' at the end;
       (B) in subparagraph (P), by striking the semicolon at the 
     end and inserting ``, and''; and
       (C) by adding at the end the following new subparagraph:
       ``(Q) in the case of a prostate cancer DNA Specimen 
     Provenance Assay test (DSPA test) (as defined in section 
     1861(jjj)), unless such test is furnished on or after January 
     1, 2019, and before January 1, 2024, and such test is ordered 
     by the physician who furnished the prostate cancer biopsy 
     that obtained the specimen tested;''.
       (b) Payment Amount and Related Requirements.--Section 1834 
     of the Social Security Act (42 U.S.C. 1395m), as amended by 
     section 2204, is further amended by adding at the end the 
     following new subsection:
       ``(w) Prostate Cancer DNA Specimen Provenance Assay 
     Tests.--
       ``(1) Payment for covered tests.--
       ``(A) In general.--Subject to subparagraph (B), the payment 
     amount for a prostate cancer DNA Specimen Provenance Assay 
     test (DSPA test) (as defined in section 1861(jjj)) shall be 
     $200. Such payment shall be payment for all of the specimens 
     obtained from the biopsy furnished to an individual that are 
     tested.
       ``(B) Limitation.--Payment for a DSPA test under 
     subparagraph (A) may only be made on an assignment-related 
     basis.
       ``(C) Prohibition on separate payment.--No separate payment 
     shall be made for obtaining DNA that was separately taken 
     from an individual at the time of a biopsy described in 
     subparagraph (A).
       ``(2) HCPCS code and modifier assignment.--
       ``(A) In general.--The Secretary shall assign one or more 
     HCPCS codes to a prostate cancer DNA Specimen Provenance 
     Assay test and may use a modifier to facilitate making 
     payment under this section for such test.
       ``(B) Identification of dna match on claim.--The Secretary 
     shall require an indication on a claim for a prostate cancer 
     DNA Specimen Provenance Assay test of whether the DNA of the 
     prostate biopsy specimens match the DNA of the individual 
     diagnosed with prostate cancer. Such indication may be made 
     through use of a HCPCS code, a modifier, or other means, as 
     determined appropriate by the Secretary.
       ``(3) DNA match review.--
       ``(A) In general.--The Secretary shall review at least 
     three years of claims under part B for prostate cancer DNA 
     Specimen Provenance Assay tests to identify whether the DNA 
     of the prostate biopsy specimens match the DNA of the 
     individuals diagnosed with prostate cancer.
       ``(B) Posting on internet website.--Not later than July 1, 
     2022, the Secretary shall post on the Internet website of the 
     Centers for Medicare & Medicaid Services the findings of the 
     review conducted under subparagraph (A).''.
       (c) Cost-sharing.--Section 1833(a)(1) of the Social 
     Security Act (42 U.S.C. 1395l(a)(1)) is amended--
       (1) by striking ``and (BB)'' and inserting ``(BB)''; and

[[Page H869]]

       (2) by inserting before the semicolon at the end the 
     following: ``, and (CC) with respect to a prostate cancer DNA 
     Specimen Provenance Assay test (DSPA test) (as defined in 
     section 1861(jjj)), the amount paid shall be an amount equal 
     to 80 percent of the lesser of the actual charge for the test 
     or the amount specified under section 1834(w)''.

     SEC. 2415. STRENGTHENING RULES IN CASE OF COMPETITION FOR 
                   DIABETIC TESTING STRIPS.

       (a) Special Rule in Case of Competition for Diabetic 
     Testing Strips.--
       (1) In general.--Paragraph (10) of section 1847(b) of the 
     Social Security Act (42 U.S.C. 1395w-3(b)) is amended--
       (A) in subparagraph (A), by striking the second sentence 
     and inserting the following new sentence: ``With respect to 
     bids to furnish such types of products on or after January 1, 
     2019, the volume for such types of products shall be 
     determined by the Secretary through the use of multiple 
     sources of data (from mail order and non-mail order Medicare 
     markets), including market-based data measuring sales of 
     diabetic testing strip products that are not exclusively sold 
     by a single retailer from such markets.''; and
       (B) by adding at the end the following new subparagraphs:
       ``(C) Demonstration of ability to furnish types of diabetic 
     testing strip products.--With respect to bids to furnish 
     diabetic testing strip products on or after January 1, 2019, 
     an entity shall attest to the Secretary that the entity has 
     the ability to obtain an inventory of the types and 
     quantities of diabetic testing strip products that will allow 
     the entity to furnish such products in a manner consistent 
     with its bid and--
       ``(i) demonstrate to the Secretary, through letters of 
     intent with manufacturers, wholesalers, or other suppliers, 
     or other evidence as the Secretary may specify, such ability; 
     or
       ``(ii) demonstrate to the Secretary that it made a good 
     faith attempt to obtain such a letter of intent or such other 
     evidence.
       ``(D) Use of unlisted types in calculation of percentage.--
     With respect to bids to furnish diabetic testing strip 
     products on or after January 1, 2019, in determining under 
     subparagraph (A) whether a bid submitted by an entity under 
     such subparagraph covers 50 percent (or such higher 
     percentage as the Secretary may specify) of all types of 
     diabetic testing strip products, the Secretary may not 
     attribute a percentage to types of diabetic testing strip 
     products that the Secretary does not identify by brand, 
     model, and market share volume.
       ``(E) Adherence to demonstration.--
       ``(i) In general.--In the case of an entity that is 
     furnishing diabetic testing strip products on or after 
     January 1, 2019, under a contract entered into under the 
     competition conducted pursuant to paragraph (1), the 
     Secretary shall establish a process to monitor, on an ongoing 
     basis, the extent to which such entity continues to cover the 
     product types included in the entity's bid.
       ``(ii) Termination.--If the Secretary determines that an 
     entity described in clause (i) fails to maintain in 
     inventory, or otherwise maintain ready access to (through 
     requirements, contracts, or otherwise) a type of product 
     included in the entity's bid, the Secretary may terminate 
     such contract unless the Secretary finds that the failure of 
     the entity to maintain inventory of, or ready access to, the 
     product is the result of the discontinuation of the product 
     by the product manufacturer, a market-wide shortage of the 
     product, or the introduction of a newer model or version of 
     the product in the market involved.''.
       (b) Codifying and Expanding Anti-switching Rule.--Section 
     1847(b) of the Social Security Act (42 U.S.C. 1395w-3(b)), as 
     amended by subsection (a)(1), is further amended--
       (1) by redesignating paragraph (11) as paragraph (12); and
       (2) by inserting after paragraph (10) the following new 
     paragraph:
       ``(11) Additional special rules in case of competition for 
     diabetic testing strips.--
       ``(A) In general.--With respect to an entity that is 
     furnishing diabetic testing strip products to individuals 
     under a contract entered into under the competitive 
     acquisition program established under this section, the 
     entity shall furnish to each individual a brand of such 
     products that is compatible with the home blood glucose 
     monitor selected by the individual.
       ``(B) Prohibition on influencing and incentivizing.--An 
     entity described in subparagraph (A) may not attempt to 
     influence or incentivize an individual to switch the brand of 
     glucose monitor or diabetic testing strip product selected by 
     the individual, including by--
       ``(i) persuading, pressuring, or advising the individual to 
     switch; or
       ``(ii) furnishing information about alternative brands to 
     the individual where the individual has not requested such 
     information.
       ``(C) Provision of information.--
       ``(i) Standardized information.--Not later than January 1, 
     2019, the Secretary shall develop and make available to 
     entities described in subparagraph (A) standardized 
     information that describes the rights of an individual with 
     respect to such an entity. The information described in the 
     preceding sentence shall include information regarding--

       ``(I) the requirements established under subparagraphs (A) 
     and (B);
       ``(II) the right of the individual to purchase diabetic 
     testing strip products from another mail order supplier of 
     such products or a retail pharmacy if the entity is not able 
     to furnish the brand of such product that is compatible with 
     the home blood glucose monitor selected by the individual; 
     and
       ``(III) the right of the individual to return diabetic 
     testing strip products furnished to the individual by the 
     entity.

       ``(ii) Requirement.--With respect to diabetic testing strip 
     products furnished on or after the date on which the 
     Secretary develops the standardized information under clause 
     (i), an entity described in subparagraph (A) may not 
     communicate directly to an individual until the entity has 
     verbally provided the individual with such standardized 
     information.
       ``(D) Order refills.--With respect to diabetic testing 
     strip products furnished on or after January 1, 2019, the 
     Secretary shall require an entity furnishing diabetic testing 
     strip products to an individual to contact and receive a 
     request from the individual for such products not more than 
     14 days prior to dispensing a refill of such products to the 
     individual.''.
       (c) Implementation; Non-application of the Paperwork 
     Reduction Act.--
       (1) Implementation.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services may implement 
     the provisions of, and amendments made by, this section by 
     program instruction or otherwise.
       (2) Non-application of the paperwork reduction act.--
     Chapter 35 of title 44, United States Code (commonly referred 
     to as the ``Paperwork Reduction Act of 1995''), shall not 
     apply to this section or the amendments made by this section.

                    TITLE V--OTHER HEALTH EXTENDERS

     SEC. 2501. 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) 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     254b-2(b)(1)), as amended by section 3101 of Public Law 115-
     96, is amended by amending subparagraph (F) to read as 
     follows:
       ``(F) $3,600,000,000 for each of fiscal years 2018 and 
     2019.''.
       (b) Other Community Health Centers Provisions.--Section 330 
     of the Public Health Service Act (42 U.S.C. 254b) is 
     amended--
       (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
     inserting ``use disorder'';
       (2) in subsection (b)(2)(A), by striking ``abuse'' and 
     inserting ``use disorder'';
       (3) in subsection (c)--
       (A) in paragraph (1), by striking subparagraphs (B) through 
     (D);
       (B) by striking ``(1) In general'' and all that follows 
     through ``The Secretary'' and inserting the following:
       ``(1) Centers.--The Secretary''; and
       (C) in paragraph (1), as amended, by redesignating clauses 
     (i) through (v) as subparagraphs (A) through (E) and moving 
     the margin of each of such redesignated subparagraph 2 ems to 
     the left;
       (4) by striking subsection (d) and inserting the following:
       ``(d) Improving Quality of Care.--
       ``(1) Supplemental awards.--The Secretary may award 
     supplemental grant funds to health centers funded under this 
     section to implement evidence-based models for increasing 
     access to high-quality primary care services, which may 
     include models related to--
       ``(A) improving the delivery of care for individuals with 
     multiple chronic conditions;
       ``(B) workforce configuration;
       ``(C) reducing the cost of care;
       ``(D) enhancing care coordination;
       ``(E) expanding the use of telehealth and technology-
     enabled collaborative learning and capacity building models;
       ``(F) care integration, including integration of behavioral 
     health, mental health, or substance use disorder services; 
     and
       ``(G) addressing emerging public health or substance use 
     disorder issues to meet the health needs of the population 
     served by the health center.
       ``(2) Sustainability.--In making supplemental awards under 
     this subsection, the Secretary may consider whether the 
     health center involved has submitted a plan for continuing 
     the activities funded under this subsection after 
     supplemental funding is expended.
       ``(3) Special consideration.--The Secretary may give 
     special consideration to applications for supplemental 
     funding under this subsection that seek to address 
     significant barriers to access to care in areas with a 
     greater shortage of health care providers and health services 
     relative to the national average.'';
       (5) in subsection (e)(1)--
       (A) in subparagraph (B)--
       (i) by striking ``2 years'' and inserting ``1 year''; and
       (ii) by adding at the end the following: ``The Secretary 
     shall not make a grant under this paragraph unless the 
     applicant provides assurances to the Secretary that within 
     120 days of receiving grant funding for the operation of the 
     health center, the applicant will submit, for approval by the 
     Secretary, an implementation plan to meet the requirements of 
     subsection (k)(3). The Secretary may extend such 120-day 
     period for achieving

[[Page H870]]

     compliance upon a demonstration of good cause by the health 
     center.''; and
       (B) in subparagraph (C)--
       (i) in the subparagraph heading, by striking ``and plans'';
       (ii) by striking ``or plan (as described in subparagraphs 
     (B) and (C) of subsection (c)(1))'';
       (iii) by striking ``or plan, including the purchase'' and 
     inserting the following: ``including--
       ``(i) the purchase'';
       (iv) by inserting ``, which may include data and 
     information systems'' after ``of equipment'';
       (v) by striking the period at the end and inserting a 
     semicolon; and
       (vi) by adding at the end the following:
       ``(ii) the provision of training and technical assistance; 
     and
       ``(iii) other activities that--

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

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

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

       (9) in subsection (k)--
       (A) in paragraph (2)--
       (i) in the paragraph heading, by inserting ``unmet'' before 
     ``need'';
       (ii) in the matter preceding subparagraph (A), by inserting 
     ``or subsection (e)(6)'' after ``subsection (e)(1)'';
       (iii) in subparagraph (A), by inserting ``unmet'' before 
     ``need for health services'';
       (iv) in subparagraph (B), by striking ``and'' at the end;
       (v) in subparagraph (C), by striking the period at the end 
     and inserting ``; and''; and
       (vi) by adding after subparagraph (C) the following:
       ``(D) in the case of an application for a grant pursuant to 
     subsection (e)(6), a demonstration that the applicant has 
     consulted with appropriate State and local government 
     agencies, and health care providers regarding the need for 
     the health services to be provided at the proposed delivery 
     site.'';
       (B) in paragraph (3)--
       (i) in the matter preceding subparagraph (A), by inserting 
     ``or subsection (e)(6)'' after ``subsection (e)(1)(B)'';
       (ii) in subparagraph (B), by striking ``in the catchment 
     area of the center'' and inserting ``, including other health 
     care providers that provide care within the catchment area, 
     local hospitals, and specialty providers in the catchment 
     area of the center, to provide access to services not 
     available through the health center and to reduce the non-
     urgent use of hospital emergency departments'';
       (iii) in subparagraph (H)(ii), by inserting ``who shall be 
     directly employed by the center'' after ``approves the 
     selection of a director for the center'';
       (iv) in subparagraph (L), by striking ``and'' at the end;
       (v) in subparagraph (M), by striking the period and 
     inserting ``; and''; and
       (vi) by inserting after subparagraph (M), the following:
       ``(N) the center has written policies and procedures in 
     place to ensure the appropriate use of Federal funds in 
     compliance with applicable Federal statutes, regulations, and 
     the terms and conditions of the Federal award.''; and
       (C) by striking paragraph (4);
       (10) in subsection (l), by adding at the end the following: 
     ``Funds expended to carry out activities under this 
     subsection and operational support activities under 
     subsection (m) shall not exceed 3 percent of the amount 
     appropriated for this section for the fiscal year 
     involved.'';
       (11) in subsection (q)(4), by adding at the end the 
     following: ``A waiver provided by the Secretary under this 
     paragraph may not remain in effect for more than 1 year and 
     may not be extended after such period. An entity may not 
     receive more than one waiver under this paragraph in 
     consecutive years.'';
       (12) in subsection (r)(3)--
       (A) by striking ``appropriate committees of Congress a 
     report concerning the distribution of funds under this 
     section'' and inserting the following: ``Committee on Health, 
     Education, Labor, and Pensions of the Senate, and the 
     Committee on Energy and Commerce of the House of 
     Representatives, a report including, at a minimum--
       ``(A) the distribution of funds for carrying out this 
     section'';
       (B) by striking ``populations. Such report shall include an 
     assessment'' and inserting the following: ``populations;
       ``(B) an assessment'';
       (C) by striking ``and the rationale for any substantial 
     changes in the distribution of funds.'' and inserting a 
     semicolon; and
       (D) by adding at the end the following:
       ``(C) the distribution of awards and funding for new or 
     expanded services in each of rural areas and urban areas;
       ``(D) the distribution of awards and funding for 
     establishing new access points, and the number of new access 
     points created;
       ``(E) the amount of unexpended funding for loan guarantees 
     and loan guarantee authority under title XVI;
       ``(F) the rationale for any substantial changes in the 
     distribution of funds;
       ``(G) the rate of closures for health centers and access 
     points;
       ``(H) the number and reason for any grants awarded pursuant 
     to subsection (e)(1)(B); and
       ``(I) the number and reason for any waivers provided 
     pursuant to subsection (q)(4).'';
       (13) in subsection (r), by adding at the end the following 
     new paragraph:
       ``(5) Funding for participation of health centers in all of 
     us research program.--In addition to any amounts made 
     available pursuant to paragraph (1) of this subsection, 
     section 402A of this Act, or section 10503 of the Patient 
     Protection and Affordable Care Act, there is authorized to be 
     appropriated, and there is appropriated, out of any monies in 
     the Treasury not otherwise appropriated, to the Secretary 
     $25,000,000 for fiscal year 2018 to support the participation 
     of health centers in the All of Us Research Program under the 
     Precision Medicine Initiative under section 498E of this 
     Act.''; and
       (14) by striking subsection (s).
       (c) National Health Service Corps.--Section 10503(b)(2) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     254b-2(b)(2)), as amended by section 3101 of Public Law 115-
     96, is amended by amending subparagraph (F) to read as 
     follows:
       ``(F) $310,000,000 for each of fiscal years 2018 and 
     2019.''.
       (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--

[[Page H871]]

       ``(A) maintenance of filled positions at existing approved 
     graduate medical residency training programs;
       ``(B) expansion of existing approved graduate medical 
     residency training programs; and
       ``(C) establishment of new approved graduate medical 
     residency training programs.
       ``(2) Per resident amount.--In making payments under 
     paragraph (1), the Secretary shall consider the cost of 
     training residents at teaching health centers and the 
     implications of the per resident amount on approved graduate 
     medical residency training programs at teaching health 
     centers.
       ``(3) Priority.--In making payments under paragraph (1)(C), 
     the Secretary shall give priority to qualified teaching 
     health centers that--
       ``(A) serve a health professional shortage area with a 
     designation in effect under section 332 or a medically 
     underserved community (as defined in section 799B); or
       ``(B) are located in a rural area (as defined in section 
     1886(d)(2)(D) of the Social Security Act).''.
       (2) Funding.--Paragraph (1) of section 340H(g) of the 
     Public Health Service Act (42 U.S.C. 256h(g)), as amended by 
     section 3101 of Public Law 115-96, is amended by striking 
     ``and $30,000,000 for the period of the first and second 
     quarters of fiscal year 2018'' and inserting ``and 
     $126,500,000 for each of fiscal years 2018 and 2019''.
       (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 Public Law 115-96, 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 Amendment.--Paragraph (4) of section 3014(h) 
     of title 18, United States Code, as amended by section 3101 
     of Public Law 115-96, is amended by striking ``and section 
     3101(d) of the CHIP and Public Health Funding Extension Act'' 
     and inserting ``and section 2501(e) of the SUSTAIN Care Act 
     of 2018''.

     SEC. 2502. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

       (a) Special Diabetes Program for Type I Diabetes.--
     Subparagraph (D) of section 330B(b)(2) of the Public Health 
     Service Act (42 U.S.C. 254c-2(b)(2)), as amended by section 
     3102 of Public Law 115-96, is amended to read as follows:
       ``(D) $150,000,000 for each of fiscal years 2018 and 2019, 
     to remain available until expended.''.
       (b) Special Diabetes Program for Indians.--Subparagraph (D) 
     of section 330C(c)(2) of the Public Health Service Act (42 
     U.S.C. 254c-3(c)(2)), as amended by section 3102 of Public 
     Law 115-96, is amended to read as follows:
       ``(D) $150,000,000 for each of fiscal years 2018 and 2019, 
     to remain available until expended.''.

     SEC. 2503. 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 to the 
     term `Indian tribe' 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 United States Virgin Islands, and the 
     Northern Mariana Islands.''.

     SEC. 2504. EXTENSION FOR SEXUAL RISK AVOIDANCE EDUCATION.

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

     ``SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION.

       ``(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;
       ``(D) be based on adolescent learning and developmental 
     theories for the age group receiving the education; and
       ``(E) be culturally appropriate, recognizing the 
     experiences of youth from diverse communities, backgrounds, 
     and experiences.
       ``(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.

[[Page H872]]

       ``(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 complete 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 rigorous 
     evaluation methodologies, the Secretary shall consult with 
     relevant stakeholders and evaluation experts.
       ``(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) Definitions.--In this section:
       ``(1) The term `age-appropriate' means suitable (in terms 
     of topics, messages, and teaching methods) to the 
     developmental and social maturity of the particular age or 
     age group of children or adolescents, based on developing 
     cognitive, emotional, and behavioral capacity typical for the 
     age or age group.
       ``(2) The term `medically accurate and complete' means 
     verified or supported by the weight of research conducted in 
     compliance with accepted scientific methods and--
       ``(A) published in peer-reviewed journals, where 
     applicable; or
       ``(B) comprising information that leading professional 
     organizations and agencies with relevant expertise in the 
     field recognize as accurate, objective, and complete.
       ``(3) The term `rigorous', with respect to research or 
     evaluation, means using--
       ``(A) established scientific methods for measuring the 
     impact of an intervention or program model in changing 
     behavior (specifically sexual activity or other sexual risk 
     behaviors), or reducing pregnancy, among youth; or
       ``(B) other evidence-based methodologies established by the 
     Secretary for purposes of this section.
       ``(4) The term `youth' refers to one or more individuals 
     who have attained age 10 but not age 20.
       ``(f) 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.''.
       (b) Effective Date.--The amendment made by this section 
     takes effect on October 1, 2017.

     SEC. 2505. EXTENSION FOR PERSONAL RESPONSIBILITY EDUCATION.

       (a) In General.--Section 513 of the Social Security Act (42 
     U.S.C. 713) is amended--
       (1) in subsection (a)(1)(A), by striking ``2017'' and 
     inserting ``2019''; and
       (2) in subsection (a)(4)--
       (A) in subparagraph (A), by striking ``2017'' each place it 
     appears and inserting ``2019''; and
       (B) 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'';
       (3) in subsection (c)(1), by inserting after ``youth with 
     HIV/AIDS,'' the following: ``victims of human trafficking,''; 
     and
       (4) in subsection (f), by striking ``2017'' and inserting 
     ``2019''.
       (b) Effective Date.--The amendments made by this section 
     take effect on October 1, 2017.

            TITLE VI--CHILD AND FAMILY SERVICES AND SUPPORT

            Subtitle A--Family First Prevention Services Act

     SEC. 2601. SHORT TITLE.

       This subtitle may be cited as the ``Family First Prevention 
     Services Act''.

         CHAPTER 1--INVESTING IN PREVENTION AND FAMILY SERVICES

     SEC. 2611. PURPOSE.

       The purpose of this chapter is to enable States to use 
     Federal funds available under parts B and E of title IV of 
     the Social Security Act to provide enhanced support to 
     children and families and prevent foster care placements 
     through the provision of mental health and substance abuse 
     prevention and treatment services, in-home parent skill-based 
     programs, and kinship navigator services.

          Subchapter A--Prevention Activities Under Title IV-E

     SEC. 2621. FOSTER CARE PREVENTION SERVICES AND PROGRAMS.

       (a) State Option.--Section 471 of the Social Security Act 
     (42 U.S.C. 671) is amended--
       (1) in subsection (a)(1), by striking ``and'' and all that 
     follows through the semicolon and inserting ``, adoption 
     assistance in accordance with section 473, and, at the option 
     of the State, services or programs specified in subsection 
     (e)(1) of this section for children who are candidates for 
     foster care or who are pregnant or parenting foster youth and 
     the parents or kin caregivers of the children, in accordance 
     with the requirements of that subsection;''; and
       (2) by adding at the end the following:
       ``(e) Prevention and Family Services and Programs.--
       ``(1) In general.--Subject to the succeeding provisions of 
     this subsection, the Secretary may make a payment to a State 
     for providing the following services or programs for a child 
     described in paragraph (2) and the parents or kin caregivers 
     of the child when the need of the child, such a parent, or 
     such a caregiver for the services or programs are directly 
     related to the safety, permanence, or well-being of the child 
     or to preventing the child from entering foster care:
       ``(A) Mental health and substance abuse prevention and 
     treatment services.--Mental health and substance abuse 
     prevention and treatment services provided by a qualified 
     clinician for not more than a 12-month period that begins on 
     any date described in paragraph (3) with respect to the 
     child.
       ``(B) In-home parent skill-based programs.--In-home parent 
     skill-based programs for not more than a 12-month period that 
     begins on any date described in paragraph (3) with respect to 
     the child and that include parenting skills training, parent 
     education, and individual and family counseling.
       ``(2) Child described.--For purposes of paragraph (1), a 
     child described in this paragraph is the following:
       ``(A) A child who is a candidate for foster care (as 
     defined in section 475(13)) but can remain safely at home or 
     in a kinship placement with receipt of services or programs 
     specified in paragraph (1).
       ``(B) A child in foster care who is a pregnant or parenting 
     foster youth.
       ``(3) Date described.--For purposes of paragraph (1), the 
     dates described in this paragraph are the following:
       ``(A) The date on which a child is identified in a 
     prevention plan maintained under paragraph (4) as a child who 
     is a candidate for foster care (as defined in section 
     475(13)).
       ``(B) The date on which a child is identified in a 
     prevention plan maintained under paragraph (4) as a pregnant 
     or parenting foster youth in need of services or programs 
     specified in paragraph (1).
       ``(4) Requirements related to providing services and 
     programs.--Services and programs specified in paragraph (1) 
     may be provided under this subsection only if specified in 
     advance in the child's prevention plan described in 
     subparagraph (A) and the requirements in subparagraphs (B) 
     through (E) are met:
       ``(A) Prevention plan.--The State maintains a written 
     prevention plan for the child that meets the following 
     requirements (as applicable):
       ``(i) Candidates.--In the case of a child who is a 
     candidate for foster care described in paragraph (2)(A), the 
     prevention plan shall--

       ``(I) identify the foster care prevention strategy for the 
     child so that the child may remain safely at home, live 
     temporarily with a kin caregiver until reunification can be

[[Page H873]]

     safely achieved, or live permanently with a kin caregiver;
       ``(II) list the services or programs to be provided to or 
     on behalf of the child to ensure the success of that 
     prevention strategy; and
       ``(III) comply with such other requirements as the 
     Secretary shall establish.

       ``(ii) Pregnant or parenting foster youth.--In the case of 
     a child who is a pregnant or parenting foster youth described 
     in paragraph (2)(B), the prevention plan shall--

       ``(I) be included in the child's case plan required under 
     section 475(1);
       ``(II) list the services or programs to be provided to or 
     on behalf of the youth to ensure that the youth is prepared 
     (in the case of a pregnant foster youth) or able (in the case 
     of a parenting foster youth) to be a parent;
       ``(III) describe the foster care prevention strategy for 
     any child born to the youth; and
       ``(IV) comply with such other requirements as the Secretary 
     shall establish.

       ``(B) Trauma-informed.--The services or programs to be 
     provided to or on behalf of a child are provided under an 
     organizational structure and treatment framework that 
     involves understanding, recognizing, and responding to the 
     effects of all types of trauma and in accordance with 
     recognized principles of a trauma-informed approach and 
     trauma-specific interventions to address trauma's 
     consequences and facilitate healing.
       ``(C) Only services and programs provided in accordance 
     with promising, supported, or well-supported practices 
     permitted.--
       ``(i) In general.--Only State expenditures for services or 
     programs specified in subparagraph (A) or (B) of paragraph 
     (1) that are provided in accordance with practices that meet 
     the requirements specified in clause (ii) of this 
     subparagraph and that meet the requirements specified in 
     clause (iii), (iv), or (v), respectively, for being a 
     promising, supported, or well-supported practice, shall be 
     eligible for a Federal matching payment under section 
     474(a)(6)(A).
       ``(ii) General practice requirements.--The general practice 
     requirements specified in this clause are the following:

       ``(I) The practice has a book, manual, or other available 
     writings that specify the components of the practice protocol 
     and describe how to administer the practice.
       ``(II) There is no empirical basis suggesting that, 
     compared to its likely benefits, the practice constitutes a 
     risk of harm to those receiving it.
       ``(III) If multiple outcome studies have been conducted, 
     the overall weight of evidence supports the benefits of the 
     practice.
       ``(IV) Outcome measures are reliable and valid, and are 
     administrated consistently and accurately across all those 
     receiving the practice.
       ``(V) There is no case data suggesting a risk of harm that 
     was probably caused by the treatment and that was severe or 
     frequent.

       ``(iii) Promising practice.--A practice shall be considered 
     to be a `promising practice' if the practice is superior to 
     an appropriate comparison practice using conventional 
     standards of statistical significance (in terms of 
     demonstrated meaningful improvements in validated measures of 
     important child and parent outcomes, such as mental health, 
     substance abuse, and child safety and well-being), as 
     established by the results or outcomes of at least one study 
     that--

       ``(I) was rated by an independent systematic review for the 
     quality of the study design and execution and determined to 
     be well-designed and well-executed; and
       ``(II) utilized some form of control (such as an untreated 
     group, a placebo group, or a wait list study).

       ``(iv) Supported practice.--A practice shall be considered 
     to be a `supported practice' if--

       ``(I) the practice is superior to an appropriate comparison 
     practice using conventional standards of statistical 
     significance (in terms of demonstrated meaningful 
     improvements in validated measures of important child and 
     parent outcomes, such as mental health, substance abuse, and 
     child safety and well-being), as established by the results 
     or outcomes of at least one study that--

       ``(aa) was rated by an independent systematic review for 
     the quality of the study design and execution and determined 
     to be well-designed and well-executed;
       ``(bb) was a rigorous random-controlled trial (or, if not 
     available, a study using a rigorous quasi-experimental 
     research design); and
       ``(cc) was carried out in a usual care or practice setting; 
     and

       ``(II) the study described in subclause (I) established 
     that the practice has a sustained effect (when compared to a 
     control group) for at least 6 months beyond the end of the 
     treatment.

       ``(v) Well-supported practice.--A practice shall be 
     considered to be a `well-supported practice' if--

       ``(I) the practice is superior to an appropriate comparison 
     practice using conventional standards of statistical 
     significance (in terms of demonstrated meaningful 
     improvements in validated measures of important child and 
     parent outcomes, such as mental health, substance abuse, and 
     child safety and well-being), as established by the results 
     or outcomes of at least two studies that--

       ``(aa) were rated by an independent systematic review for 
     the quality of the study design and execution and determined 
     to be well-designed and well-executed;
       ``(bb) were rigorous random-controlled trials (or, if not 
     available, studies using a rigorous quasi-experimental 
     research design); and
       ``(cc) were carried out in a usual care or practice 
     setting; and

       ``(II) at least one of the studies described in subclause 
     (I) established that the practice has a sustained effect 
     (when compared to a control group) for at least 1 year beyond 
     the end of treatment.

       ``(D) Guidance on practices criteria and pre-approved 
     services and programs.--
       ``(i) In general.--Not later than October 1, 2018, the 
     Secretary shall issue guidance to States regarding the 
     practices criteria required for services or programs to 
     satisfy the requirements of subparagraph (C). The guidance 
     shall include a pre-approved list of services and programs 
     that satisfy the requirements.
       ``(ii) Updates.--The Secretary shall issue updates to the 
     guidance required by clause (i) as often as the Secretary 
     determines necessary.
       ``(E) Outcome assessment and reporting.--The State shall 
     collect and report to the Secretary the following information 
     with respect to each child for whom, or on whose behalf 
     mental health and substance abuse prevention and treatment 
     services or in-home parent skill-based programs are provided 
     during a 12-month period beginning on the date the child is 
     determined by the State to be a child described in paragraph 
     (2):
       ``(i) The specific services or programs provided and the 
     total expenditures for each of the services or programs.
       ``(ii) The duration of the services or programs provided.
       ``(iii) In the case of a child described in paragraph 
     (2)(A), the child's placement status at the beginning, and at 
     the end, of the 1-year period, respectively, and whether the 
     child entered foster care within 2 years after being 
     determined a candidate for foster care.
       ``(5) State plan component.--
       ``(A) In general.--A State electing to provide services or 
     programs specified in paragraph (1) shall submit as part of 
     the State plan required by subsection (a) a prevention 
     services and programs plan component that meets the 
     requirements of subparagraph (B).
       ``(B) Prevention services and programs plan component.--In 
     order to meet the requirements of this subparagraph, a 
     prevention services and programs plan component, with respect 
     to each 5-year period for which the plan component is in 
     operation in the State, shall include the following:
       ``(i) How providing services and programs specified in 
     paragraph (1) is expected to improve specific outcomes for 
     children and families.
       ``(ii) How the State will monitor and oversee the safety of 
     children who receive services and programs specified in 
     paragraph (1), including through periodic risk assessments 
     throughout the period in which the services and programs are 
     provided on behalf of a child and reexamination of the 
     prevention plan maintained for the child under paragraph (4) 
     for the provision of the services or programs if the State 
     determines the risk of the child entering foster care remains 
     high despite the provision of the services or programs.
       ``(iii) With respect to the services and programs specified 
     in subparagraphs (A) and (B) of paragraph (1), information on 
     the specific promising, supported, or well-supported 
     practices the State plans to use to provide the services or 
     programs, including a description of--

       ``(I) the services or programs and whether the practices 
     used are promising, supported, or well-supported;
       ``(II) how the State plans to implement the services or 
     programs, including how implementation of the services or 
     programs will be continuously monitored to ensure fidelity to 
     the practice model and to determine outcomes achieved and how 
     information learned from the monitoring will be used to 
     refine and improve practices;
       ``(III) how the State selected the services or programs;
       ``(IV) the target population for the services or programs; 
     and
       ``(V) how each service or program provided will be 
     evaluated through a well-designed and rigorous process, which 
     may consist of an ongoing, cross-site evaluation approved by 
     the Secretary.

       ``(iv) A description of the consultation that the State 
     agencies responsible for administering the State plans under 
     this part and part B engage in with other State agencies 
     responsible for administering health programs, including 
     mental health and substance abuse prevention and treatment 
     services, and with other public and private agencies with 
     experience in administering child and family services, 
     including community-based organizations, in order to foster a 
     continuum of care for children described in paragraph (2) and 
     their parents or kin caregivers.
       ``(v) A description of how the State shall assess children 
     and their parents or kin caregivers to determine eligibility 
     for services or programs specified in paragraph (1).
       ``(vi) A description of how the services or programs 
     specified in paragraph (1) that are provided for or on behalf 
     of a child and the parents or kin caregivers of the child 
     will be coordinated with other child and family

[[Page H874]]

     services provided to the child and the parents or kin 
     caregivers of the child under the State plans in effect under 
     subparts 1 and 2 of part B.
       ``(vii) Descriptions of steps the State is taking to 
     support and enhance a competent, skilled, and professional 
     child welfare workforce to deliver trauma-informed and 
     evidence-based services, including--

       ``(I) ensuring that staff is qualified to provide services 
     or programs that are consistent with the promising, 
     supported, or well-supported practice models selected; and
       ``(II) developing appropriate prevention plans, and 
     conducting the risk assessments required under clause (iii).

       ``(viii) A description of how the State will provide 
     training and support for caseworkers in assessing what 
     children and their families need, connecting to the families 
     served, knowing how to access and deliver the needed trauma-
     informed and evidence-based services, and overseeing and 
     evaluating the continuing appropriateness of the services.
       ``(ix) A description of how caseload size and type for 
     prevention caseworkers will be determined, managed, and 
     overseen.
       ``(x) An assurance that the State will report to the 
     Secretary such information and data as the Secretary may 
     require with respect to the provision of services and 
     programs specified in paragraph (1), including information 
     and data necessary to determine the performance measures for 
     the State under paragraph (6) and compliance with paragraph 
     (7).
       ``(C) Reimbursement for services under the prevention plan 
     component.--
       ``(i) Limitation.--Except as provided in subclause (ii), a 
     State may not receive a Federal payment under this part for a 
     given promising, supported, or well-supported practice unless 
     (in accordance with subparagraph (B)(iii)(V)) the plan 
     includes a well-designed and rigorous evaluation strategy for 
     that practice.
       ``(ii) Waiver of limitation.--The Secretary may waive the 
     requirement for a well-designed and rigorous evaluation of 
     any well-supported practice if the Secretary deems the 
     evidence of the effectiveness of the practice to be 
     compelling and the State meets the continuous quality 
     improvement requirements included in subparagraph 
     (B)(iii)(II) with regard to the practice.
       ``(6) Prevention services measures.--
       ``(A) Establishment; annual updates.--Beginning with fiscal 
     year 2021, and annually thereafter, the Secretary shall 
     establish the following prevention services measures based on 
     information and data reported by States that elect to provide 
     services and programs specified in paragraph (1):
       ``(i) Percentage of candidates for foster care who do not 
     enter foster care.--The percentage of candidates for foster 
     care for whom, or on whose behalf, the services or programs 
     are provided who do not enter foster care, including those 
     placed with a kin caregiver outside of foster care, during 
     the 12-month period in which the services or programs are 
     provided and through the end of the succeeding 12-month 
     period.
       ``(ii) Per-child spending.--The total amount of 
     expenditures made for mental health and substance abuse 
     prevention and treatment services or in-home parent skill-
     based programs, respectively, for, or on behalf of, each 
     child described in paragraph (2).
       ``(B) Data.--The Secretary shall establish and annually 
     update the prevention services measures--
       ``(i) based on the median State values of the information 
     reported under each clause of subparagraph (A) for the 3 then 
     most recent years; and
       ``(ii) taking into account State differences in the price 
     levels of consumption goods and services using the most 
     recent regional price parities published by the Bureau of 
     Economic Analysis of the Department of Commerce or such other 
     data as the Secretary determines appropriate.
       ``(C) Publication of state prevention services measures.--
     The Secretary shall annually make available to the public the 
     prevention services measures of each State.
       ``(7) Maintenance of effort for state foster care 
     prevention expenditures.--
       ``(A) In general.--If a State elects to provide services 
     and programs specified in paragraph (1) for a fiscal year, 
     the State foster care prevention expenditures for the fiscal 
     year shall not be less than the amount of the expenditures 
     for fiscal year 2014 (or, at the option of a State described 
     in subparagraph (E), fiscal year 2015 or fiscal year 2016 
     (whichever the State elects)).
       ``(B) State foster care prevention expenditures.--The term 
     `State foster care prevention expenditures' means the 
     following:
       ``(i) TANF; iv-b; ssbg.--State expenditures for foster care 
     prevention services and activities under the State program 
     funded under part A (including from amounts made available by 
     the Federal Government), under the State plan developed under 
     part B (including any such amounts), or under the Social 
     Services Block Grant Programs under subtitle A of title XX 
     (including any such amounts).
       ``(ii) Other state programs.--State expenditures for foster 
     care prevention services and activities under any State 
     program that is not described in clause (i) (other than any 
     State expenditures for foster care prevention services and 
     activities under the State program under this part (including 
     under a waiver of the program)).
       ``(C) State expenditures.--The term `State expenditures' 
     means all State or local funds that are expended by the State 
     or a local agency including State or local funds that are 
     matched or reimbursed by the Federal Government and State or 
     local funds that are not matched or reimbursed by the Federal 
     Government.
       ``(D) Determination of prevention services and 
     activities.--The Secretary shall require each State that 
     elects to provide services and programs specified in 
     paragraph (1) to report the expenditures specified in 
     subparagraph (B) for fiscal year 2014 and for such fiscal 
     years thereafter as are necessary to determine whether the 
     State is complying with the maintenance of effort requirement 
     in subparagraph (A). The Secretary shall specify the specific 
     services and activities under each program referred to in 
     subparagraph (B) that are `prevention services and 
     activities' for purposes of the reports.
       ``(E) State described.--For purposes of subparagraph (A), a 
     State is described in this subparagraph if the population of 
     children in the State in 2014 was less than 200,000 (as 
     determined by the Bureau of the Census).
       ``(8) Prohibition against use of state foster care 
     prevention expenditures and federal iv-e prevention funds for 
     matching or expenditure requirement.--A State that elects to 
     provide services and programs specified in paragraph (1) 
     shall not use any State foster care prevention expenditures 
     for a fiscal year for the State share of expenditures under 
     section 474(a)(6) for a fiscal year.
       ``(9) Administrative costs.--Expenditures described in 
     section 474(a)(6)(B)--
       ``(A) shall not be eligible for payment under subparagraph 
     (A), (B), or (E) of section 474(a)(3); and
       ``(B) shall be eligible for payment under section 
     474(a)(6)(B) without regard to whether the expenditures are 
     incurred on behalf of a child who is, or is potentially, 
     eligible for foster care maintenance payments under this 
     part.
       ``(10) Application.--
       ``(A) In general.--The provision of services or programs 
     under this subsection to or on behalf of a child described in 
     paragraph (2) shall not be considered to be receipt of aid or 
     assistance under the State plan under this part for purposes 
     of eligibility for any other program established under this 
     Act.
       ``(B) Candidates in kinship care.--A child described in 
     paragraph (2) for whom such services or programs under this 
     subsection are provided for more than 6 months while in the 
     home of a kin caregiver, and who would satisfy the AFDC 
     eligibility requirement of section 472(a)(3)(A)(ii)(II) but 
     for residing in the home of the caregiver for more than 6 
     months, is deemed to satisfy that requirement for purposes of 
     determining whether the child is eligible for foster care 
     maintenance payments under section 472.''.
       (b) Definition.--Section 475 of such Act (42 U.S.C. 675) is 
     amended by adding at the end the following:
       ``(13) The term `child who is a candidate for foster care' 
     means, a child who is identified in a prevention plan under 
     section 471(e)(4)(A) as being at imminent risk of entering 
     foster care (without regard to whether the child would be 
     eligible for foster care maintenance payments under section 
     472 or is or would be eligible for adoption assistance or 
     kinship guardianship assistance payments under section 473) 
     but who can remain safely in the child's home or in a kinship 
     placement as long as services or programs specified in 
     section 471(e)(1) that are necessary to prevent the entry of 
     the child into foster care are provided. The term includes a 
     child whose adoption or guardianship arrangement is at risk 
     of a disruption or dissolution that would result in a foster 
     care placement.''.
       (c) Payments Under Title IV-E.--Section 474(a) of such Act 
     (42 U.S.C. 674(a)) is amended--
       (1) in paragraph (5), by striking the period at the end and 
     inserting ``; plus''; and
       (2) by adding at the end the following:
       ``(6) subject to section 471(e)--
       ``(A) for each quarter--
       ``(i) subject to clause (ii)--

       ``(I) beginning after September 30, 2019, and before 
     October 1, 2026, an amount equal to 50 percent of the total 
     amount expended during the quarter for the provision of 
     services or programs specified in subparagraph (A) or (B) of 
     section 471(e)(1) that are provided in accordance with 
     promising, supported, or well-supported practices that meet 
     the applicable criteria specified for the practices in 
     section 471(e)(4)(C); and
       ``(II) beginning after September 30, 2026, an amount equal 
     to the Federal medical assistance percentage (which shall be 
     as defined in section 1905(b), in the case of a State other 
     than the District of Columbia, or 70 percent, in the case of 
     the District of Columbia) of the total amount expended during 
     the quarter for the provision of services or programs 
     specified in subparagraph (A) or (B) of section 471(e)(1) 
     that are provided in accordance with promising, supported, or 
     well-supported practices that meet the applicable criteria 
     specified for the practices in section 471(e)(4)(C) (or, with 
     respect to the payments made during the quarter under a 
     cooperative agreement or contract entered into by the State 
     and an Indian tribe, tribal organization, or tribal 
     consortium for the administration or payment of funds under 
     this part, an amount equal to the Federal medical assistance 
     percentage that would apply under section 479B(d) (in this 
     paragraph referred to as the `tribal FMAP') if the Indian 
     tribe, tribal organization, or tribal consortium

[[Page H875]]

     made the payments under a program operated under that 
     section, unless the tribal FMAP is less than the Federal 
     medical assistance percentage that applies to the State); 
     except that

       ``(ii) not less than 50 percent of the total amount 
     expended by a State under clause (i) for a fiscal year shall 
     be for the provision of services or programs specified in 
     subparagraph (A) or (B) of section 471(e)(1) that are 
     provided in accordance with well-supported practices; plus
       ``(B) for each quarter specified in subparagraph (A), an 
     amount equal to the sum of the following proportions of the 
     total amount expended during the quarter--
       ``(i) 50 percent of so much of the expenditures as are 
     found necessary by the Secretary for the proper and efficient 
     administration of the State plan for the provision of 
     services or programs specified in section 471(e)(1), 
     including expenditures for activities approved by the 
     Secretary that promote the development of necessary processes 
     and procedures to establish and implement the provision of 
     the services and programs for individuals who are eligible 
     for the services and programs and expenditures attributable 
     to data collection and reporting; and
       ``(ii) 50 percent of so much of the expenditures with 
     respect to the provision of services and programs specified 
     in section 471(e)(1) as are for training of personnel 
     employed or preparing for employment by the State agency or 
     by the local agency administering the plan in the political 
     subdivision and of the members of the staff of State-licensed 
     or State-approved child welfare agencies providing services 
     to children described in section 471(e)(2) and their parents 
     or kin caregivers, including on how to determine who are 
     individuals eligible for the services or programs, how to 
     identify and provide appropriate services and programs, and 
     how to oversee and evaluate the ongoing appropriateness of 
     the services and programs.''.
       (d) Technical Assistance and Best Practices, Clearinghouse, 
     and Data Collection and Evaluations.--Section 476 of such Act 
     (42 U.S.C. 676) is amended by adding at the end the 
     following:
       ``(d) Technical Assistance and Best Practices, 
     Clearinghouse, Data Collection, and Evaluations Relating to 
     Prevention Services and Programs.--
       ``(1) Technical assistance and best practices.--The 
     Secretary shall provide to States and, as applicable, to 
     Indian tribes, tribal organizations, and tribal consortia, 
     technical assistance regarding the provision of services and 
     programs described in section 471(e)(1) and shall disseminate 
     best practices with respect to the provision of the services 
     and programs, including how to plan and implement a well-
     designed and rigorous evaluation of a promising, supported, 
     or well-supported practice.
       ``(2) Clearinghouse of promising, supported, and well-
     supported practices.--The Secretary shall, directly or 
     through grants, contracts, or interagency agreements, 
     evaluate research on the practices specified in clauses 
     (iii), (iv), and (v), respectively, of section 471(e)(4)(C), 
     and programs that meet the requirements described in section 
     427(a)(1), including culturally specific, or location- or 
     population-based adaptations of the practices, to identify 
     and establish a public clearinghouse of the practices that 
     satisfy each category described by such clauses. In addition, 
     the clearinghouse shall include information on the specific 
     outcomes associated with each practice, including whether the 
     practice has been shown to prevent child abuse and neglect 
     and reduce the likelihood of foster care placement by 
     supporting birth families and kinship families and improving 
     targeted supports for pregnant and parenting youth and their 
     children.
       ``(3) Data collection and evaluations.--The Secretary, 
     directly or through grants, contracts, or interagency 
     agreements, may collect data and conduct evaluations with 
     respect to the provision of services and programs described 
     in section 471(e)(1) for purposes of assessing the extent to 
     which the provision of the services and programs--
       ``(A) reduces the likelihood of foster care placement;
       ``(B) increases use of kinship care arrangements; or
       ``(C) improves child well-being.
       ``(4) Reports to congress.--
       ``(A) In general.--The Secretary shall submit to the 
     Committee on Finance of the Senate and the Committee on Ways 
     and Means of the House of Representatives periodic reports 
     based on the provision of services and programs described in 
     section 471(e)(1) and the activities carried out under this 
     subsection.
       ``(B) Public availability.--The Secretary shall make the 
     reports to the Congress submitted under this paragraph 
     publicly available.
       ``(5) Appropriation.--Out of any money in the Treasury of 
     the United States not otherwise appropriated, there are 
     appropriated to the Secretary $1,000,000 for fiscal year 2018 
     and each fiscal year thereafter to carry out this 
     subsection.''.
       (e) Application to Programs Operated by Indian Tribal 
     Organizations.--
       (1) In general.--Section 479B of such Act (42 U.S.C. 679c) 
     is amended--
       (A) in subsection (c)(1)--
       (i) in subparagraph (C)(i)--

       (I) in subclause (II), by striking ``and'' after the 
     semicolon;
       (II) in subclause (III), by striking the period at the end 
     and inserting ``; and''; and
       (III) by adding at the end the following:
       ``(IV) at the option of the tribe, organization, or 
     consortium, services and programs specified in section 
     471(e)(1) to children described in section 471(e)(2) and 
     their parents or kin caregivers, in accordance with section 
     471(e) and subparagraph (E).''; and

       (ii) by adding at the end the following:
       ``(E) Prevention services and programs for children and 
     their parents and kin caregivers.--
       ``(i) In general.--In the case of a tribe, organization, or 
     consortium that elects to provide services and programs 
     specified in section 471(e)(1) to children described in 
     section 471(e)(2) and their parents or kin caregivers under 
     the plan, the Secretary shall specify the requirements 
     applicable to the provision of the services and programs. The 
     requirements shall, to the greatest extent practicable, be 
     consistent with the requirements applicable to States under 
     section 471(e) and shall permit the provision of the services 
     and programs in the form of services and programs that are 
     adapted to the culture and context of the tribal communities 
     served.
       ``(ii) Performance measures.--The Secretary shall establish 
     specific performance measures for each tribe, organization, 
     or consortium that elects to provide services and programs 
     specified in section 471(e)(1). The performance measures 
     shall, to the greatest extent practicable, be consistent with 
     the prevention services measures required for States under 
     section 471(e)(6) but shall allow for consideration of 
     factors unique to the provision of the services by tribes, 
     organizations, or consortia.''; and
       (B) in subsection (d)(1), by striking ``and (5)'' and 
     inserting ``(5), and (6)(A)''.
       (2) Conforming amendment.--The heading for subsection (d) 
     of section 479B of such Act (42 U.S.C. 679c) is amended by 
     striking ``for Foster Care Maintenance and Adoption 
     Assistance Payments''.
       (f) Application to Programs Operated by Territories.--
     Section 1108(a)(2) of the Social Security Act (42 U.S.C. 
     1308(a)(2)) is amended by striking ``or 413(f)'' and 
     inserting ``413(f), or 474(a)(6)''.

     SEC. 2622. FOSTER CARE MAINTENANCE PAYMENTS FOR CHILDREN WITH 
                   PARENTS IN A LICENSED RESIDENTIAL FAMILY-BASED 
                   TREATMENT FACILITY FOR SUBSTANCE ABUSE.

       (a) In General.--Section 472 of the Social Security Act (42 
     U.S.C. 672) is amended--
       (1) in subsection (a)(2)(C), by striking ``or'' and 
     inserting ``, with a parent residing in a licensed 
     residential family-based treatment facility, but only to the 
     extent permitted under subsection (j), or in a''; and
       (2) by adding at the end the following:
       ``(j) Children Placed With a Parent Residing in a Licensed 
     Residential Family-based Treatment Facility for Substance 
     Abuse.--
       ``(1) In general.--Notwithstanding the preceding provisions 
     of this section, a child who is eligible for foster care 
     maintenance payments under this section, or who would be 
     eligible for the payments if the eligibility were determined 
     without regard to paragraphs (1)(B) and (3) of subsection 
     (a), shall be eligible for the payments for a period of not 
     more than 12 months during which the child is placed with a 
     parent who is in a licensed residential family-based 
     treatment facility for substance abuse, but only if--
       ``(A) the recommendation for the placement is specified in 
     the child's case plan before the placement;
       ``(B) the treatment facility provides, as part of the 
     treatment for substance abuse, parenting skills training, 
     parent education, and individual and family counseling; and
       ``(C) the substance abuse treatment, parenting skills 
     training, parent education, and individual and family 
     counseling is provided under an organizational structure and 
     treatment framework that involves understanding, recognizing, 
     and responding to the effects of all types of trauma and in 
     accordance with recognized principles of a trauma-informed 
     approach and trauma-specific interventions to address the 
     consequences of trauma and facilitate healing.
       ``(2) Application.--With respect to children for whom 
     foster care maintenance payments are made under paragraph 
     (1), only the children who satisfy the requirements of 
     paragraphs (1)(B) and (3) of subsection (a) shall be 
     considered to be children with respect to whom foster care 
     maintenance payments are made under this section for purposes 
     of subsection (h) or section 473(b)(3)(B).''.
       (b) Conforming Amendment.--Section 474(a)(1) of such Act 
     (42 U.S.C. 674(a)(1)) is amended by inserting ``subject to 
     section 472(j),'' before ``an amount equal to the Federal'' 
     the first place it appears.

     SEC. 2623. TITLE IV-E PAYMENTS FOR EVIDENCE-BASED KINSHIP 
                   NAVIGATOR PROGRAMS.

       Section 474(a) of the Social Security Act (42 U.S.C. 
     674(a)), as amended by section 2621(c) of this Act, is 
     amended--
       (1) in paragraph (6), by striking the period at the end and 
     inserting ``; plus''; and
       (2) by adding at the end the following:
       ``(7) an amount equal to 50 percent of the amounts expended 
     by the State during the quarter as the Secretary determines 
     are for kinship navigator programs that meet the requirements 
     described in section 427(a)(1) and that the Secretary 
     determines are operated in accordance with promising, 
     supported, or well-supported practices that meet the 
     applicable criteria specified for the practices in section 
     471(e)(4)(C), without regard

[[Page H876]]

     to whether the expenditures are incurred on behalf of 
     children who are, or are potentially, eligible for foster 
     care maintenance payments under this part.''.

            Subchapter B--Enhanced Support Under Title IV-B

     SEC. 2631. ELIMINATION OF TIME LIMIT FOR FAMILY REUNIFICATION 
                   SERVICES WHILE IN FOSTER CARE AND PERMITTING 
                   TIME-LIMITED FAMILY REUNIFICATION SERVICES WHEN 
                   A CHILD RETURNS HOME FROM FOSTER CARE.

       (a) In General.--Section 431(a)(7) of the Social Security 
     Act (42 U.S.C. 629a(a)(7)) is amended--
       (1) in the paragraph heading, by striking ``Time-limited 
     family'' and inserting ``Family''; and
       (2) in subparagraph (A)--
       (A) by striking ``time-limited family'' and inserting 
     ``family'';
       (B) by inserting ``or a child who has been returned home'' 
     after ``child care institution''; and
       (C) by striking ``, but only during the 15-month period 
     that begins on the date that the child, pursuant to section 
     475(5)(F), is considered to have entered foster care'' and 
     inserting ``and to ensure the strength and stability of the 
     reunification. In the case of a child who has been returned 
     home, the services and activities shall only be provided 
     during the 15-month period that begins on the date that the 
     child returns home''.
       (b) Conforming Amendments.--
       (1) Section 430 of such Act (42 U.S.C. 629) is amended in 
     the matter preceding paragraph (1), by striking ``time-
     limited''.
       (2) Subsections (a)(4), (a)(5)(A), and (b)(1) of section 
     432 of such Act (42 U.S.C. 629b) are amended by striking 
     ``time-limited'' each place it appears.

     SEC. 2632. REDUCING BUREAUCRACY AND UNNECESSARY DELAYS WHEN 
                   PLACING CHILDREN IN HOMES ACROSS STATE LINES.

       (a) State Plan Requirement.--
       (1) In general.--Section 471(a)(25) of the Social Security 
     Act (42 U.S.C. 671(a)(25)) is amended--
       (A) by striking ``provide'' and inserting ``provides''; and
       (B) by inserting ``, which, in the case of a State other 
     than the Commonwealth of Puerto Rico, the United States 
     Virgin Islands, Guam, and American Samoa, not later than 
     October 1, 2027, shall include the use of an electronic 
     interstate case-processing system'' before the first 
     semicolon.
       (2) Exemption of indian tribes.--Section 479B(c) of such 
     Act (42 U.S.C. 679c(c)) is amended by adding at the end the 
     following:
       ``(4) Inapplicability of state plan requirement to have in 
     effect procedures providing for the use of an electronic 
     interstate case-processing system.--The requirement in 
     section 471(a)(25) that a State plan provide that the State 
     shall have in effect procedures providing for the use of an 
     electronic interstate case-processing system shall not apply 
     to an Indian tribe, tribal organization, or tribal consortium 
     that elects to operate a program under this part.''.
       (b) Funding for the Development of an Electronic Interstate 
     Case-processing System to Expedite the Interstate Placement 
     of Children in Foster Care or Guardianship, or for 
     Adoption.--Section 437 of such Act (42 U.S.C. 629g) is 
     amended by adding at the end the following:
       ``(g) Funding for the Development of an Electronic 
     Interstate Case-processing System to Expedite the Interstate 
     Placement of Children in Foster Care or Guardianship, or for 
     Adoption.--
       ``(1) Purpose.--The purpose of this subsection is to 
     facilitate the development of an electronic interstate case-
     processing system for the exchange of data and documents to 
     expedite the placements of children in foster, guardianship, 
     or adoptive homes across State lines.
       ``(2) Requirements.--A State that seeks funding under this 
     subsection shall submit to the Secretary the following 
     information:
       ``(A) A description of the goals and outcomes to be 
     achieved, which goals and outcomes must result in--
       ``(i) reducing the time it takes for a child to be provided 
     with a safe and appropriate permanent living arrangement 
     across State lines;
       ``(ii) improving administrative processes and reducing 
     costs in the foster care system; and
       ``(iii) the secure exchange of relevant case files and 
     other necessary materials in real time, and timely 
     communications and placement decisions regarding interstate 
     placements of children.
       ``(B) A description of the activities to be funded in whole 
     or in part with the funds, including the sequencing of the 
     activities.
       ``(C) A description of the strategies for integrating 
     programs and services for children who are placed across 
     State lines.
       ``(D) Such other information as the Secretary may require.
       ``(3) Funding authority.--The Secretary may provide funds 
     to a State that complies with paragraph (2). In providing 
     funds under this subsection, the Secretary shall prioritize 
     States that are not yet connected with the electronic 
     interstate case-processing system referred to in paragraph 
     (1).
       ``(4) Use of funds.--A State to which funding is provided 
     under this subsection shall use the funding to support the 
     State in connecting with, or enhancing or expediting services 
     provided under, the electronic interstate case-processing 
     system referred to in paragraph (1).
       ``(5) Evaluations.--Not later than 1 year after the final 
     year in which funds are awarded under this subsection, the 
     Secretary shall submit to the Congress, and make available to 
     the general public by posting on a website, a report that 
     contains the following information:
       ``(A) How using the electronic interstate case-processing 
     system developed pursuant to paragraph (4) has changed the 
     time it takes for children to be placed across State lines.
       ``(B) The number of cases subject to the Interstate Compact 
     on the Placement of Children that were processed through the 
     electronic interstate case-processing system, and the number 
     of interstate child placement cases that were processed 
     outside the electronic interstate case-processing system, by 
     each State in each year.
       ``(C) The progress made by States in implementing the 
     electronic interstate case-processing system.
       ``(D) How using the electronic interstate case-processing 
     system has affected various metrics related to child safety 
     and well-being, including the time it takes for children to 
     be placed across State lines.
       ``(E) How using the electronic interstate case-processing 
     system has affected administrative costs and caseworker time 
     spent on placing children across State lines.
       ``(6) Data integration.--The Secretary, in consultation 
     with the Secretariat for the Interstate Compact on the 
     Placement of Children and the States, shall assess how the 
     electronic interstate case-processing system developed 
     pursuant to paragraph (4) could be used to better serve and 
     protect children that come to the attention of the child 
     welfare system, by--
       ``(A) connecting the system with other data systems (such 
     as systems operated by State law enforcement and judicial 
     agencies, systems operated by the Federal Bureau of 
     Investigation for the purposes of the Innocence Lost National 
     Initiative, and other systems);
       ``(B) simplifying and improving reporting related to 
     paragraphs (34) and (35) of section 471(a) regarding children 
     or youth who have been identified as being a sex trafficking 
     victim or children missing from foster care; and
       ``(C) improving the ability of States to quickly comply 
     with background check requirements of section 471(a)(20), 
     including checks of child abuse and neglect registries as 
     required by section 471(a)(20)(B).''.
       (c) Reservation of Funds to Improve the Interstate 
     Placement of Children.--Section 437(b) of such Act (42 U.S.C. 
     629g(b)) is amended by adding at the end the following:
       ``(4) Improving the interstate placement of children.--The 
     Secretary shall reserve $5,000,000 of the amount made 
     available for fiscal year 2018 for grants under subsection 
     (g), and the amount so reserved shall remain available 
     through fiscal year 2022.''.

     SEC. 2633. ENHANCEMENTS TO GRANTS TO IMPROVE WELL-BEING OF 
                   FAMILIES AFFECTED BY SUBSTANCE ABUSE.

       Section 437(f) of the Social Security Act (42 U.S.C. 
     629g(f)) is amended--
       (1) in the subsection heading, by striking ``Increase the 
     Well-being of, and to Improve the Permanency Outcomes for, 
     Children Affected by'' and inserting ``Implement IV-E 
     Prevention Services, and Improve the Well-being of, and 
     Improve Permanency Outcomes for, Children and Families 
     Affected by Heroin, Opioids, and Other'';
       (2) by striking paragraph (2) and inserting the following:
       ``(2) Regional partnership defined.--In this subsection, 
     the term `regional partnership' means a collaborative 
     agreement (which may be established on an interstate, State, 
     or intrastate basis) entered into by the following:
       ``(A) Mandatory partners for all partnership grants.--
       ``(i) The State child welfare agency that is responsible 
     for the administration of the State plan under this part and 
     part E.
       ``(ii) The State agency responsible for administering the 
     substance abuse prevention and treatment block grant provided 
     under subpart II of part B of title XIX of the Public Health 
     Service Act.
       ``(B) Mandatory partners for partnership grants proposing 
     to serve children in out-of-home placements.--If the 
     partnership proposes to serve children in out-of-home 
     placements, the Juvenile Court or Administrative Office of 
     the Court that is most appropriate to oversee the 
     administration of court programs in the region to address the 
     population of families who come to the attention of the court 
     due to child abuse or neglect.
       ``(C) Optional partners.--At the option of the partnership, 
     any of the following:
       ``(i) An Indian tribe or tribal consortium.
       ``(ii) Nonprofit child welfare service providers.
       ``(iii) For-profit child welfare service providers.
       ``(iv) Community health service providers, including 
     substance abuse treatment providers.
       ``(v) Community mental health providers.
       ``(vi) Local law enforcement agencies.
       ``(vii) School personnel.
       ``(viii) Tribal child welfare agencies (or a consortia of 
     the agencies).
       ``(ix) Any other providers, agencies, personnel, officials, 
     or entities that are related to the provision of child and 
     family services under a State plan approved under this 
     subpart.

[[Page H877]]

       ``(D) Exception for regional partnerships where the lead 
     applicant is an indian tribe or tribal consortia.--If an 
     Indian tribe or tribal consortium enters into a regional 
     partnership for purposes of this subsection, the Indian tribe 
     or tribal consortium--
       ``(i) may (but is not required to) include the State child 
     welfare agency as a partner in the collaborative agreement;
       ``(ii) may not enter into a collaborative agreement only 
     with tribal child welfare agencies (or a consortium of the 
     agencies); and
       ``(iii) if the condition described in paragraph (2)(B) 
     applies, may include tribal court organizations in lieu of 
     other judicial partners.'';
       (3) in paragraph (3)--
       (A) in subparagraph (A)--
       (i) by striking ``2012 through 2016'' and inserting ``2017 
     through 2021''; and
       (ii) by striking ``$500,000 and not more than $1,000,000'' 
     and inserting ``$250,000 and not more than $1,000,000'';
       (B) in subparagraph (B)--
       (i) in the subparagraph heading, by inserting ``; 
     planning'' after ``approval'';
       (ii) in clause (i), by striking ``clause (ii)'' and 
     inserting ``clauses (ii) and (iii)''; and
       (iii) by adding at the end the following:
       ``(iii) Sufficient planning.--A grant awarded under this 
     subsection shall be disbursed in two phases: a planning phase 
     (not to exceed 2 years) and an implementation phase. The 
     total disbursement to a grantee for the planning phase may 
     not exceed $250,000, and may not exceed the total anticipated 
     funding for the implementation phase.''; and
       (C) by adding at the end the following:
       ``(D) Limitation on payment for a fiscal year.--No payment 
     shall be made under subparagraph (A) or (C) for a fiscal year 
     until the Secretary determines that the eligible partnership 
     has made sufficient progress in meeting the goals of the 
     grant and that the members of the eligible partnership are 
     coordinating to a reasonable degree with the other members of 
     the eligible partnership.'';
       (4) in paragraph (4)--
       (A) in subparagraph (B)--
       (i) in clause (i), by inserting ``, parents, and families'' 
     after ``children'';
       (ii) in clause (ii), by striking ``safety and permanence 
     for such children; and'' and inserting ``safe, permanent 
     caregiving relationships for the children;'';
       (iii) in clause (iii), by striking ``or'' and inserting 
     ``increase reunification rates for children who have been 
     placed in out-of-home care, or decrease''; and
       (iv) by redesignating clause (iii) as clause (v) and 
     inserting after clause (ii) the following:
       ``(iii) improve the substance abuse treatment outcomes for 
     parents including retention in treatment and successful 
     completion of treatment;
       ``(iv) facilitate the implementation, delivery, and 
     effectiveness of prevention services and programs under 
     section 471(e); and'';
       (B) in subparagraph (D), by striking ``where 
     appropriate,''; and
       (C) by striking subparagraphs (E) and (F) and inserting the 
     following:
       ``(E) A description of a plan for sustaining the services 
     provided by or activities funded under the grant after the 
     conclusion of the grant period, including through the use of 
     prevention services and programs under section 471(e) and 
     other funds provided to the State for child welfare and 
     substance abuse prevention and treatment services.
       ``(F) Additional information needed by the Secretary to 
     determine that the proposed activities and implementation 
     will be consistent with research or evaluations showing which 
     practices and approaches are most effective.'';
       (5) in paragraph (5)(A), by striking ``abuse treatment'' 
     and inserting ``use disorder treatment including medication 
     assisted treatment and in-home substance abuse disorder 
     treatment and recovery'';
       (6) in paragraph (7)--
       (A) by striking ``and'' at the end of subparagraph (C); and
       (B) by redesignating subparagraph (D) as subparagraph (E) 
     and inserting after subparagraph (C) the following:
       ``(D) demonstrate a track record of successful 
     collaboration among child welfare, substance abuse disorder 
     treatment and mental health agencies; and'';
       (7) in paragraph (8)--
       (A) in subparagraph (A)--
       (i) by striking ``establish indicators that will be'' and 
     inserting ``review indicators that are''; and
       (ii) by striking ``in using funds made available under such 
     grants to achieve the purpose of this subsection'' and 
     inserting ``and establish a set of core indicators related to 
     child safety, parental recovery, parenting capacity, and 
     family well-being. In developing the core indicators, to the 
     extent possible, indicators shall be made consistent with the 
     outcome measures described in section 471(e)(6)''; and
       (B) in subparagraph (B)--
       (i) in the matter preceding clause (i), by inserting ``base 
     the performance measures on lessons learned from prior rounds 
     of regional partnership grants under this subsection, and'' 
     before ``consult''; and
       (ii) by striking clauses (iii) and (iv) and inserting the 
     following:
       ``(iii) Other stakeholders or constituencies as determined 
     by the Secretary.'';
       (8) in paragraph (9)(A), by striking clause (i) and 
     inserting the following:
       ``(i) Semiannual reports.--Not later than September 30 of 
     each fiscal year in which a recipient of a grant under this 
     subsection is paid funds under the grant, and every 6 months 
     thereafter, the grant recipient shall submit to the Secretary 
     a report on the services provided and activities carried out 
     during the reporting period, progress made in achieving the 
     goals of the program, the number of children, adults, and 
     families receiving services, and such additional information 
     as the Secretary determines is necessary. The report due not 
     later than September 30 of the last such fiscal year shall 
     include, at a minimum, data on each of the performance 
     indicators included in the evaluation of the regional 
     partnership.''; and
       (9) in paragraph (10), by striking ``2012 through 2016'' 
     and inserting ``2017 through 2021''.

                      Subchapter C--Miscellaneous

     SEC. 2641. REVIEWING AND IMPROVING LICENSING STANDARDS FOR 
                   PLACEMENT IN A RELATIVE FOSTER FAMILY HOME.

       (a) Identification of Reputable Model Licensing 
     Standards.--Not later than October 1, 2018, the Secretary of 
     Health and Human Services shall identify reputable model 
     licensing standards with respect to the licensing of foster 
     family homes (as defined in section 472(c)(1) of the Social 
     Security Act).
       (b) State Plan Requirement.--Section 471(a) of the Social 
     Security Act (42 U.S.C. 671(a)) is amended--
       (1) in paragraph (34)(B), by striking ``and'' after the 
     semicolon;
       (2) in paragraph (35)(B), by striking the period at the end 
     and inserting a semicolon; and
       (3) by adding at the end the following:
       ``(36) provides that, not later than April 1, 2019, the 
     State shall submit to the Secretary information addressing--
       ``(A) whether the State licensing standards are in accord 
     with model standards identified by the Secretary, and if not, 
     the reason for the specific deviation and a description as to 
     why having a standard that is reasonably in accord with the 
     corresponding national model standards is not appropriate for 
     the State;
       ``(B) whether the State has elected to waive standards 
     established in 471(a)(10)(A) for relative foster family homes 
     (pursuant to waiver authority provided by 471(a)(10)(D)), a 
     description of which standards the State most commonly 
     waives, and if the State has not elected to waive the 
     standards, the reason for not waiving these standards;
       ``(C) if the State has elected to waive standards specified 
     in subparagraph (B), how caseworkers are trained to use the 
     waiver authority and whether the State has developed a 
     process or provided tools to assist caseworkers in waiving 
     nonsafety standards per the authority provided in 
     471(a)(10)(D) to quickly place children with relatives; and
       ``(D) a description of the steps the State is taking to 
     improve caseworker training or the process, if any; and''.

     SEC. 2642. DEVELOPMENT OF A STATEWIDE PLAN TO PREVENT CHILD 
                   ABUSE AND NEGLECT FATALITIES.

       Section 422(b)(19) of the Social Security Act (42 U.S.C. 
     622(b)(19)) is amended to read as follows:
       ``(19) document steps taken to track and prevent child 
     maltreatment deaths by including--
       ``(A) a description of the steps the State is taking to 
     compile complete and accurate information on the deaths 
     required by Federal law to be reported by the State agency 
     referred to in paragraph (1), including gathering relevant 
     information on the deaths from the relevant organizations in 
     the State including entities such as State vital statistics 
     department, child death review teams, law enforcement 
     agencies, offices of medical examiners, or coroners; and
       ``(B) a description of the steps the State is taking to 
     develop and implement a comprehensive, statewide plan to 
     prevent the fatalities that involves and engages relevant 
     public and private agency partners, including those in public 
     health, law enforcement, and the courts.''.

     SEC. 2643. MODERNIZING THE TITLE AND PURPOSE OF TITLE IV-E.

       (a) Part Heading.--The heading for part E of title IV of 
     the Social Security Act (42 U.S.C. 670 et seq.) is amended to 
     read as follows:

      ``PART E--FEDERAL PAYMENTS FOR FOSTER CARE, PREVENTION, AND 
                             PERMANENCY''.

       (b) Purpose.--The first sentence of section 470 of such Act 
     (42 U.S.C. 670) is amended--
       (1) by striking ``1995) and'' and inserting ``1995),'';
       (2) by inserting ``kinship guardianship assistance, and 
     prevention services or programs specified in section 
     471(e)(1),'' after ``needs,''; and
       (3) by striking ``(commencing with the fiscal year which 
     begins October 1, 1980)''.

     SEC. 2644. EFFECTIVE DATES.

       (a) Effective Dates.--
       (1) In general.--Except as provided in paragraph (2), 
     subject to subsection (b), the amendments made by this 
     chapter shall take effect on October 1, 2018.
       (2) Exceptions.--The amendments made by sections 2621(d), 
     2641, and 2643 shall take effect on the date of enactment of 
     this Act.
       (b) Transition Rule.--

[[Page H878]]

       (1) In general.--In the case of a State plan under part B 
     or E of title IV of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendments made by this chapter, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such part solely on the basis of the 
     failure of the plan to meet such additional requirements 
     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 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 the 
     session shall be deemed to be a separate regular session of 
     the State legislature.
       (2) Application to programs operated by indian tribal 
     organizations.--In the case of an Indian tribe, tribal 
     organization, or tribal consortium which the Secretary of 
     Health and Human Services determines requires time to take 
     action necessary to comply with the additional requirements 
     imposed by the amendments made by this chapter (whether the 
     tribe, organization, or tribal consortium has a plan under 
     section 479B of the Social Security Act or a cooperative 
     agreement or contract entered into with a State), the 
     Secretary shall provide the tribe, organization, or tribal 
     consortium with such additional time as the Secretary 
     determines is necessary for the tribe, organization, or 
     tribal consortium to take the action to comply with the 
     additional requirements before being regarded as failing to 
     comply with the requirements.

   CHAPTER 2--ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A 
                           FOSTER FAMILY HOME

     SEC. 2651. LIMITATION ON FEDERAL FINANCIAL PARTICIPATION FOR 
                   PLACEMENTS THAT ARE NOT IN FOSTER FAMILY HOMES.

       (a) Limitation on Federal Financial Participation.--
       (1) In general.--Section 472 of the Social Security Act (42 
     U.S.C. 672), as amended by section 2622 of this Act, is 
     amended--
       (A) in subsection (a)(2)(C), by inserting ``, but only to 
     the extent permitted under subsection (k)'' after 
     ``institution''; and
       (B) by adding at the end the following:
       ``(k) Limitation on Federal Financial Participation.--
       ``(1) In general.--Beginning with the third week for which 
     foster care maintenance payments are made under this section 
     on behalf of a child placed in a child-care institution, no 
     Federal payment shall be made to the State under section 
     474(a)(1) for amounts expended for foster care maintenance 
     payments on behalf of the child unless--
       ``(A) the child is placed in a child-care institution that 
     is a setting specified in paragraph (2) (or is placed in a 
     licensed residential family-based treatment facility 
     consistent with subsection (j)); and
       ``(B) in the case of a child placed in a qualified 
     residential treatment program (as defined in paragraph (4)), 
     the requirements specified in paragraph (3) and section 
     475A(c) are met.
       ``(2) Specified settings for placement.--The settings for 
     placement specified in this paragraph are the following:
       ``(A) A qualified residential treatment program (as defined 
     in paragraph (4)).
       ``(B) A setting specializing in providing prenatal, post-
     partum, or parenting supports for youth.
       ``(C) In the case of a child who has attained 18 years of 
     age, a supervised setting in which the child is living 
     independently.
       ``(D) A setting providing high-quality residential care and 
     supportive services to children and youth who have been found 
     to be, or are at risk of becoming, sex trafficking victims, 
     in accordance with section 471(a)(9)(C).
       ``(3) Assessment to determine appropriateness of placement 
     in a qualified residential treatment program.--
       ``(A) Deadline for assessment.--In the case of a child who 
     is placed in a qualified residential treatment program, if 
     the assessment required under section 475A(c)(1) is not 
     completed within 30 days after the placement is made, no 
     Federal payment shall be made to the State under section 
     474(a)(1) for any amounts expended for foster care 
     maintenance payments on behalf of the child during the 
     placement.
       ``(B) Deadline for transition out of placement.--If the 
     assessment required under section 475A(c)(1) determines that 
     the placement of a child in a qualified residential treatment 
     program is not appropriate, a court disapproves such a 
     placement under section 475A(c)(2), or a child who has been 
     in an approved placement in a qualified residential treatment 
     program is going to return home or be placed with a fit and 
     willing relative, a legal guardian, or an adoptive parent, or 
     in a foster family home, Federal payments shall be made to 
     the State under section 474(a)(1) for amounts expended for 
     foster care maintenance payments on behalf of the child while 
     the child remains in the qualified residential treatment 
     program only during the period necessary for the child to 
     transition home or to such a placement. In no event shall a 
     State receive Federal payments under section 474(a)(1) for 
     amounts expended for foster care maintenance payments on 
     behalf of a child who remains placed in a qualified 
     residential treatment program after the end of the 30-day 
     period that begins on the date a determination is made that 
     the placement is no longer the recommended or approved 
     placement for the child.
       ``(4) Qualified residential treatment program.--For 
     purposes of this part, the term `qualified residential 
     treatment program' means a program that--
       ``(A) has a trauma-informed treatment model that is 
     designed to address the needs, including clinical needs as 
     appropriate, of children with serious emotional or behavioral 
     disorders or disturbances and, with respect to a child, is 
     able to implement the treatment identified for the child by 
     the assessment of the child required under section 475A(c);
       ``(B) subject to paragraphs (5) and (6), has registered or 
     licensed nursing staff and other licensed clinical staff 
     who--
       ``(i) provide care within the scope of their practice as 
     defined by State law;
       ``(ii) are on-site in accordance with the treatment model 
     referred to in subparagraph (A); and
       ``(iii) are available 24 hours a day and 7 days a week;
       ``(C) to extent appropriate, and in accordance with the 
     child's best interests, facilitates participation of family 
     members in the child's treatment program;
       ``(D) facilitates outreach to the family members of the 
     child, including siblings, documents how the outreach is made 
     (including contact information), and maintains contact 
     information for any known biological family and fictive kin 
     of the child;
       ``(E) documents how family members are integrated into the 
     treatment process for the child, including post-discharge, 
     and how sibling connections are maintained;
       ``(F) provides discharge planning and family-based 
     aftercare support for at least 6 months post-discharge; and
       ``(G) is licensed in accordance with section 471(a)(10) and 
     is accredited by any of the following independent, not-for-
     profit organizations:
       ``(i) The Commission on Accreditation of Rehabilitation 
     Facilities (CARF).
       ``(ii) The Joint Commission on Accreditation of Healthcare 
     Organizations (JCAHO).
       ``(iii) The Council on Accreditation (COA).
       ``(iv) Any other independent, not-for-profit accrediting 
     organization approved by the Secretary.
       ``(5) Administrative costs.--The prohibition in paragraph 
     (1) on Federal payments under section 474(a)(1) shall not be 
     construed as prohibiting Federal payments for administrative 
     expenditures incurred on behalf of a child placed in a child-
     care institution and for which payment is available under 
     section 474(a)(3).
       ``(6) Rule of construction.--The requirements in paragraph 
     (4)(B) shall not be construed as requiring a qualified 
     residential treatment program to acquire nursing and 
     behavioral health staff solely through means of a direct 
     employer to employee relationship.''.
       (2) Conforming amendment.--Section 474(a)(1) of such Act 
     (42 U.S.C. 674(a)(1)), as amended by section 2622(b) of this 
     Act, is amended by striking ``section 472(j)'' and inserting 
     ``subsections (j) and (k) of section 472''.
       (b) Definition of Foster Family Home, Child-care 
     Institution.--Section 472(c) of such Act (42 U.S.C. 
     672(c)(1)) is amended to read as follows:
       ``(c) Definitions.--For purposes of this part:
       ``(1) Foster family home.--
       ``(A) In general.--The term `foster family home' means the 
     home of an individual or family--
       ``(i) that is licensed or approved by the State in which it 
     is situated as a foster family home that meets the standards 
     established for the licensing or approval; and
       ``(ii) in which a child in foster care has been placed in 
     the care of an individual, who resides with the child and who 
     has been licensed or approved by the State to be a foster 
     parent--

       ``(I) that the State deems capable of adhering to the 
     reasonable and prudent parent standard;
       ``(II) that provides 24-hour substitute care for children 
     placed away from their parents or other caretakers; and
       ``(III) that provides the care for not more than six 
     children in foster care.

       ``(B) State flexibility.--The number of foster children 
     that may be cared for in a home under subparagraph (A) may 
     exceed the numerical limitation in subparagraph (A)(ii)(III), 
     at the option of the State, for any of the following reasons:
       ``(i) To allow a parenting youth in foster care to remain 
     with the child of the parenting youth.
       ``(ii) To allow siblings to remain together.
       ``(iii) To allow a child with an established meaningful 
     relationship with the family to remain with the family.
       ``(iv) To allow a family with special training or skills to 
     provide care to a child who has a severe disability.
       ``(C) Rule of construction.--Subparagraph (A) shall not be 
     construed as prohibiting a foster parent from renting the 
     home in which the parent cares for a foster child placed in 
     the parent's care.
       ``(2) Child-care institution.--
       ``(A) In general.--The term `child-care institution' means 
     a private child-care institution, or a public child-care 
     institution which accommodates no more than 25 children, 
     which is licensed by the State in which it is situated or has 
     been approved by the agency

[[Page H879]]

     of the State responsible for licensing or approval of 
     institutions of this type as meeting the standards 
     established for the licensing.
       ``(B) Supervised settings.--In the case of a child who has 
     attained 18 years of age, the term shall include a supervised 
     setting in which the individual is living independently, in 
     accordance with such conditions as the Secretary shall 
     establish in regulations.
       ``(C) Exclusions.--The term shall not include detention 
     facilities, forestry camps, training schools, or any other 
     facility operated primarily for the detention of children who 
     are determined to be delinquent.''.
       (c) Training for State Judges, Attorneys, and Other Legal 
     Personnel in Child Welfare Cases.--Section 438(b)(1) of such 
     Act (42 U.S.C. 629h(b)(1)) is amended in the matter preceding 
     subparagraph (A) by inserting ``shall provide for the 
     training of judges, attorneys, and other legal personnel in 
     child welfare cases on Federal child welfare policies and 
     payment limitations with respect to children in foster care 
     who are placed in settings that are not a foster family 
     home,'' after ``with respect to the child,''.
       (d) Assurance of Nonimpact on Juvenile Justice System.--
       (1) State plan requirement.--Section 471(a) of such Act (42 
     U.S.C. 671(a)), as amended by section 2641 of this Act, is 
     further amended by adding at the end the following:
       ``(37) includes a certification that, in response to the 
     limitation imposed under section 472(k) with respect to 
     foster care maintenance payments made on behalf of any child 
     who is placed in a setting that is not a foster family home, 
     the State will not enact or advance policies or practices 
     that would result in a significant increase in the population 
     of youth in the State's juvenile justice system.''.
       (2) GAO study and report.--The Comptroller General of the 
     United States shall evaluate the impact, if any, on State 
     juvenile justice systems of the limitation imposed under 
     section 472(k) of the Social Security Act (as added by 
     subsection (a)(1) of this section) on foster care maintenance 
     payments made on behalf of any child who is placed in a 
     setting that is not a foster family home, in accordance with 
     the amendments made by subsections (a) and (b) of this 
     section. In particular, the Comptroller General shall 
     evaluate the extent to which children in foster care who also 
     are subject to the juvenile justice system of the State are 
     placed in a facility under the jurisdiction of the juvenile 
     justice system and whether the lack of available congregate 
     care placements under the jurisdiction of the child welfare 
     systems is a contributing factor to that result. Not later 
     than December 31, 2024, the Comptroller General shall submit 
     to Congress a report on the results of the evaluation.

     SEC. 2652. ASSESSMENT AND DOCUMENTATION OF THE NEED FOR 
                   PLACEMENT IN A QUALIFIED RESIDENTIAL TREATMENT 
                   PROGRAM.

       Section 475A of the Social Security Act (42 U.S.C. 675a) is 
     amended by adding at the end the following:
       ``(c) Assessment, Documentation, and Judicial Determination 
     Requirements for Placement in a Qualified Residential 
     Treatment Program.--In the case of any child who is placed in 
     a qualified residential treatment program (as defined in 
     section 472(k)(4)), the following requirements shall apply 
     for purposes of approving the case plan for the child and the 
     case system review procedure for the child:
       ``(1)(A) Within 30 days of the start of each placement in 
     such a setting, a qualified individual (as defined in 
     subparagraph (D)) shall--
       ``(i) assess the strengths and needs of the child using an 
     age-appropriate, evidence-based, validated, functional 
     assessment tool approved by the Secretary;
       ``(ii) determine whether the needs of the child can be met 
     with family members or through placement in a foster family 
     home or, if not, which setting from among the settings 
     specified in section 472(k)(2) would provide the most 
     effective and appropriate level of care for the child in the 
     least restrictive environment and be consistent with the 
     short- and long-term goals for the child, as specified in the 
     permanency plan for the child; and
       ``(iii) develop a list of child-specific short- and long-
     term mental and behavioral health goals.
       ``(B)(i) The State shall assemble a family and permanency 
     team for the child in accordance with the requirements of 
     clauses (ii) and (iii). The qualified individual conducting 
     the assessment required under subparagraph (A) shall work in 
     conjunction with the family of, and permanency team for, the 
     child while conducting and making the assessment.
       ``(ii) The family and permanency team shall consist of all 
     appropriate biological family members, relative, and fictive 
     kin of the child, as well as, as appropriate, professionals 
     who are a resource to the family of the child, such as 
     teachers, medical or mental health providers who have treated 
     the child, or clergy. In the case of a child who has attained 
     age 14, the family and permanency team shall include the 
     members of the permanency planning team for the child that 
     are selected by the child in accordance with section 
     475(5)(C)(iv).
       ``(iii) The State shall document in the child's case plan--
       ``(I) the reasonable and good faith effort of the State to 
     identify and include all such individuals on the family of, 
     and permanency team for, the child;
       ``(II) all contact information for members of the family 
     and permanency team, as well as contact information for other 
     family members and fictive kin who are not part of the family 
     and permanency team;
       ``(III) evidence that meetings of the family and permanency 
     team, including meetings relating to the assessment required 
     under subparagraph (A), are held at a time and place 
     convenient for family;
       ``(IV) if reunification is the goal, evidence demonstrating 
     that the parent from whom the child was removed provided 
     input on the members of the family and permanency team;
       ``(V) evidence that the assessment required under 
     subparagraph (A) is determined in conjunction with the family 
     and permanency team;
       ``(VI) the placement preferences of the family and 
     permanency team relative to the assessment that recognizes 
     children should be placed with their siblings unless there is 
     a finding by the court that such placement is contrary to 
     their best interest; and
       ``(VII) if the placement preferences of the family and 
     permanency team and child are not the placement setting 
     recommended by the qualified individual conducting the 
     assessment under subparagraph (A), the reasons why the 
     preferences of the team and of the child were not 
     recommended.
       ``(C) In the case of a child who the qualified individual 
     conducting the assessment under subparagraph (A) determines 
     should not be placed in a foster family home, the qualified 
     individual shall specify in writing the reasons why the needs 
     of the child cannot be met by the family of the child or in a 
     foster family home. A shortage or lack of foster family homes 
     shall not be an acceptable reason for determining that the 
     needs of the child cannot be met in a foster family home. The 
     qualified individual also shall specify in writing why the 
     recommended placement in a qualified residential treatment 
     program is the setting that will provide the child with the 
     most effective and appropriate level of care in the least 
     restrictive environment and how that placement is consistent 
     with the short- and long-term goals for the child, as 
     specified in the permanency plan for the child.
       ``(D)(i) Subject to clause (ii), in this subsection, the 
     term `qualified individual' means a trained professional or 
     licensed clinician who is not an employee of the State agency 
     and who is not connected to, or affiliated with, any 
     placement setting in which children are placed by the State.
       ``(ii) The Secretary may approve a request of a State to 
     waive any requirement in clause (i) upon a submission by the 
     State, in accordance with criteria established by the 
     Secretary, that certifies that the trained professionals or 
     licensed clinicians with responsibility for performing the 
     assessments described in subparagraph (A) shall maintain 
     objectivity with respect to determining the most effective 
     and appropriate placement for a child.
       ``(2) Within 60 days of the start of each placement in a 
     qualified residential treatment program, a family or juvenile 
     court or another court (including a tribal court) of 
     competent jurisdiction, or an administrative body appointed 
     or approved by the court, independently, shall--
       ``(A) consider the assessment, determination, and 
     documentation made by the qualified individual conducting the 
     assessment under paragraph (1);
       ``(B) determine whether the needs of the child can be met 
     through placement in a foster family home or, if not, whether 
     placement of the child in a qualified residential treatment 
     program provides the most effective and appropriate level of 
     care for the child in the least restrictive environment and 
     whether that placement is consistent with the short- and 
     long-term goals for the child, as specified in the permanency 
     plan for the child; and
       ``(C) approve or disapprove the placement.
       ``(3) The written documentation made under paragraph (1)(C) 
     and documentation of the determination and approval or 
     disapproval of the placement in a qualified residential 
     treatment program by a court or administrative body under 
     paragraph (2) shall be included in and made part of the case 
     plan for the child.
       ``(4) As long as a child remains placed in a qualified 
     residential treatment program, the State agency shall submit 
     evidence at each status review and each permanency hearing 
     held with respect to the child--
       ``(A) demonstrating that ongoing assessment of the 
     strengths and needs of the child continues to support the 
     determination that the needs of the child cannot be met 
     through placement in a foster family home, that the placement 
     in a qualified residential treatment program provides the 
     most effective and appropriate level of care for the child in 
     the least restrictive environment, and that the placement is 
     consistent with the short- and long-term goals for the child, 
     as specified in the permanency plan for the child;
       ``(B) documenting the specific treatment or service needs 
     that will be met for the child in the placement and the 
     length of time the child is expected to need the treatment or 
     services; and
       ``(C) documenting the efforts made by the State agency to 
     prepare the child to return home or to be placed with a fit 
     and willing relative, a legal guardian, or an adoptive 
     parent, or in a foster family home.

[[Page H880]]

       ``(5) In the case of any child who is placed in a qualified 
     residential treatment program for more than 12 consecutive 
     months or 18 nonconsecutive months (or, in the case of a 
     child who has not attained age 13, for more than 6 
     consecutive or nonconsecutive months), the State agency shall 
     submit to the Secretary--
       ``(A) the most recent versions of the evidence and 
     documentation specified in paragraph (4); and
       ``(B) the signed approval of the head of the State agency 
     for the continued placement of the child in that setting.''.

     SEC. 2653. PROTOCOLS TO PREVENT INAPPROPRIATE DIAGNOSES.

       (a) State Plan Requirement.--Section 422(b)(15)(A) of the 
     Social Security Act (42 U.S.C. 622(b)(15)(A)) is amended--
       (1) in clause (vi), by striking ``and'' after the 
     semicolon;
       (2) by redesignating clause (vii) as clause (viii); and
       (3) by inserting after clause (vi) the following:
       ``(vii) the procedures and protocols the State has 
     established to ensure that children in foster care placements 
     are not inappropriately diagnosed with mental illness, other 
     emotional or behavioral disorders, medically fragile 
     conditions, or developmental disabilities, and placed in 
     settings that are not foster family homes as a result of the 
     inappropriate diagnoses; and''.
       (b) Evaluation.--Section 476 of such Act (42 U.S.C. 676), 
     as amended by section 2621(d) of this Act, is further amended 
     by adding at the end the following:
       ``(e) Evaluation of State Procedures and Protocols to 
     Prevent Inappropriate Diagnoses of Mental Illness or Other 
     Conditions.--The Secretary shall conduct an evaluation of the 
     procedures and protocols established by States in accordance 
     with the requirements of section 422(b)(15)(A)(vii). The 
     evaluation shall analyze the extent to which States comply 
     with and enforce the procedures and protocols and the 
     effectiveness of various State procedures and protocols and 
     shall identify best practices. Not later than January 1, 
     2020, the Secretary shall submit a report on the results of 
     the evaluation to Congress.''.

     SEC. 2654. ADDITIONAL DATA AND REPORTS REGARDING CHILDREN 
                   PLACED IN A SETTING THAT IS NOT A FOSTER FAMILY 
                   HOME.

       Section 479A(a)(7)(A) of the Social Security Act (42 U.S.C. 
     679b(a)(7)(A)) is amended by striking clauses (i) through 
     (vi) and inserting the following:
       ``(i) with respect to each such placement--

       ``(I) the type of the placement setting, including whether 
     the placement is shelter care, a group home and if so, the 
     range of the child population in the home, a residential 
     treatment facility, a hospital or institution providing 
     medical, rehabilitative, or psychiatric care, a setting 
     specializing in providing prenatal, post-partum, or parenting 
     supports, or some other kind of child-care institution and if 
     so, what kind;
       ``(II) the number of children in the placement setting and 
     the age, race, ethnicity, and gender of each of the children;
       ``(III) for each child in the placement setting, the length 
     of the placement of the child in the setting, whether the 
     placement of the child in the setting is the first placement 
     of the child and if not, the number and type of previous 
     placements of the child, and whether the child has special 
     needs or another diagnosed mental or physical illness or 
     condition; and
       ``(IV) the extent of any specialized education, treatment, 
     counseling, or other services provided in the setting; and

       ``(ii) separately, the number and ages of children in the 
     placements who have a permanency plan of another planned 
     permanent living arrangement; and''.

     SEC. 2655. CRIMINAL RECORDS CHECKS AND CHECKS OF CHILD ABUSE 
                   AND NEGLECT REGISTRIES FOR ADULTS WORKING IN 
                   CHILD-CARE INSTITUTIONS AND OTHER GROUP CARE 
                   SETTINGS.

       (a) State Plan Requirement.--Section 471(a)(20) of the 
     Social Security Act (42 U.S.C. 671(a)(20)) is amended--
       (1) in each of subparagraphs (A)(ii) and (B)(iii), by 
     striking ``and'' after the semicolon;
       (2) in subparagraph (C), by adding ``and'' after the 
     semicolon; and
       (3) by inserting after subparagraph (C) the following:
       ``(D) provides procedures for any child care institution, 
     including a group home, residential treatment center, 
     shelter, or other congregate care setting, to conduct 
     criminal records checks, including fingerprint-based checks 
     of national crime information databases (as defined in 
     section 534(f)(3)(A) of title 28, United States Code), and 
     checks described in subparagraph (B) of this paragraph, on 
     any adult working in a child-care institution, including a 
     group home, residential treatment center, shelter, or other 
     congregate care setting, unless the State reports to the 
     Secretary the alternative criminal records checks and child 
     abuse registry checks the State conducts on any adult working 
     in a child-care institution, including a group home, 
     residential treatment center, shelter, or other congregate 
     care setting, and why the checks specified in this 
     subparagraph are not appropriate for the State;''.
       (b) Technical Amendments.--Subparagraphs (A) and (C) of 
     section 471(a)(20) of the Social Security Act (42 U.S.C. 
     671(a)(20)) are each amended by striking ``section 
     534(e)(3)(A)'' and inserting ``section 534(f)(3)(A)''.

     SEC. 2656. EFFECTIVE DATES; APPLICATION TO WAIVERS.

       (a) Effective Dates.--
       (1) In general.--Subject to paragraph (2) and subsections 
     (b) through (d), the amendments made by this chapter shall 
     take effect on January 1, 2018.
       (2) Transition rule.--In the case of a State plan under 
     part B or E of title IV of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendments made by this chapter, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such part solely on the basis of the 
     failure of the plan to meet the additional requirements 
     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 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 the 
     session shall be deemed to be a separate regular session of 
     the State legislature.
       (b) Limitation on Federal Financial Participation for 
     Placements That Are Not in Foster Family Homes and Related 
     Provisions.--
       (1) In general.--The amendments made by sections 2651(a), 
     2651(b), 2651(d), and 2652 shall take effect on October 1, 
     2019.
       (2) State option to delay effective date for not more than 
     2 years.--If a State requests a delay in the effective date 
     provided for in paragraph (1), the Secretary of Health and 
     Human Services shall delay the effective date with respect to 
     the State for the amount of time requested by the State not 
     to exceed 2 years. If the effective date is so delayed for a 
     period with respect to a State under the preceding sentence, 
     then--
       (A) notwithstanding section 2644, the date that the 
     amendments made by section 2621(c) take effect with respect 
     to the State shall be delayed for the period; and
       (B) in applying section 474(a)(6) of the Social Security 
     Act with respect to the State, ``on or after the date this 
     paragraph takes effect with respect to the State'' is deemed 
     to be substituted for ``after September 30, 2019'' in 
     subparagraph (A)(i)(I) of such section.
       (c) Criminal Records Checks and Checks of Child Abuse and 
     Neglect Registries for Adults Working in Child-care 
     Institutions and Other Group Care Settings.--The amendments 
     made by section 2655 shall take effect on October 1, 2018.
       (d) Application to States With Waivers.--In the case of a 
     State that, on the date of enactment of this Act, has in 
     effect a waiver approved under section 1130 of the Social 
     Security Act (42 U.S.C. 1320a-9), the amendments made by this 
     chapter shall not apply with respect to the State before the 
     expiration (determined without regard to any extensions) of 
     the waiver to the extent the amendments are inconsistent with 
     the terms of the waiver.

      CHAPTER 3--CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES

     SEC. 2661. SUPPORTING AND RETAINING FOSTER FAMILIES FOR 
                   CHILDREN.

       (a) Supporting and Retaining Foster Parents as a Family 
     Support Service.--Section 431(a)(2)(B) of the Social Security 
     Act (42 U.S.C. 631(a)(2)(B)) is amended by redesignating 
     clauses (iii) through (vi) as clauses (iv) through (vii), 
     respectively, and inserting after clause (ii) the following:
       ``(iii) To support and retain foster families so they can 
     provide quality family-based settings for children in foster 
     care.''.
       (b) Support for Foster Family Homes.--Section 436 of such 
     Act (42 U.S.C. 629f) is amended by adding at the end the 
     following:
       ``(c) Support for Foster Family Homes.--Out of any money in 
     the Treasury of the United States not otherwise appropriated, 
     there are appropriated to the Secretary for fiscal year 2018, 
     $8,000,000 for the Secretary to make competitive grants to 
     States, Indian tribes, or tribal consortia to support the 
     recruitment and retention of high-quality foster families to 
     increase their capacity to place more children in family 
     settings, focused on States, Indian tribes, or tribal 
     consortia with the highest percentage of children in non-
     family settings. The amount appropriated under this 
     subparagraph shall remain available through fiscal year 
     2022.''.

     SEC. 2662. EXTENSION OF CHILD AND FAMILY SERVICES PROGRAMS.

       (a) Extension of Stephanie Tubbs Jones Child Welfare 
     Services Program.--Section 425 of the Social Security Act (42 
     U.S.C. 625) is amended by striking ``2012 through 2016'' and 
     inserting ``2017 through 2021''.
       (b) Extension of Promoting Safe and Stable Families Program 
     Authorizations.--
       (1) In general.--Section 436(a) of such Act (42 U.S.C. 
     629f(a)) is amended by striking all that follows 
     ``$345,000,000'' and inserting ``for each of fiscal years 
     2017 through 2021.''.
       (2) Discretionary grants.--Section 437(a) of such Act (42 
     U.S.C. 629g(a)) is amended by striking ``2012 through 2016'' 
     and inserting ``2017 through 2021''.
       (c) Extension of Funding Reservations for Monthly 
     Caseworker Visits and Regional Partnership Grants.--Section 
     436(b) of such Act (42 U.S.C. 629f(b)) is amended--
       (1) in paragraph (4)(A), by striking ``2012 through 2016'' 
     and inserting ``2017 through 2021''; and
       (2) in paragraph (5), by striking ``2012 through 2016'' and 
     inserting ``2017 through 2021''.

[[Page H881]]

       (d) Reauthorization of Funding for State Courts.--
       (1) Extension of program.--Section 438(c)(1) of such Act 
     (42 U.S.C. 629h(c)(1)) is amended by striking ``2012 through 
     2016'' and inserting ``2017 through 2021''.
       (2) Extension of federal share.--Section 438(d) of such Act 
     (42 U.S.C. 629h(d)) is amended by striking ``2012 through 
     2016'' and inserting ``2017 through 2021''.
       (e) Repeal of Expired Provisions.--Section 438(e) of such 
     Act (42 U.S.C. 629h(e)) is repealed.

     SEC. 2663. IMPROVEMENTS TO THE JOHN H. CHAFEE FOSTER CARE 
                   INDEPENDENCE PROGRAM AND RELATED PROVISIONS.

       (a) Authority to Serve Former Foster Youth up to Age 23.--
     Section 477 of the Social Security Act (42 U.S.C. 677) is 
     amended--
       (1) in subsection (a)(5), by inserting ``(or 23 years of 
     age, in the case of a State with a certification under 
     subsection (b)(3)(A)(ii) to provide assistance and services 
     to youths who have aged out of foster care and have not 
     attained such age, in accordance with such subsection)'' 
     after ``21 years of age'';
       (2) in subsection (b)(3)(A)--
       (A) by inserting ``(i)'' before ``A certification'';
       (B) by striking ``children who have left foster care'' and 
     all that follows through the period and inserting ``youths 
     who have aged out of foster care and have not attained 21 
     years of age.''; and
       (C) by adding at the end the following:
       ``(ii) If the State has elected under section 475(8)(B) to 
     extend eligibility for foster care to all children who have 
     not attained 21 years of age, or if the Secretary determines 
     that the State agency responsible for administering the State 
     plans under this part and part B uses State funds or any 
     other funds not provided under this part to provide services 
     and assistance for youths who have aged out of foster care 
     that are comparable to the services and assistance the youths 
     would receive if the State had made such an election, the 
     certification required under clause (i) may provide that the 
     State will provide assistance and services to youths who have 
     aged out of foster care and have not attained 23 years of 
     age.''; and
       (3) in subsection (b)(3)(B), by striking ``children who 
     have left foster care'' and all that follows through the 
     period and inserting ``youths who have aged out of foster 
     care and have not attained 21 years of age (or 23 years of 
     age, in the case of a State with a certification under 
     subparagraph (A)(i) to provide assistance and services to 
     youths who have aged out of foster care and have not attained 
     such age, in accordance with subparagraph (A)(ii)).''.
       (b) Authority to Redistribute Unspent Funds.--Section 
     477(d) of such Act (42 U.S.C. 677(d)) is amended--
       (1) in paragraph (4), by inserting ``or does not expend 
     allocated funds within the time period specified under 
     section 477(d)(3)'' after ``provided by the Secretary''; and
       (2) by adding at the end the following:
       ``(5) Redistribution of unexpended amounts.--
       ``(A) Availability of amounts.--To the extent that amounts 
     paid to States under this section in a fiscal year remain 
     unexpended by the States at the end of the succeeding fiscal 
     year, the Secretary may make the amounts available for 
     redistribution in the second succeeding fiscal year among the 
     States that apply for additional funds under this section for 
     that second succeeding fiscal year.
       ``(B) Redistribution.--
       ``(i) In general.--The Secretary shall redistribute the 
     amounts made available under subparagraph (A) for a fiscal 
     year among eligible applicant States. In this subparagraph, 
     the term `eligible applicant State' means a State that has 
     applied for additional funds for the fiscal year under 
     subparagraph (A) if the Secretary determines that the State 
     will use the funds for the purpose for which originally 
     allotted under this section.
       ``(ii) Amount to be redistributed.--The amount to be 
     redistributed to each eligible applicant State shall be the 
     amount so made available multiplied by the State foster care 
     ratio, (as defined in subsection (c)(4), except that, in such 
     subsection, `all eligible applicant States (as defined in 
     subsection (d)(5)(B)(i))' shall be substituted for `all 
     States').
       ``(iii) Treatment of redistributed amount.--Any amount made 
     available to a State under this paragraph shall be regarded 
     as part of the allotment of the State under this section for 
     the fiscal year in which the redistribution is made.
       ``(C) Tribes.--For purposes of this paragraph, the term 
     `State' includes an Indian tribe, tribal organization, or 
     tribal consortium that receives an allotment under this 
     section.''.
       (c) Expanding and Clarifying the Use of Education and 
     Training Vouchers.--
       (1) In general.--Section 477(i)(3) of such Act (42 U.S.C. 
     677(i)(3)) is amended--
       (A) by striking ``on the date'' and all that follows 
     through ``23'' and inserting ``to remain eligible until they 
     attain 26''; and
       (B) by inserting ``, but in no event may a youth 
     participate in the program for more than 5 years (whether or 
     not consecutive)'' before the period.
       (2) Conforming amendment.--Section 477(i)(1) of such Act 
     (42 U.S.C. 677(i)(1)) is amended by inserting ``who have 
     attained 14 years of age'' before the period.
       (d) Other Improvements.--Section 477 of such Act (42 U.S.C. 
     677), as amended by subsections (a), (b), and (c) of this 
     section, is amended--
       (1) in the section heading, by striking ``independence 
     program'' and inserting ``program for successful transition 
     to adulthood'';
       (2) in subsection (a)--
       (A) in paragraph (1)--
       (i) by striking ``identify children who are likely to 
     remain in foster care until 18 years of age and to help these 
     children make the transition to self-sufficiency by providing 
     services'' and inserting ``support all youth who have 
     experienced foster care at age 14 or older in their 
     transition to adulthood through transitional services'';
       (ii) by inserting ``and post-secondary education'' after 
     ``high school diploma''; and
       (iii) by striking ``training in daily living skills, 
     training in budgeting and financial management skills'' and 
     inserting ``training and opportunities to practice daily 
     living skills (such as financial literacy training and 
     driving instruction)'';
       (B) in paragraph (2), by striking ``who are likely to 
     remain in foster care until 18 years of age receive the 
     education, training, and services necessary to obtain 
     employment'' and inserting ``who have experienced foster care 
     at age 14 or older achieve meaningful, permanent connections 
     with a caring adult'';
       (C) in paragraph (3), by striking ``who are likely to 
     remain in foster care until 18 years of age prepare for and 
     enter postsecondary training and education institutions'' and 
     inserting ``who have experienced foster care at age 14 or 
     older engage in age or developmentally appropriate 
     activities, positive youth development, and experiential 
     learning that reflects what their peers in intact families 
     experience''; and
       (D) by striking paragraph (4) and redesignating paragraphs 
     (5) through (8) as paragraphs (4) through (7);
       (3) in subsection (b)--
       (A) in paragraph (2)(D), by striking ``adolescents'' and 
     inserting ``youth''; and
       (B) in paragraph (3)--
       (i) in subparagraph (D)--

       (I) by inserting ``including training on youth 
     development'' after ``to provide training''; and
       (II) by striking ``adolescents preparing for independent 
     living'' and all that follows through the period and 
     inserting ``youth preparing for a successful transition to 
     adulthood and making a permanent connection with a caring 
     adult.'';

       (ii) in subparagraph (H), by striking ``adolescents'' each 
     place it appears and inserting ``youth''; and
       (iii) in subparagraph (K)--

       (I) by striking ``an adolescent'' and inserting ``a 
     youth''; and
       (II) by striking ``the adolescent'' each place it appears 
     and inserting ``the youth''; and

       (4) in subsection (f), by striking paragraph (2) and 
     inserting the following:
       ``(2) Report to congress.--Not later than October 1, 2019, 
     the Secretary shall submit to the Committee on Ways and Means 
     of the House of Representatives and the Committee on Finance 
     of the Senate a report on the National Youth in Transition 
     Database and any other databases in which States report 
     outcome measures relating to children in foster care and 
     children who have aged out of foster care or left foster care 
     for kinship guardianship or adoption. The report shall 
     include the following:
       ``(A) A description of the reasons for entry into foster 
     care and of the foster care experiences, such as length of 
     stay, number of placement settings, case goal, and discharge 
     reason of 17-year-olds who are surveyed by the National Youth 
     in Transition Database and an analysis of the comparison of 
     that description with the reasons for entry and foster care 
     experiences of children of other ages who exit from foster 
     care before attaining age 17.
       ``(B) A description of the characteristics of the 
     individuals who report poor outcomes at ages 19 and 21 to the 
     National Youth in Transition Database.
       ``(C) Benchmarks for determining what constitutes a poor 
     outcome for youth who remain in or have exited from foster 
     care and plans the executive branch will take to incorporate 
     these benchmarks in efforts to evaluate child welfare agency 
     performance in providing services to children transitioning 
     from foster care.
       ``(D) An analysis of the association between types of 
     placement, number of overall placements, time spent in foster 
     care, and other factors, and outcomes at ages 19 and 21.
       ``(E) An analysis of the differences in outcomes for 
     children in and formerly in foster care at age 19 and 21 
     among States.''.
       (e) Clarifying Documentation Provided to Foster Youth 
     Leaving Foster Care.--Section 475(5)(I) of such Act (42 
     U.S.C. 675(5)(I)) is amended by inserting after ``REAL ID Act 
     of 2005'' the following: ``, and any official documentation 
     necessary to prove that the child was previously in foster 
     care''.

  CHAPTER 4--CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND 
                           LEGAL GUARDIANSHIP

     SEC. 2665. REAUTHORIZING ADOPTION AND LEGAL GUARDIANSHIP 
                   INCENTIVE PROGRAMS.

       (a) In General.--Section 473A of the Social Security Act 
     (42 U.S.C. 673b) is amended--
       (1) in subsection (b)(4), by striking ``2013 through 2015'' 
     and inserting ``2016 through 2020'';

[[Page H882]]

       (2) in subsection (h)(1)(D), by striking ``2016'' and 
     inserting ``2021''; and
       (3) in subsection (h)(2), by striking ``2016'' and 
     inserting ``2021''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect as if enacted on October 1, 2017.

                    CHAPTER 5--TECHNICAL CORRECTIONS

     SEC. 2667. TECHNICAL CORRECTIONS TO DATA EXCHANGE STANDARDS 
                   TO IMPROVE PROGRAM COORDINATION.

       (a) In General.--Section 440 of the Social Security Act (42 
     U.S.C. 629m) is amended to read as follows:

     ``SEC. 440. DATA EXCHANGE STANDARDS FOR IMPROVED 
                   INTEROPERABILITY.

       ``(a) Designation.--The Secretary shall, in consultation 
     with an interagency work group established by the Office of 
     Management and Budget and considering State government 
     perspectives, by rule, designate data exchange standards to 
     govern, under this part and part E--
       ``(1) necessary categories of information that State 
     agencies operating programs under State plans approved under 
     this part are required under applicable Federal law to 
     electronically exchange with another State agency; and
       ``(2) Federal reporting and data exchange required under 
     applicable Federal law.
       ``(b) Requirements.--The data exchange standards required 
     by paragraph (1) shall, to the extent practicable--
       ``(1) incorporate a widely accepted, non-proprietary, 
     searchable, computer-readable format, such as the Extensible 
     Markup Language;
       ``(2) contain interoperable standards developed and 
     maintained by intergovernmental partnerships, such as the 
     National Information Exchange Model;
       ``(3) incorporate interoperable standards developed and 
     maintained by Federal entities with authority over 
     contracting and financial assistance;
       ``(4) be consistent with and implement applicable 
     accounting principles;
       ``(5) be implemented in a manner that is cost-effective and 
     improves program efficiency and effectiveness; and
       ``(6) be capable of being continually upgraded as 
     necessary.
       ``(c) Rule of Construction.--Nothing in this subsection 
     shall be construed to require a change to existing data 
     exchange standards found to be effective and efficient.''.
       (b) Effective Date.--Not later than the date that is 24 
     months after the date of the enactment of this section, the 
     Secretary of Health and Human Services shall issue a proposed 
     rule that--
       (1) identifies federally required data exchanges, include 
     specification and timing of exchanges to be standardized, and 
     address the factors used in determining whether and when to 
     standardize data exchanges; and
       (2) specifies State implementation options and describes 
     future milestones.

     SEC. 2668. TECHNICAL CORRECTIONS TO STATE REQUIREMENT TO 
                   ADDRESS THE DEVELOPMENTAL NEEDS OF YOUNG 
                   CHILDREN.

       Section 422(b)(18) of the Social Security Act (42 U.S.C. 
     622(b)(18)) is amended by striking ``such children'' and 
     inserting ``all vulnerable children under 5 years of age''.

CHAPTER 6--ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN 
                          ADOPTION ASSISTANCE

     SEC. 2669. DELAY OF ADOPTION ASSISTANCE PHASE-IN.

       (a) In General.--The table in section 473(e)(1)(B) of the 
     Social Security Act (42 U.S.C. 673(e)(1)(B)) is amended by 
     striking the last 2 rows and inserting the following:


 
 
----------------------------------------------------------------------------------------------------------------
``2017 through 2023..........................  2
2024.........................................  2 (or, in the case of a child for whom an adoption assistance
                                                agreement is entered into under this section on or after July 1,
                                                2024, any age)
2025 or thereafter...........................  any age.''.
----------------------------------------------------------------------------------------------------------------

       (b) Effective Date.--The amendment made by this section 
     shall take effect on January 1, 2018.

     SEC. 2670. GAO STUDY AND REPORT ON STATE REINVESTMENT OF 
                   SAVINGS RESULTING FROM INCREASE IN ADOPTION 
                   ASSISTANCE.

       (a) Study.--The Comptroller General of the United States 
     shall study the extent to which States are complying with the 
     requirements of section 473(a)(8) of the Social Security Act 
     relating to the effects of phasing out the AFDC income 
     eligibility requirements for adoption assistance payments 
     under section 473 of the Social Security Act, as enacted by 
     section 402 of the Fostering Connections to Success and 
     Increasing Adoptions Act of 2008 (Public Law 110-351; 122 
     Stat. 3975) and amended by section 206 of the Preventing Sex 
     Trafficking and Strengthening Families Act (Public Law 113-
     183; 128 Stat. 1919). In particular, the Comptroller General 
     shall analyze the extent to which States are complying with 
     the following requirements under section 473(a)(8)(D) of the 
     Social Security Act:
       (1) The requirement to spend an amount equal to the amount 
     of the savings (if any) in State expenditures under part E of 
     title IV of the Social Security Act resulting from phasing 
     out the AFDC income eligibility requirements for adoption 
     assistance payments under section 473 of such Act to provide 
     to children of families any service that may be provided 
     under part B or E of title IV of such Act.
       (2) The requirement that a State shall spend not less than 
     30 percent of the amount of any savings described in 
     paragraph (1) on post-adoption services, post-guardianship 
     services, and services to support and sustain positive 
     permanent outcomes for children who otherwise might enter 
     into foster care under the responsibility of the State, with 
     at least \2/3\ of the spending by the State to comply with 
     the 30 percent requirement being spent on post-adoption and 
     post-guardianship services.
       (b) Report.--The Comptroller General of the United States 
     shall submit to the Committee on Finance of the Senate, the 
     Committee on Ways and Means of the House of Representatives, 
     and the Secretary of Health and Human Services a report that 
     contains the results of the study required by subsection (a), 
     including recommendations to ensure compliance with laws 
     referred to in subsection (a).

  Subtitle B--Supporting Social Impact Partnerships to Pay for Results

     SEC. 2681. SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY FOR 
                   RESULTS.

       Title XX of the Social Security Act (42 U.S.C. 1397 et 
     seq.) is amended--
       (1) in the title heading, by striking ``TO STATES'' and 
     inserting ``AND PROGRAMS''; and
       (2) by adding at the end the following:

           ``Subtitle C--Social Impact Demonstration Projects


                               ``purposes

       ``Sec. 2051. The purposes of this subtitle are the 
     following:
       ``(1) To improve the lives of families and individuals in 
     need in the United States by funding social programs that 
     achieve real results.
       ``(2) To redirect funds away from programs that, based on 
     objective data, are ineffective, and into programs that 
     achieve demonstrable, measurable results.
       ``(3) To ensure Federal funds are used effectively on 
     social services to produce positive outcomes for both service 
     recipients and taxpayers.
       ``(4) To establish the use of social impact partnerships to 
     address some of our Nation's most pressing problems.
       ``(5) To facilitate the creation of public-private 
     partnerships that bundle philanthropic or other private 
     resources with existing public spending to scale up effective 
     social interventions already being implemented by private 
     organizations, nonprofits, charitable organizations, and 
     State and local governments across the country.
       ``(6) To bring pay-for-performance to the social sector, 
     allowing the United States to improve the impact and 
     effectiveness of vital social services programs while 
     redirecting inefficient or duplicative spending.
       ``(7) To incorporate outcomes measurement and randomized 
     controlled trials or other rigorous methodologies for 
     assessing program impact.


                ``social impact partnership application

       ``Sec. 2052.  (a) Notice.--Not later than 1 year after the 
     date of the enactment of this subtitle, the Secretary of the 
     Treasury, in consultation with the Federal Interagency 
     Council on Social Impact Partnerships, shall publish in the 
     Federal Register a request for proposals from States or local 
     governments for social impact partnership projects in 
     accordance with this section.
       ``(b) Required Outcomes for Social Impact Partnership 
     Project.--To qualify as a social impact partnership project 
     under this subtitle, a project must produce one or more 
     measurable, clearly defined outcomes that result in social 
     benefit and Federal, State, or local savings through any of 
     the following:
       ``(1) Increasing work and earnings by individuals in the 
     United States who are unemployed for more than 6 consecutive 
     months.
       ``(2) Increasing employment and earnings of individuals who 
     have attained 16 years of age but not 25 years of age.
       ``(3) Increasing employment among individuals receiving 
     Federal disability benefits.
       ``(4) Reducing the dependence of low-income families on 
     Federal means-tested benefits.
       ``(5) Improving rates of high school graduation.
       ``(6) Reducing teen and unplanned pregnancies.
       ``(7) Improving birth outcomes and early childhood health 
     and development among low-income families and individuals.
       ``(8) Reducing rates of asthma, diabetes, or other 
     preventable diseases among low-income families and 
     individuals to reduce the utilization of emergency and other 
     high-cost care.
       ``(9) Increasing the proportion of children living in two-
     parent families.
       ``(10) Reducing incidences and adverse consequences of 
     child abuse and neglect.
       ``(11) Reducing the number of youth in foster care by 
     increasing adoptions, permanent guardianship arrangements, 
     reunifications,

[[Page H883]]

     or placements with a fit and willing relative, or by avoiding 
     placing children in foster care by ensuring they can be cared 
     for safely in their own homes.
       ``(12) Reducing the number of children and youth in foster 
     care residing in group homes, child care institutions, 
     agency-operated foster homes, or other non-family foster 
     homes, unless it is determined that it is in the interest of 
     the child's long-term health, safety, or psychological well-
     being to not be placed in a family foster home.
       ``(13) Reducing the number of children returning to foster 
     care.
       ``(14) Reducing recidivism among juvenile offenders, 
     individuals released from prison, or other high-risk 
     populations.
       ``(15) Reducing the rate of homelessness among our most 
     vulnerable populations.
       ``(16) Improving the health and well-being of those with 
     mental, emotional, and behavioral health needs.
       ``(17) Improving the educational outcomes of special-needs 
     or low-income children.
       ``(18) Improving the employment and well-being of returning 
     United States military members.
       ``(19) Increasing the financial stability of low-income 
     families.
       ``(20) Increasing the independence and employability of 
     individuals who are physically or mentally disabled.
       ``(21) Other measurable outcomes defined by the State or 
     local government that result in positive social outcomes and 
     Federal savings.
       ``(c) Application Required.--The notice described in 
     subsection (a) shall require a State or local government to 
     submit an application for the social impact partnership 
     project that addresses the following:
       ``(1) The outcome goals of the project.
       ``(2) A description of each intervention in the project and 
     anticipated outcomes of the intervention.
       ``(3) Rigorous evidence demonstrating that the intervention 
     can be expected to produce the desired outcomes.
       ``(4) The target population that will be served by the 
     project.
       ``(5) The expected social benefits to participants who 
     receive the intervention and others who may be impacted.
       ``(6) Projected Federal, State, and local government costs 
     and other costs to conduct the project.
       ``(7) Projected Federal, State, and local government 
     savings and other savings, including an estimate of the 
     savings to the Federal Government, on a program-by-program 
     basis and in the aggregate, if the project is implemented and 
     the outcomes are achieved as a result of the intervention.
       ``(8) If savings resulting from the successful completion 
     of the project are estimated to accrue to the State or local 
     government, the likelihood of the State or local government 
     to realize those savings.
       ``(9) A plan for delivering the intervention through a 
     social impact partnership model.
       ``(10) A description of the expertise of each service 
     provider that will administer the intervention, including a 
     summary of the experience of the service provider in 
     delivering the proposed intervention or a similar 
     intervention, or demonstrating that the service provider has 
     the expertise necessary to deliver the proposed intervention.
       ``(11) An explanation of the experience of the State or 
     local government, the intermediary, or the service provider 
     in raising private and philanthropic capital to fund social 
     service investments.
       ``(12) The detailed roles and responsibilities of each 
     entity involved in the project, including any State or local 
     government entity, intermediary, service provider, 
     independent evaluator, investor, or other stakeholder.
       ``(13) A summary of the experience of the service provider 
     in delivering the proposed intervention or a similar 
     intervention, or a summary demonstrating the service provider 
     has the expertise necessary to deliver the proposed 
     intervention.
       ``(14) A summary of the unmet need in the area where the 
     intervention will be delivered or among the target population 
     who will receive the intervention.
       ``(15) The proposed payment terms, the methodology used to 
     calculate outcome payments, the payment schedule, and 
     performance thresholds.
       ``(16) The project budget.
       ``(17) The project timeline.
       ``(18) The criteria used to determine the eligibility of an 
     individual for the project, including how selected 
     populations will be identified, how they will be referred to 
     the project, and how they will be enrolled in the project.
       ``(19) The evaluation design.
       ``(20) The metrics that will be used in the evaluation to 
     determine whether the outcomes have been achieved as a result 
     of the intervention and how the metrics will be measured.
       ``(21) An explanation of how the metrics used in the 
     evaluation to determine whether the outcomes achieved as a 
     result of the intervention are independent, objective 
     indicators of impact and are not subject to manipulation by 
     the service provider, intermediary, or investor.
       ``(22) A summary explaining the independence of the 
     evaluator from the other entities involved in the project and 
     the evaluator's experience in conducting rigorous evaluations 
     of program effectiveness including, where available, well-
     implemented randomized controlled trials on the intervention 
     or similar interventions.
       ``(23) The capacity of the service provider to deliver the 
     intervention to the number of participants the State or local 
     government proposes to serve in the project.
       ``(24) A description of whether and how the State or local 
     government and service providers plan to sustain the 
     intervention, if it is timely and appropriate to do so, to 
     ensure that successful interventions continue to operate 
     after the period of the social impact partnership.
       ``(d) Project Intermediary Information Required.--The 
     application described in subsection (c) shall also contain 
     the following information about any intermediary for the 
     social impact partnership project (whether an intermediary is 
     a service provider or other entity):
       ``(1) Experience and capacity for providing or facilitating 
     the provision of the type of intervention proposed.
       ``(2) The mission and goals.
       ``(3) Information on whether the intermediary is already 
     working with service providers that provide this intervention 
     or an explanation of the capacity of the intermediary to 
     begin working with service providers to provide the 
     intervention.
       ``(4) Experience working in a collaborative environment 
     across government and nongovernmental entities.
       ``(5) Previous experience collaborating with public or 
     private entities to implement evidence-based programs.
       ``(6) Ability to raise or provide funding to cover 
     operating costs (if applicable to the project).
       ``(7) Capacity and infrastructure to track outcomes and 
     measure results, including--
       ``(A) capacity to track and analyze program performance and 
     assess program impact; and
       ``(B) experience with performance-based awards or 
     performance-based contracting and achieving project 
     milestones and targets.
       ``(8) Role in delivering the intervention.
       ``(9) How the intermediary would monitor program success, 
     including a description of the interim benchmarks and outcome 
     measures.
       ``(e) Feasibility Studies Funded Through Other Sources.--
     The notice described in subsection (a) shall permit a State 
     or local government to submit an application for social 
     impact partnership funding that contains information from a 
     feasibility study developed for purposes other than applying 
     for funding under this subtitle.


            ``awarding social impact partnership agreements

       ``Sec. 2053.  (a) Timeline in Awarding Agreement.--Not 
     later than 6 months after receiving an application in 
     accordance with section 2052, the Secretary, in consultation 
     with the Federal Interagency Council on Social Impact 
     Partnerships, shall determine whether to enter into an 
     agreement for a social impact partnership project with a 
     State or local government.
       ``(b) Considerations in Awarding Agreement.--In determining 
     whether to enter into an agreement for a social impact 
     partnership project (the application for which was submitted 
     under section 2052) the Secretary, in consultation with the 
     Federal Interagency Council on Social Impact Partnerships and 
     the head of any Federal agency administering a similar 
     intervention or serving a population similar to that served 
     by the project, shall consider each of the following:
       ``(1) The recommendations made by the Commission on Social 
     Impact Partnerships.
       ``(2) The value to the Federal Government of the outcomes 
     expected to be achieved if the outcomes specified in the 
     agreement are achieved as a result of the intervention.
       ``(3) The likelihood, based on evidence provided in the 
     application and other evidence, that the State or local 
     government in collaboration with the intermediary and the 
     service providers will achieve the outcomes.
       ``(4) The savings to the Federal Government if the outcomes 
     specified in the agreement are achieved as a result of the 
     intervention.
       ``(5) The savings to the State and local governments if the 
     outcomes specified in the agreement are achieved as a result 
     of the intervention.
       ``(6) The expected quality of the evaluation that would be 
     conducted with respect to the agreement.
       ``(7) The capacity and commitment of the State or local 
     government to sustain the intervention, if appropriate and 
     timely and if the intervention is successful, beyond the 
     period of the social impact partnership.
       ``(c) Agreement Authority.--
       ``(1) Agreement requirements.--In accordance with this 
     section, the Secretary, in consultation with the Federal 
     Interagency Council on Social Impact Partnerships and the 
     head of any Federal agency administering a similar 
     intervention or serving a population similar to that served 
     by the project, may enter into an agreement for a social 
     impact partnership project with a State or local government 
     if the Secretary, in consultation with the Federal 
     Interagency Council on Social Impact Partnerships, determines 
     that each of the following requirements are met:
       ``(A) The State or local government agrees to achieve one 
     or more outcomes as a result of the intervention, as 
     specified in the agreement and validated by independent 
     evaluation, in order to receive payment.
       ``(B) The Federal payment to the State or local government 
     for each specified outcome

[[Page H884]]

     achieved as a result of the intervention is less than or 
     equal to the value of the outcome to the Federal Government 
     over a period not to exceed 10 years, as determined by the 
     Secretary, in consultation with the State or local 
     government.
       ``(C) The duration of the project does not exceed 10 years.
       ``(D) The State or local government has demonstrated, 
     through the application submitted under section 2052, that, 
     based on prior rigorous experimental evaluations or rigorous 
     quasi-experimental studies, the intervention can be expected 
     to achieve each outcome specified in the agreement.
       ``(E) The State, local government, intermediary, or service 
     provider has experience raising private or philanthropic 
     capital to fund social service investments (if applicable to 
     the project).
       ``(F) The State or local government has shown that each 
     service provider has experience delivering the intervention, 
     a similar intervention, or has otherwise demonstrated the 
     expertise necessary to deliver the intervention.
       ``(2) Payment.--The Secretary shall pay the State or local 
     government only if the independent evaluator described in 
     section 2055 determines that the social impact partnership 
     project has met the requirements specified in the agreement 
     and achieved an outcome as a result of the intervention, as 
     specified in the agreement and validated by independent 
     evaluation.
       ``(d) Notice of Agreement Award.--Not later than 30 days 
     after entering into an agreement under this section the 
     Secretary shall publish a notice in the Federal Register that 
     includes, with regard to the agreement, the following:
       ``(1) The outcome goals of the social impact partnership 
     project.
       ``(2) A description of each intervention in the project.
       ``(3) The target population that will be served by the 
     project.
       ``(4) The expected social benefits to participants who 
     receive the intervention and others who may be impacted.
       ``(5) The detailed roles, responsibilities, and purposes of 
     each Federal, State, or local government entity, 
     intermediary, service provider, independent evaluator, 
     investor, or other stakeholder.
       ``(6) The payment terms, the methodology used to calculate 
     outcome payments, the payment schedule, and performance 
     thresholds.
       ``(7) The project budget.
       ``(8) The project timeline.
       ``(9) The project eligibility criteria.
       ``(10) The evaluation design.
       ``(11) The metrics that will be used in the evaluation to 
     determine whether the outcomes have been achieved as a result 
     of each intervention and how these metrics will be measured.
       ``(12) The estimate of the savings to the Federal, State, 
     and local government, on a program-by-program basis and in 
     the aggregate, if the agreement is entered into and 
     implemented and the outcomes are achieved as a result of each 
     intervention.
       ``(e) Authority to Transfer Administration of Agreement.--
     The Secretary may transfer to the head of another Federal 
     agency the authority to administer (including making payments 
     under) an agreement entered into under subsection (c), and 
     any funds necessary to do so.
       ``(f) Requirement on Funding Used to Benefit Children.--Not 
     less than 50 percent of all Federal payments made to carry 
     out agreements under this section shall be used for 
     initiatives that directly benefit children.


                      ``feasibility study funding

       ``Sec. 2054.  (a) Requests for Funding for Feasibility 
     Studies.--The Secretary shall reserve a portion of the amount 
     made available to carry out this subtitle to assist States or 
     local governments in developing feasibility studies to apply 
     for social impact partnership funding under section 2052. To 
     be eligible to receive funding to assist with completing a 
     feasibility study, a State or local government shall submit 
     an application for feasibility study funding addressing the 
     following:
       ``(1) A description of the outcome goals of the social 
     impact partnership project.
       ``(2) A description of the intervention, including 
     anticipated program design, target population, an estimate 
     regarding the number of individuals to be served, and setting 
     for the intervention.
       ``(3) Evidence to support the likelihood that the 
     intervention will produce the desired outcomes.
       ``(4) A description of the potential metrics to be used.
       ``(5) The expected social benefits to participants who 
     receive the intervention and others who may be impacted.
       ``(6) Estimated costs to conduct the project.
       ``(7) Estimates of Federal, State, and local government 
     savings and other savings if the project is implemented and 
     the outcomes are achieved as a result of each intervention.
       ``(8) An estimated timeline for implementation and 
     completion of the project, which shall not exceed 10 years.
       ``(9) With respect to a project for which the State or 
     local government selects an intermediary to operate the 
     project, any partnerships needed to successfully execute the 
     project and the ability of the intermediary to foster the 
     partnerships.
       ``(10) The expected resources needed to complete the 
     feasibility study for the State or local government to apply 
     for social impact partnership funding under section 2052.
       ``(b) Federal Selection of Applications for Feasibility 
     Study.--Not later than 6 months after receiving an 
     application for feasibility study funding under subsection 
     (a), the Secretary, in consultation with the Federal 
     Interagency Council on Social Impact Partnerships and the 
     head of any Federal agency administering a similar 
     intervention or serving a population similar to that served 
     by the project, shall select State or local government 
     feasibility study proposals for funding based on the 
     following:
       ``(1) The recommendations made by the Commission on Social 
     Impact Partnerships.
       ``(2) The likelihood that the proposal will achieve the 
     desired outcomes.
       ``(3) The value of the outcomes expected to be achieved as 
     a result of each intervention.
       ``(4) The potential savings to the Federal Government if 
     the social impact partnership project is successful.
       ``(5) The potential savings to the State and local 
     governments if the project is successful.
       ``(c) Public Disclosure.--Not later than 30 days after 
     selecting a State or local government for feasibility study 
     funding under this section, the Secretary shall cause to be 
     published on the website of the Federal Interagency Council 
     on Social Impact Partnerships information explaining why a 
     State or local government was granted feasibility study 
     funding.
       ``(d) Funding Restriction.--
       ``(1) Feasibility study restriction.--The Secretary may not 
     provide feasibility study funding under this section for more 
     than 50 percent of the estimated total cost of the 
     feasibility study reported in the State or local government 
     application submitted under subsection (a).
       ``(2) Aggregate restriction.--Of the total amount made 
     available to carry out this subtitle, the Secretary may not 
     use more than $10,000,000 to provide feasibility study 
     funding to States or local governments under this section.
       ``(3) No guarantee of funding.--The Secretary shall have 
     the option to award no funding under this section.
       ``(e) Submission of Feasibility Study Required.--Not later 
     than 9 months after the receipt of feasibility study funding 
     under this section, a State or local government receiving the 
     funding shall complete the feasibility study and submit the 
     study to the Federal Interagency Council on Social Impact 
     Partnerships.
       ``(f) Delegation of Authority.--The Secretary may transfer 
     to the head of another Federal agency the authorities 
     provided in this section and any funds necessary to exercise 
     the authorities.


                             ``evaluations

       ``Sec. 2055.  (a) Authority to Enter Into Agreements.--For 
     each State or local government awarded a social impact 
     partnership project approved by the Secretary under this 
     subtitle, the head of the relevant agency, as recommended by 
     the Federal Interagency Council on Social Impact Partnerships 
     and determined by the Secretary, shall enter into an 
     agreement with the State or local government to pay for all 
     or part of the independent evaluation to determine whether 
     the State or local government project has achieved a specific 
     outcome as a result of the intervention in order for the 
     State or local government to receive outcome payments under 
     this subtitle.
       ``(b) Evaluator Qualifications.--The head of the relevant 
     agency may not enter into an agreement with a State or local 
     government unless the head determines that the evaluator is 
     independent of the other parties to the agreement and has 
     demonstrated substantial experience in conducting rigorous 
     evaluations of program effectiveness including, where 
     available and appropriate, well-implemented randomized 
     controlled trials on the intervention or similar 
     interventions.
       ``(c) Methodologies to Be Used.--The evaluation used to 
     determine whether a State or local government will receive 
     outcome payments under this subtitle shall use experimental 
     designs using random assignment or other reliable, evidence-
     based research methodologies, as certified by the Federal 
     Interagency Council on Social Impact Partnerships, that allow 
     for the strongest possible causal inferences when random 
     assignment is not feasible.
       ``(d) Progress Report.--
       ``(1) Submission of report.--The independent evaluator 
     shall--
       ``(A) not later than 2 years after a project has been 
     approved by the Secretary and biannually thereafter until the 
     project is concluded, submit to the head of the relevant 
     agency and the Federal Interagency Council on Social Impact 
     Partnerships a written report summarizing the progress that 
     has been made in achieving each outcome specified in the 
     agreement; and
       ``(B) before the scheduled time of the first outcome 
     payment and before the scheduled time of each subsequent 
     payment, submit to the head of the relevant agency and the 
     Federal Interagency Council on Social Impact Partnerships a 
     written report that includes the results of the evaluation 
     conducted to determine whether an outcome payment should be 
     made along with information on the unique factors that 
     contributed to achieving or failing to achieve the outcome, 
     the challenges faced in attempting to achieve the outcome, 
     and information on the improved future delivery of this or 
     similar interventions.

[[Page H885]]

       ``(2) Submission to the secretary and congress.--Not later 
     than 30 days after receipt of the written report pursuant to 
     paragraph (1)(B), the Federal Interagency Council on Social 
     Impact Partnerships shall submit the report to the Secretary 
     and each committee of jurisdiction in the House of 
     Representatives and the Senate.
       ``(e) Final Report.--
       ``(1) Submission of report.--Within 6 months after the 
     social impact partnership project is completed, the 
     independent evaluator shall--
       ``(A) evaluate the effects of the activities undertaken 
     pursuant to the agreement with regard to each outcome 
     specified in the agreement; and
       ``(B) submit to the head of the relevant agency and the 
     Federal Interagency Council on Social Impact Partnerships a 
     written report that includes the results of the evaluation 
     and the conclusion of the evaluator as to whether the State 
     or local government has fulfilled each obligation of the 
     agreement, along with information on the unique factors that 
     contributed to the success or failure of the project, the 
     challenges faced in attempting to achieve the outcome, and 
     information on the improved future delivery of this or 
     similar interventions.
       ``(2) Submission to the secretary and congress.--Not later 
     than 30 days after receipt of the written report pursuant to 
     paragraph (1)(B), the Federal Interagency Council on Social 
     Impact Partnerships shall submit the report to the Secretary 
     and each committee of jurisdiction in the House of 
     Representatives and the Senate.
       ``(f) Limitation on Cost of Evaluations.--Of the amount 
     made available under this subtitle for social impact 
     partnership projects, the Secretary may not obligate more 
     than 15 percent to evaluate the implementation and outcomes 
     of the projects.
       ``(g) Delegation of Authority.--The Secretary may transfer 
     to the head of another Federal agency the authorities 
     provided in this section and any funds necessary to exercise 
     the authorities.


      ``federal interagency council on social impact partnerships

       ``Sec. 2056.  (a) Establishment.--There is established the 
     Federal Interagency Council on Social Impact Partnerships (in 
     this section referred to as the `Council') to--
       ``(1) coordinate with the Secretary on the efforts of 
     social impact partnership projects funded under this 
     subtitle;
       ``(2) advise and assist the Secretary in the development 
     and implementation of the projects;
       ``(3) advise the Secretary on specific programmatic and 
     policy matter related to the projects;
       ``(4) provide subject-matter expertise to the Secretary 
     with regard to the projects;
       ``(5) certify to the Secretary that each State or local 
     government that has entered into an agreement with the 
     Secretary for a social impact partnership project under this 
     subtitle and each evaluator selected by the head of the 
     relevant agency under section 2055 has access to Federal 
     administrative data to assist the State or local government 
     and the evaluator in evaluating the performance and outcomes 
     of the project;
       ``(6) address issues that will influence the future of 
     social impact partnership projects in the United States;
       ``(7) provide guidance to the executive branch on the 
     future of social impact partnership projects in the United 
     States;
       ``(8) prior to approval by the Secretary, certify that each 
     State and local government application for a social impact 
     partnership contains rigorous, independent data and reliable, 
     evidence-based research methodologies to support the 
     conclusion that the project will yield savings to the State 
     or local government or the Federal Government if the project 
     outcomes are achieved;
       ``(9) certify to the Secretary, in the case of each 
     approved social impact partnership that is expected to yield 
     savings to the Federal Government, that the project will 
     yield a projected savings to the Federal Government if the 
     project outcomes are achieved, and coordinate with the 
     relevant Federal agency to produce an after-action accounting 
     once the project is complete to determine the actual Federal 
     savings realized, and the extent to which actual savings 
     aligned with projected savings; and
       ``(10) provide periodic reports to the Secretary and make 
     available reports periodically to Congress and the public on 
     the implementation of this subtitle.
       ``(b) Composition of Council.--The Council shall have 11 
     members, as follows:
       ``(1) Chair.--The Chair of the Council shall be the 
     Director of the Office of Management and Budget.
       ``(2) Other members.--The head of each of the following 
     entities shall designate one officer or employee of the 
     entity to be a Council member:
       ``(A) The Department of Labor.
       ``(B) The Department of Health and Human Services.
       ``(C) The Social Security Administration.
       ``(D) The Department of Agriculture.
       ``(E) The Department of Justice.
       ``(F) The Department of Housing and Urban Development.
       ``(G) The Department of Education.
       ``(H) The Department of Veterans Affairs.
       ``(I) The Department of the Treasury.
       ``(J) The Corporation for National and Community Service.


               ``commission on social impact partnerships

       ``Sec. 2057.  (a) Establishment.--There is established the 
     Commission on Social Impact Partnerships (in this section 
     referred to as the `Commission').
       ``(b) Duties.--The duties of the Commission shall be to--
       ``(1) assist the Secretary and the Federal Interagency 
     Council on Social Impact Partnerships in reviewing 
     applications for funding under this subtitle;
       ``(2) make recommendations to the Secretary and the Federal 
     Interagency Council on Social Impact Partnerships regarding 
     the funding of social impact partnership agreements and 
     feasibility studies; and
       ``(3) provide other assistance and information as requested 
     by the Secretary or the Federal Interagency Council on Social 
     Impact Partnerships.
       ``(c) Composition.--The Commission shall be composed of 
     nine members, of whom--
       ``(1) one shall be appointed by the President, who will 
     serve as the Chair of the Commission;
       ``(2) one shall be appointed by the Majority Leader of the 
     Senate;
       ``(3) one shall be appointed by the Minority Leader of the 
     Senate;
       ``(4) one shall be appointed by the Speaker of the House of 
     Representatives;
       ``(5) one shall be appointed by the Minority Leader of the 
     House of Representatives;
       ``(6) one shall be appointed by the Chairman of the 
     Committee on Finance of the Senate;
       ``(7) one shall be appointed by the ranking member of the 
     Committee on Finance of the Senate;
       ``(8) one member shall be appointed by the Chairman of the 
     Committee on Ways and Means of the House of Representatives; 
     and
       ``(9) one shall be appointed by the ranking member of the 
     Committee on Ways and Means of the House of Representatives.
       ``(d) Qualifications of Commission Members.--The members of 
     the Commission shall--
       ``(1) be experienced in finance, economics, pay for 
     performance, or program evaluation;
       ``(2) have relevant professional or personal experience in 
     a field related to one or more of the outcomes listed in this 
     subtitle; or
       ``(3) be qualified to review applications for social impact 
     partnership projects to determine whether the proposed 
     metrics and evaluation methodologies are appropriately 
     rigorous and reliant upon independent data and evidence-based 
     research.
       ``(e) Timing of Appointments.--The appointments of the 
     members of the Commission shall be made not later than 120 
     days after the date of the enactment of this subtitle, or, in 
     the event of a vacancy, not later than 90 days after the date 
     the vacancy arises. If a member of Congress fails to appoint 
     a member by that date, the President may select a member of 
     the President's choice on behalf of the member of Congress. 
     Notwithstanding the preceding sentence, if not all 
     appointments have been made to the Commission as of that 
     date, the Commission may operate with no fewer than five 
     members until all appointments have been made.
       ``(f) Term of Appointments.--
       ``(1) In general.--The members appointed under subsection 
     (c) shall serve as follows:
       ``(A) Three members shall serve for 2 years.
       ``(B) Three members shall serve for 3 years.
       ``(C) Three members (one of which shall be Chair of the 
     Commission appointed by the President) shall serve for 4 
     years.
       ``(2) Assignment of terms.--The Commission shall designate 
     the term length that each member appointed under subsection 
     (c) shall serve by unanimous agreement. In the event that 
     unanimous agreement cannot be reached, term lengths shall be 
     assigned to the members by a random process.
       ``(g) Vacancies.--Subject to subsection (e), in the event 
     of a vacancy in the Commission, whether due to the 
     resignation of a member, the expiration of a member's term, 
     or any other reason, the vacancy shall be filled in the 
     manner in which the original appointment was made and shall 
     not affect the powers of the Commission.
       ``(h) Appointment Power.--Members of the Commission 
     appointed under subsection (c) shall not be subject to 
     confirmation by the Senate.


                      ``limitation on use of funds

       ``Sec. 2058. Of the amounts made available to carry out 
     this subtitle, the Secretary may not use more than $2,000,000 
     in any fiscal year to support the review, approval, and 
     oversight of social impact partnership projects, including 
     activities conducted by--
       ``(1) the Federal Interagency Council on Social Impact 
     Partnerships; and
       ``(2) any other agency consulted by the Secretary before 
     approving a social impact partnership project or a 
     feasibility study under section 2054.


              ``no federal funding for credit enhancements

       ``Sec. 2059. No amount made available to carry out this 
     subtitle may be used to provide any insurance, guarantee, or 
     other credit enhancement to a State or local government under 
     which a Federal payment would be made to a State or local 
     government as the result of a State or local government 
     failing to achieve an outcome specified in an agreement.


                        ``availability of funds

       ``Sec. 2060. Amounts made available to carry out this 
     subtitle shall remain available until 10 years after the date 
     of the enactment of this subtitle.

[[Page H886]]

  



                               ``website

       ``Sec. 2061. The Federal Interagency Council on Social 
     Impact Partnerships shall establish and maintain a public 
     website that shall display the following:
       ``(1) A copy of, or method of accessing, each notice 
     published regarding a social impact partnership project 
     pursuant to this subtitle.
       ``(2) A copy of each feasibility study funded under this 
     subtitle.
       ``(3) For each State or local government that has entered 
     into an agreement with the Secretary for a social impact 
     partnership project, the website shall contain the following 
     information:
       ``(A) The outcome goals of the project.
       ``(B) A description of each intervention in the project.
       ``(C) The target population that will be served by the 
     project.
       ``(D) The expected social benefits to participants who 
     receive the intervention and others who may be impacted.
       ``(E) The detailed roles, responsibilities, and purposes of 
     each Federal, State, or local government entity, 
     intermediary, service provider, independent evaluator, 
     investor, or other stakeholder.
       ``(F) The payment terms, methodology used to calculate 
     outcome payments, the payment schedule, and performance 
     thresholds.
       ``(G) The project budget.
       ``(H) The project timeline.
       ``(I) The project eligibility criteria.
       ``(J) The evaluation design.
       ``(K) The metrics used to determine whether the proposed 
     outcomes have been achieved and how these metrics are 
     measured.
       ``(4) A copy of the progress reports and the final reports 
     relating to each social impact partnership project.
       ``(5) An estimate of the savings to the Federal, State, and 
     local government, on a program-by-program basis and in the 
     aggregate, resulting from the successful completion of the 
     social impact partnership project.


                             ``regulations

       ``Sec. 2062. The Secretary, in consultation with the 
     Federal Interagency Council on Social Impact Partnerships, 
     may issue regulations as necessary to carry out this 
     subtitle.


                             ``definitions

       ``Sec. 2063. In this subtitle:
       ``(1) Agency.--The term `agency' has the meaning given that 
     term in section 551 of title 5, United States Code.
       ``(2) Intervention.--The term `intervention' means a 
     specific service delivered to achieve an impact through a 
     social impact partnership project.
       ``(3) Secretary.--The term `Secretary' means the Secretary 
     of the Treasury.
       ``(4) Social impact partnership project.--The term `social 
     impact partnership project' means a project that finances 
     social services using a social impact partnership model.
       ``(5) Social impact partnership model.--The term `social 
     impact partnership model' means a method of financing social 
     services in which--
       ``(A) Federal funds are awarded to a State or local 
     government only if a State or local government achieves 
     certain outcomes agreed on by the State or local government 
     and the Secretary; and
       ``(B) the State or local government coordinates with 
     service providers, investors (if applicable to the project), 
     and (if necessary) an intermediary to identify--
       ``(i) an intervention expected to produce the outcome;
       ``(ii) a service provider to deliver the intervention to 
     the target population; and
       ``(iii) investors to fund the delivery of the intervention.
       ``(6) State.--The term `State' means each State of the 
     United States, the District of Columbia, each commonwealth, 
     territory or possession of the United States, and each 
     federally recognized Indian tribe.


                               ``funding

       ``Sec. 2064. Out of any money in the Treasury of the United 
     States not otherwise appropriated, there is hereby 
     appropriated $92,000,000 for fiscal year 2018 to carry out 
     this subtitle.''.

         Subtitle C--Modernizing Child Support Enforcement Fees

     SEC. 2691. MODERNIZING CHILD SUPPORT ENFORCEMENT FEES.

       (a) In General.-- Section 454(6)(B)(ii) of the Social 
     Security Act (42 U.S.C. 654(6)(B)(ii)) is amended--
       (1) by striking ``$25'' and inserting ``$35''; and
       (2) by striking ``$500'' each place it appears and 
     inserting ``$550''.
       (b) Effective Date.--
       (1) In general.--The amendment made by subsection (a) shall 
     take effect on the 1st day of the 1st fiscal year that begins 
     on or after the date of the enactment of this Act, and shall 
     apply to payments under part D of title IV of the Social 
     Security Act for calendar quarters beginning on or after such 
     1st day.
       (2) Delay permitted if state legislation required.--If the 
     Secretary of Health and Human Services determines that State 
     legislation (other than legislation appropriating funds) is 
     required in order for a State plan developed pursuant to part 
     D of title IV of the Social Security Act to meet the 
     requirement imposed by the amendment made by subsection (a), 
     the plan shall not be regarded as failing to meet the 
     requirement before the 1st day of the 1st calendar quarter 
     beginning after the first regular session of the State 
     legislature that begins after the date of the enactment of 
     this Act. For purposes of the preceding sentence, if the 
     State has a 2-year legislative session, each year of the 
     session is deemed to be a separate regular session of the 
     State legislature.

       Subtitle D--Increasing Efficiency of Prison Data Reporting

     SEC. 2699. INCREASING EFFICIENCY OF PRISON DATA REPORTING.

       (a) In General.--Section 1611(e)(1)(I)(i)(II) of the Social 
     Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is amended by 
     striking ``30 days'' each place it appears and inserting ``15 
     days''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply with respect to any payment made by the 
     Commissioner of Social Security pursuant to section 
     1611(e)(1)(I)(i)(II) of the Social Security Act (as amended 
     by such subsection) on or after the date that is 6 months 
     after the date of enactment of this Act.

                           TITLE VII--OFFSETS

     SEC. 2701. PAYMENT FOR EARLY DISCHARGES TO HOSPICE CARE.

       (a) In General.--Section 1886(d)(5)(J) of the Social 
     Security Act (42 U.S.C. 1395ww(d)(5)(J)) is amended--
       (1) in clause (ii)--
       (A) in subclause (III), by striking ``or'' at the end;
       (B) by redesignating subclause (IV) as subclause (V); and
       (C) by inserting after subclause (III) the following new 
     subclause:

       ``(IV) for discharges occurring on or after October 1, 
     2022, is provided hospice care by a hospice program; or''; 
     and

       (2) in clause (iv)--
       (A) by inserting after the first sentence the following new 
     sentence: ``The Secretary shall include in the proposed rule 
     published for fiscal year 2023, a description of the effect 
     of clause (ii)(IV).''; and
       (B) in subclause (I), by striking ``and (III)'' and 
     inserting ``(III), and, in the case of proposed and final 
     rules for fiscal year 2023 and subsequent fiscal years, 
     (IV)''.
       (b) MedPAC Evaluation and Report on Hospital to Hospice 
     Transfers.--
       (1) Evaluation.--The Medicare Payment Advisory Commission 
     (in this subsection referred to as the ``Commission'') shall 
     conduct an evaluation of the effects of the amendments made 
     by subsection (a), including the effects on--
       (A) the numbers of discharges of patients from an inpatient 
     hospital setting to a hospice program;
       (B) the lengths of stays of patients in an inpatient 
     hospital setting who are discharged to a hospice program;
       (C) spending under the Medicare program under title XVIII 
     of the Social Security Act; and
       (D) other areas determined appropriate by the Commission.
       (2) Consideration.--In conducting the evaluation under 
     paragraph (1), the Commission shall consider factors such as 
     whether the timely access to hospice care by patients 
     admitted to a hospital has been affected through changes to 
     hospital policies or behaviors made as a result of such 
     amendments.
       (3) Preliminary results.--Not later than March 15, 2024, 
     the Commission shall provide Congress with preliminary 
     results on the evaluation being conducted under paragraph 
     (1).
       (4) Report.--Not later than March 15, 2025, the Commission 
     shall submit to Congress a report on the evaluation conducted 
     under paragraph (1).

     SEC. 2702. HOME HEALTH MARKET BASKET REDUCTION.

       Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 
     1395fff(b)(3)(B)) is amended--
       (1) in clause (iii), in the last sentence, by inserting 
     before the period at the end the following: ``and for 2020 
     shall be 1.5 percent''; and
       (2) in clause (vi), by inserting ``and 2020'' after 
     ``except 2018''.

     SEC. 2703. REDUCTION FOR NON-EMERGENCY ESRD AMBULANCE 
                   TRANSPORTS.

       Section 1834(l)(15) of the Social Security Act (42. U.S.C. 
     1395m(l)(15)) is amended by striking ``on or after October 1, 
     2013'' and inserting ``during the period beginning on October 
     1, 2013, and ending on September 30, 2018, and by 23 percent 
     for such services furnished on or after October 1, 2018''.

     SEC. 2704. EXTENSION OF TARGET FOR RELATIVE VALUE ADJUSTMENTS 
                   FOR MISVALUED SERVICES AND TRANSITIONAL PAYMENT 
                   RULES FOR CERTAIN RADIATION THERAPY SERVICES 
                   UNDER THE PHYSICIAN FEE SCHEDULE.

       Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) 
     is amended--
       (1) in subsection (b)(11), by striking ``2017 and 2018'' 
     and inserting ``2017, 2018, and 2019''; and
       (2) in subsection (c)(2)--
       (A) in subparagraph (K)(iv), by striking ``2017 and 2018'' 
     and inserting ``2017, 2018, and 2019''; and
       (B) in subparagraph (O), by striking ``2018'' and inserting 
     ``2019''.

     SEC. 2705. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR 
                   MEDICARE ADVANTAGE PLANS FAILING TO ACHIEVE 
                   MINIMUM QUALITY RATINGS.

       Section 1857(h)(3) of the Social Security Act (42 U.S.C. 
     1395w-27(h)(3)) is amended by striking ``2018'' and inserting 
     ``2027''.

     SEC. 2706. MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)) is amended by striking ``during and after 
     fiscal year 2021''

[[Page H887]]

     and all that follows through the period at the end and 
     inserting ``during and after fiscal year 2021, $0.''.

     SEC. 2707. PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES 
                   AND OUTPATIENT OCCUPATIONAL THERAPY SERVICES 
                   FURNISHED BY A THERAPY ASSISTANT.

       Section 1834 of the Social Security Act (42 U.S.C. 1395m), 
     as amended by sections 2204 and 2414, is further amended by 
     adding at the end the following new subsection:
       ``(x) Payment for Outpatient Physical Therapy Services and 
     Outpatient Occupational Therapy Services Furnished by a 
     Therapy Assistant.--
       ``(1) In general.--In the case of an outpatient physical 
     therapy service or outpatient occupational therapy service 
     furnished on or after January 1, 2022, for which payment is 
     made under section 1848 or subsection (k), that is furnished 
     in whole or in part by a therapy assistant (as defined by the 
     Secretary), the amount of payment for such service shall be 
     an amount equal to 85 percent of the amount of payment 
     otherwise applicable for the service under this part. Nothing 
     in the preceding sentence shall be construed to change 
     applicable requirements with respect to such services.
       ``(2) Use of modifier.--
       ``(A) Establishment.--Not later than January 1, 2019, the 
     Secretary shall establish a modifier to indicate (in a form 
     and manner specified by the Secretary), in the case of an 
     outpatient physical therapy service or outpatient 
     occupational therapy service furnished in whole or in part by 
     a therapy assistant (as so defined), that the service was 
     furnished by a therapy assistant.
       ``(B) Required use.--Each request for payment, or bill 
     submitted, for an outpatient physical therapy service or 
     outpatient occupational therapy service furnished in whole or 
     in part by a therapy assistant (as so defined) on or after 
     January 1, 2020, shall include the modifier established under 
     subparagraph (A) for each such service.
       ``(3) Implementation.--The Secretary shall implement this 
     subsection through notice and comment rulemaking.''.

     SEC. 2708. CHANGES TO LONG-TERM CARE HOSPITAL PAYMENTS.

       (a) Extension.--Section 1886(m)(6)(B)(i) of the Social 
     Security Act (42 U.S.C. 1395ww(m)(6)(B)(i)) is amended--
       (1) in subclause (I), by striking ``fiscal year 2016 or 
     fiscal year 2017'' and inserting ``fiscal years 2016 through 
     2019''; and
       (2) in subclause (II), by striking ``2018'' and inserting 
     ``2020''.
       (b) Temporary Adjustment to Site Neutral Payment Rates.--
     Section 1886(m)(6)(B) of the Social Security Act (42 U.S.C. 
     1395ww(m)(6)(B)) is amended--
       (1) in clause (ii), in the matter preceding subclause (I), 
     by striking ``In this paragraph'' and inserting ``Subject to 
     clause (iv), in this paragraph''; and
       (2) by adding at the end the following new clause:
       ``(iv) Adjustment.--For each of fiscal years 2018 through 
     2026, the amount that would otherwise apply under clause 
     (ii)(I) for the year (determined without regard to this 
     clause) shall be reduced by 4.6 percent.''.

     SEC. 2709. NON-BUDGET NEUTRAL TRANSITIONAL PASS-THROUGH 
                   PAYMENT CHANGE FOR CERTAIN PRODUCTS.

       (a) In General.--Subsection 1833(t)(6)(A)(iv) of the Social 
     Security Act (42 U.S.C. 1395l(t)(6)(A)(iv)) is amended by 
     inserting ``(except, beginning as of April 1, 2018, a 
     biosimilar biological product (as defined under section 
     1847A(c)(6)(H)))'' after ``biological''.
       (b) Application.--The amendment made by subsection (a) 
     shall apply with respect to biosimilar biological products 
     beginning on April 1, 2018, regardless of whether such 
     products were receiving pass-through status for an additional 
     payment under section 1833(t)(6) of the Social Security Act 
     (42 U.S.C. 1395l(t)(6)) before such date. In the case of a 
     product that was receiving such an additional payment 
     pursuant to clause (iv) of subparagraph (A) of such section 
     as of the day before such date and after application of the 
     amendment under subsection (a) is not eligible for such an 
     additional payment as of such date, such product may not be 
     eligible for such an additional payment pursuant to any other 
     clause of such subparagraph (A).

     SEC. 2710. THIRD PARTY LIABILITY IN MEDICAID AND CHIP.

       (a) Modification of Third Party Liability Rules Related to 
     Special Treatment of Certain Types of Care and Payments.--
       (1) In general.--Section 1902(a)(25)(E) of the Social 
     Security Act (42 U.S.C. 1396a(a)(25)(E)) is amended, in the 
     matter preceding clause (i), by striking ``prenatal or''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect on the date of enactment of this Act.
       (b) Delay in Effective Date and Repeal of Certain 
     Bipartisan Budget Act of 2013 Amendments.--
       (1) Repeal.--Effective as of September 30, 2017, subsection 
     (b) of section 202 of the Bipartisan Budget Act of 2013 
     (Public Law 113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) 
     (including any amendments made by such subsection) is 
     repealed and the provisions amended by such subsection shall 
     be applied and administered as if such amendments had never 
     been enacted.
       (2) Delay in effective date.--Subsection (c) of section 202 
     of the Bipartisan Budget Act of 2013 (Public Law 113-67; 127 
     Stat. 1177; 42 U.S.C. 1396a note) is amended to read as 
     follows:
       ``(c) Effective Date.--The amendments made by subsection 
     (a) shall take effect on October 1, 2019.''.
       (3) Effective date; treatment.--The repeal and amendment 
     made by this subsection shall take effect as if enacted on 
     September 30, 2017, and shall apply with respect to any open 
     claims, including claims pending, generated, or filed, after 
     such date. The amendments made by subsections (a) and (b) of 
     section 202 of the Bipartisan Budget Act of 2013 (Public Law 
     113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) that took 
     effect on October 1, 2017, are null and void and section 
     1902(a)(25) of the Social Security Act (42 U.S.C. 
     1396a(a)(25)) shall be applied and administered as if such 
     amendments had not taken effect on such date.
       (c) GAO Study and Report.--Not later than 18 months after 
     the date of enactment of this Act, the Comptroller General of 
     the United States shall submit a report to the Committee on 
     Energy and Commerce of the House of Representatives and the 
     Committee on Finance of the Senate on the impacts of the 
     amendments made by subsections (a)(1) and (b)(2), including--
       (1) the impact, or potential effect, of such amendments on 
     access to prenatal and preventive pediatric care (including 
     early and periodic screening, diagnostic, and treatment 
     services) covered under State plans under such title (or 
     waivers of such plans);
       (2) the impact, or potential effect, of such amendments on 
     access to services covered under such plans or waivers for 
     individuals on whose behalf child support enforcement is 
     being carried out by a State agency under part D of title IV 
     of such Act; and
       (3) the impact, or potential effect, on providers of 
     services under such plans or waivers of delays in payment or 
     related issues that result from such amendments.
       (d) 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)) is 
     amended--
       (A) 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 ``(and, at State option, child'' and 
     inserting ``and child''; and
       (C) by striking ``title XXI)'' and inserting ``title XXI''.

     SEC. 2711. 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), 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

[[Page H888]]

     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 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).''.
       (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. 2712. 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. 2713. MEDICAID IMPROVEMENT FUND RESCISSION.

       Section 1941(b) of the Social Security Act (42 U.S.C 1396w-
     1(b)) is amended--
       (1) in paragraph (1), by striking ``$5,000,000'' and 
     inserting ``$0''; and
       (2) in paragraph (3)(A) (as added by section 3006(2)(B) of 
     the Helping Ensure Access for Little Ones, Toddlers, and 
     Hopeful Youth by Keeping Insurance Delivery Stable Act 
     (Public Law 115-120)), by striking ``$980,000,000'' and 
     inserting ``$0''.

     SEC. 2714. SUNSETTING EXCLUSION OF BIOSIMILARS FROM MEDICARE 
                   PART D COVERAGE GAP DISCOUNT PROGRAM.

       Section 1860D-14A(g)(2)(A) of the Social Security Act (42 
     U.S.C. 1395w-114a(g)(2)(A)) is amended by inserting ``, with 
     respect to a plan year before 2019,'' after ``other than''.

     SEC. 2715. 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 (1) through (9) and inserting the following new 
     paragraphs:
       ``(1) for each of fiscal years 2018 and 2019, $900,000,000;
       ``(2) for each of fiscal years 2020 and 2021, 
     $1,000,000,000;
       ``(3) for each of fiscal years 2022 through 2027, 
     $1,100,000,000; and
       ``(4) for fiscal year 2028 and each subsequent fiscal year, 
     $2,000,000,000.''.

                     DIVISION G--BUDGETARY EFFECTS

     SEC. 3001. BUDGETARY EFFECTS.

       (a) In General.--The budgetary effects of division D and 
     each succeeding division shall not be entered on either PAYGO 
     scorecard maintained pursuant to section 4(d) of the 
     Statutory Pay-As-You-Go Act of 2010.
       (b) Senate PAYGO Scorecards.--The budgetary effects of 
     division D and each succeeding division shall not be entered 
     on any PAYGO scorecard maintained for purposes of section 
     4106 of H. Con. Res. 71 (115th Congress).
       (c) Classification of Budgetary Effects.--Notwithstanding 
     Rule 3 of the Budget Scorekeeping Guidelines set forth in the 
     joint explanatory statement of the committee of conference 
     accompanying Conference Report 105-217 and section 250(c)(8) 
     of the Balanced Budget and Emergency Deficit Control Act of 
     1985, the budgetary effects of division D and each succeeding 
     division shall not be estimated--
       (1) for purposes of section 251 of such Act; and
       (2) for purposes of paragraph (4)(C) of section 3 of the 
     Statutory Pay-As-You-Go Act of 2010 as being included in an 
     appropriation Act.

  The SPEAKER pro tempore. Pursuant to House Resolution 727, the motion 
shall be debatable for 1 hour equally divided and controlled by the 
chair and ranking minority member of the Committee on Appropriations.
  The gentleman from New Jersey (Mr. Frelinghuysen) and the gentlewoman 
from New York (Mrs. Lowey) each will control 30 minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, for the fifth time since last fall, I rise today to 
present another continuing resolution, the House amendment to Senate 
amendment to H.R. 1892, to fund the operations of the Federal 
Government through March 23, fund the Department of Defense for the 
rest of fiscal year 2018, and extend critical healthcare programs, 
including funding for community health centers.
  Our current continuing resolution expires on Thursday, and without 
this legislation, large segments of the Federal Government will shut 
down again. Of course, all of us are keenly aware that more time is 
needed for our leaders in the House, the Senate, and the White House to 
negotiate overall funding levels for the 2018 fiscal year. This bill 
should allow that to happen.
  Mr. Speaker, this continuing resolution also makes a very limited 
number of technical changes in funding levels for only the most 
essential needs, including:
  To prevent delays in preparation for the 2020 Census;
  To ensure that the judicial branch is able to pay jurors;
  To provide $225 million in emergency funding for the Small Business 
Administration to provide emergency loans to those whose lives and 
livelihoods were destroyed by last year's historic natural disasters.
  This legislation also includes the full fiscal year 2018 Department 
of Defense Appropriations bill, totaling $659 billion for our Armed 
Forces.
  And I don't have to remind my colleagues that this bill has already 
passed this House three times on a bipartisan basis--most recently, 
last week.
  Mr. Speaker, we ask a great deal of our men and women in uniform, and 
we have an obligation to provide them and their families the resources 
they need to be safe, to complete their missions successfully at home 
and abroad. Governing from CR to CR just creates more unpredictability, 
more instability, and has real-life consequences for both our troops 
and civilians who support them.
  Mr. Speaker, the challenges we face around the world cannot be met 
under this Federal CR stop-and-go process. While we delay doing the 
Nation's business, our military and economic competitors are 
consolidating their gains.
  Finally, I would add, this legislation includes necessary funding 
extensions for bipartisan health priorities like community health 
centers and other public health programs. It also funds important 
Medicare extenders and includes commonsense reforms and improvements in 
the program.
  But let no one doubt our position on continuing resolutions. They are 
bad fiscal policy. They do not allow programs to grow, to be reduced or 
eliminated, if that is needed. They maintain outdated policies and stop 
new, critically important programs from ever starting, including 
programs that enhance national security and protect our Armed Forces 
from our enemies.
  Continuing resolutions are fiscally wasteful and prevent the 
executive branch and Congress from planning and preparing, and this is 
true for the private sector as well.
  Most importantly, they undermine congressional oversight that is 
constitutionally mandated for our appropriations.
  While I am pleased that we are here to include the Defense 
Appropriations

[[Page H889]]

bill in this continuing resolution, we must still pass all 12 
appropriations bills for the 2018 fiscal year, as well as our third 
emergency disaster supplemental.
  As soon as congressional and White House leaders reach a bipartisan 
agreement, which could and should happen at any moment, our committee 
will get to work immediately to finish negotiations on all 12 year-long 
funding bills.
  Mr. Speaker, I urge my colleagues to support this legislation, and I 
reserve the balance of my time.
  Mrs. LOWEY. Mr. Speaker, I yield myself such time as I may consume.
  Since President Trump's draconian FY 2018 budget was released last 
year, Democrats have warned Republicans that a bipartisan budget 
agreement was needed to adequately invest in American families and 
communities. Without a budget agreement, programs as diverse as Head 
Start, job training, and terrorism prevention grants are in danger of 
inadequate funding, at best.
  Instead of engaging with Democrats to reach a budget agreement, the 
majority is seeking to advance a full year of funding for only the 
Department of Defense, busting budget caps, while punting every other 
Federal service and investment to an uncertain future.
  Mr. Speaker, the most powerful country in the world now being 
completely run by a Republican government can't keep the lights on more 
than weeks at a time. How did we get here?
  Democrats will not go along with any plan that neglects critical 
national security and domestic needs. If this bill were to become law, 
the majority would have no workable plan to make the investments that 
are necessary for priorities, including biomedical research, 
infrastructure projects, Pell Grants, homeland security, assistance for 
local communities, veterans health, opioid funding, job training, the 
FBI, and other Federal law enforcement and more.
  This is not a serious bill. We know that it will be quickly rejected 
by the Senate. It is the furthest possible cry from regular order that 
the majority so frequently discusses yet rarely follows. It is nothing 
more than a political ploy that will place us on the brink of another 
shutdown.

                              {time}  1730

  It is well past time to increase budget caps and enact responsible 
spending bills. The majority displays a lack of urgency regarding 
reaching a budget agreement and enacting appropriations law, choosing 
instead to advance partisan measures that fail to lift unmanageable 
budget caps for both defense and nondefense.
  Republicans must abandon these partisan short-term bills and work 
with Democrats to fund the entirety of government for the remainder of 
the fiscal year to serve the American people.
  Mr. Speaker, I reserve the balance of my time.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Alabama (Mr. Aderholt), the chairman of the Subcommittee on 
Agriculture, Rural Development, Food and Drug Administration, and 
Related Agencies.
  Mr. ADERHOLT. Mr. Speaker, today, as the House takes up the fifth 
continuing resolution for FY18, it seems all too appropriate to quote 
President Reagan where he says: ``Here we go again.''
  I rise here on the floor of the House this afternoon to urge my 
colleagues to support the CR, which, of course, runs through March 23.
  As the chairman of the Committee on Appropriations' Subcommittee on 
Agriculture, Rural Development, Food and Drug Administration, and 
Related Agencies, our Nation's farmers and ranchers will find it hard 
to access credit during the upcoming planting season. And those 
recovering from disastrous weather events will not be able to access 
essential programs in order to help them if we do not finalize a full-
year funding agreement right away.
  These are just a couple of examples of the hardships that are faced 
by our citizens here in the U.S. that depend on this legislation.
  As I say, this is the fifth CR for this fiscal year. My colleagues on 
the other side of the aisle must come to the table willing to negotiate 
on these budget caps.
  As Members know, the House has passed each of the 12 appropriations 
bills. We have done our job. Of course, the other body continues to be 
the weakest link in all this, as it needs to seriously reform their 
process in order to do the work of the people.
  Finally, I appreciate that this bill includes full-year funding for 
the Department of Defense. To quote President Reagan once again: ``We 
have no choice but to maintain ready defense forces that are second to 
none. Yes, the cost is high, but the price of neglect would be 
infinitely higher.''
  Mrs. LOWEY. Mr. Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Pelosi), the Democratic leader.
  Ms. PELOSI. Mr. Speaker, I thank the gentlewoman for yielding to me, 
and I commend her for her extraordinary leadership on the 
Appropriations Committee, where important decisions are made about how 
to allocate the resources of our country to invest in the aspirations 
of the American people, to respect the sacrifice of our men and women 
in uniform, and to honor the vows of our Founders for a country that is 
making the future better for every generation to come.
  The distinguished chairman of the committee, Mr. Frelinghuysen, 
opened his remarks by saying he came to the floor to introduce the 
fifth continuing resolution. And the gentleman who followed him talked 
about this being the fifth continuing resolution.
  The more is not the merrier. It is like golf: the lower the score, 
the better. To have five continuing resolutions is a statement of 
incompetence and ineptitude.
  The Republicans control the House, the Senate, and the White House; 
yet they are pressing forward on their fifth stopgap, short-term 
spending bill, demonstrating their failure to govern.
  Since President Reagan was mentioned, I will mention our very first 
President, our patriarch, George Washington. President Washington, when 
he was leaving office, cautioned against political parties who were at 
war with their own government.
  Does that sound familiar to you?
  Here we are again, 2 days from another shutdown, careening toward 
another manufactured Republican crisis, demonstrating the Republican 
failure to govern.
  We don't want to go to that place. As Members of Congress, we take a 
solemn oath to support and defend the Constitution of the United States 
and to protect the American people.
  Democrats support a strong national defense. We, too, want our men 
and women in uniform to have the resources they need to keep them safe 
and to keep the American people safe as they accomplish their mission.
  But we will not allow Republicans to use this continuing resolution, 
the fifth time they had to come to the floor because they could not 
govern, to hollow out our Nation's commitment to the health, education, 
and economic security of America's working families.
  We all know that our military might is part of our Nation's strength, 
but the health, education, security, and well-being of the American 
people is also a source of that strength.
  Instead of working constructively with Democrats to meet the needs of 
the American people, Republicans are trying to starve the domestic 
budget. I just want to remind our colleagues: One-third, 34 percent--
one-third--of the nondefense domestic budget goes to national security. 
When you starve the domestic budget, you are not making us stronger. 
One-third of the domestic budget is about security; Homeland Security, 
Veterans Affairs, the State Department, and antiterrorism activities of 
the Justice Department.
  But Republicans refuse to give our patriots funded on the domestic 
side of the budget the resources they need to do their job, just the 
chaos and uncertainty of yet another stopgap extension.
  As Defense Secretary Mattis said, stopgap CRs ``just create 
unpredictability. It makes us rigid. We cannot deal with new and 
revealing threats. We know our enemies are not standing still, so it is 
about as unwise as it can be.'' And here are, as unwise as can be for 
the fifth time.

  And while their continuing resolution seeks to ransack every other 
commitment to the health of the American people, Republicans hide 
behind a fig leaf of a 2-year extension of community health centers.

[[Page H890]]

  We all support community health centers. It was a very important part 
of the Affordable Care Act. A very important part. Our colleague, 
assistant leader Mr. Clyburn from South Carolina, was one of the great 
champions of all time of Congress on expanding funding for programs for 
care and for bricks and mortar for our community health centers. This 
is a very important piece for us. We should be extending it in a fuller 
bill to 5 years, except it is used here to hide from the fact of so 
much other domestic investment that we are not making.
  Republicans are eliminating the Home Visiting initiative that is 
vital for maternal and child care, and cutting off workforce training 
for low-income Americans seeking good-paying jobs in healthcare.
  The sole purpose of this Republican bill is to destroy our leverage 
to achieve parity in the caps, to eliminate any need for bipartisan 
compromise, to eliminate any need to invest in working families.
  Why?
  Because if they get their defense number, then they don't have to 
negotiate about the domestic number. And as I said, we support our men 
and women in uniform having what they need to be safe and to keep us 
safe. But the strength of our country is measured in other ways as 
well.
  They don't believe that and they can't pass that, so they have to put 
the defense bill there. But we cannot support that because, again, it 
comes at the expense instead of as a source of strength to our country.
  Democrats simply want action on the critical overdue and bipartisan 
priorities of the American people so beautifully spelled out by our 
ranking member, Congresswoman Lowey.
  Again, we need funding for the opioid epidemic. The President talked 
about that. Show us the money. The opioid epidemic claims the lives of 
115 Americans every day, and it is getting worse every year in every 
district in the country. Bipartisan support is there to fight the 
opioid epidemic. Let's do it.
  We need more funding for veterans, to meet our responsibility and 
ensure that no veteran is denied the care they deserve upon returning 
from the battlefield.
  We need emergency disaster funding for all communities ravaged by 
hurricanes and wildfires.
  We need to save millions of hardworking Americans' endangered 
pensions.
  We need to pass the bipartisan Dream Act immediately. This is a moral 
priority for us. This is about the character of our Nation, who we are 
as a country. A nation, over time, constantly invigorated by people 
coming to our country to seek the American Dream; a dream that is 
predicated on every generation working to make the future better for 
the next; a dream that takes determination, optimism, hope, and 
courage. And when these newcomers come to America with that 
determination, that courage, that optimism, that hope, they associate 
themselves with the values of our Founders to make the future better 
for the next generation. These newcomers to America make America more 
American.
  So we asked to bring the Hurd-Aguilar bill to the floor. It is 
bipartisan. It has bipartisan support on the floor. It would pass. Have 
the courage to bring a bill that protects the DREAMers to the floor of 
the House.
  These priorities that I mentioned are all bipartisan. They would pass 
if brought to the floor for an up-or-down vote. The GOP squandered all 
their time, energy, votes, and enthusiasm on tax breaks for 
corporations and the wealthiest, with 83 percent of the tax bill going 
to the top 1 percent. And now Republicans need to get serious and get 
to work on a budget that funds both the military and the domestic 
investments that keep our Nation strong.
  I just want to make one point about that tax bill again. Did you see 
that the Speaker of the House sang the glory of the tax bill because a 
woman was getting $1.50 a week more in her paycheck? Did you see that? 
Do you believe that that is a good thing when the top 1 percent were 
probably getting $1,500 a week compared to her $1.50 a week in their 
paycheck?
  Thank God, after millions of people objected, the Speaker withdrew 
that tweet. But I don't think he withdrew that sentiment, because it is 
the same sentiment that haunts all of these negotiations about 
investing in the American people.
  Republicans must stop governing from manufactured crisis to crisis, 
and work with Democrats to pass many urgent, long-overdue priorities of 
the American people. As our distinguished ranking member, Mrs. Lowey, 
said earlier in her remarks, ``We must abandon these short-term 
bills.'' She spelled out very clearly why. I associate myself with her 
remarks.

  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas (Mr. Carter), the chairman of the Committee on 
Appropriations' Subcommittee on Homeland Security.
  Mr. CARTER of Texas. Mr. Speaker, our fine Secretary of Defense this 
morning testified before the Committee on Armed Services. He remarked 
that if the military is forced to continue to operate under a 
continuing resolution for the rest of the year, it will be unable to 
provide pay to our brave men and women in uniform, unable to recruit 
personnel we need, unable to maintain our naval ships, unable to 
maintain our aircraft, unable to supply our troops in the theater of 
combat, and unable to strike contracts critical toward modernizing our 
force. Unable, unable, unable.
  As Congress, it is our responsibility to make our military force the 
most able in the world; able to keep our country safe and able to 
promote the ideals of freedom across the globe.
  It would be deeply irresponsible for Members of this House to vote 
against providing full-year funding to the Defense Department, which 
addresses the needs of today and tomorrow, not last year.
  The Secretary was on the Hill to discuss something very important: 
The Department's National Defense Strategy, which seeks to address the 
significant challenges we face with rising adversaries in China and 
Russia, along with enduring threats of a nuclear-armed Korea, a 
terrorist state in Iran, a terrorist network like ISIS. And he said: 
``I regret that, without sustained predictable appropriations, my 
presence here today wastes your time because no strategy can survive 
without funding necessary to resource it.''
  Mr. Speaker, this bill funds our military for the year with funding 
that addresses the challenges we face today and separates this critical 
funding from the political fights here in Washington, D.C. Our troops 
need our support for this bill.
  The SPEAKER pro tempore (Mr. Poe of Texas). The time of the gentleman 
has expired.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield an additional 30 seconds to 
the gentleman from Texas.
  Mr. CARTER of Texas. Mr. Speaker, they need what this bill provides. 
Because of that, I support the bill and I urge its passage.

                              {time}  1745

  Mrs. LOWEY. Mr. Speaker, I am pleased to yield 5 minutes to the 
gentleman from Indiana (Mr. Visclosky), the ranking member of the 
Appropriations Committee Subcommittee on Defense.
  Mr. VISCLOSKY. Mr. Speaker, the first observation I would make is: 
When I was raised by my parents, I was taught not to whine and not to 
blame others for problems that arose, but, rather, to work hard to 
solve them.
  I think it is long past time for people in this body to blame people 
in another body for the collective inability of the Congress of the 
United States to make a decision about something so important as the 
budget of the United States of America.
  It is a leadership issue for the Democratic leadership and the 
Republican leadership of the House to come to an agreement to overturn 
the caps of the Budget Control Act. It is time for the Democratic and 
Republican leadership of the Senate to do the same and for those two 
bodies to come to an agreement collectively to meet our constitutional 
responsibilities.
  A few days ago, I was on this floor and said that we were confronted 
with a number problem. That is, what is our total spending for this 
fiscal year? We are in the 129th day of it for the Department of 
Defense. What is the total budget number for all of our domestic 
spending so that we can have a strong and vibrant economy and people?
  We still have a number problem. For the sake of the country, for the 
sake of

[[Page H891]]

this institution, for the sake of our committee and the good work that 
Chairman Frelinghuysen, Mrs. Lowey, and the members of our committee 
have done repeatedly, please let us have some leadership.
  Lewis Carroll wrote ``Through the Looking Glass,'' and there was an 
interchange in that story:
  `` `Well, in our country,' said Alice, still panting a little, `you'd 
generally get to somewhere else--if you ran very fast for a long time, 
as we've been doing.' ''
  `` `A slow sort of country!' said the Queen. `Now, here, you see, it 
takes all the running you can do, to keep in the same place.' ''
  In September, we did the first CR to December 8 because it was going 
to be different then, but we are in the same place. Then we did a CR 
for December 22 because it was going to be different then, but we are 
in the same place. Then we did a CR for January 19 because it was going 
to be different and a new year, but we are in the same place.
  Today, we have February 8 because it was going to be different on 
February 8, and now it is going to be the fifth time we have done a 
continuing resolution to March 23 because it is going to be different 
next month. That is fine.
  We did our Defense Appropriations bill. We did it in July; then we 
did it in September; then we did it in December; then we did it in 
February--four times between CRs, repeatedly doing the same Defense 
Appropriations bill. We have done it nine times. If we go through this 
sequence one more time, Mr. Speaker, I am not going to be able to keep 
track of my numbers anymore.
  This is a numbers problem, and I would conclude by noting that I, for 
one, did not vote for the Budget Control Act, and I would note that an 
independently elected Congress set it aside for 2 years because they 
knew a mistake had been made. Then a subsequently elected Congress did 
away with the Budget Control Act because they had a 2-year deal because 
they knew they had made a mistake.
  There are negotiations--apparently taking place as we meet here 
today--to set it aside for another 2 years because they know we made a 
mistake within our legislation, because Chairman Frelinghuysen, Mrs. 
Lowey, my chairwoman, Ms. Granger, and I, everybody has been honest. We 
are going to set aside sequestration because we need to spend 
additional moneys on defense.
  How many times does Congress have to hit its head with a hammer to 
not fix this problem permanently? Three different independently elected 
Congresses have overturned a really rotten bill, and we are still in 
the same place. It is time to stop for the sake of this country.
  Give the chairman, give the ranking member, give the committees in 
both Houses numbers so we can complete our bills. The last time I 
looked, every department of this country has completed their work on 
fiscal year 2019, are going to present us with their budgets next week, 
and they don't know what we are doing this year.
  Mr. Speaker, this is unbecoming of a great nation.
  Mr. FRELINGHUYSEN. Mr. Speaker, I am pleased to yield 2 minutes to 
the gentleman from Texas (Mr. Brady), the chairman of the Ways and 
Means Committee.
  Mr. BRADY of Texas. Mr. Speaker, I thank the chairman for his 
leadership and hard work on this effort.
  For over a year, the Ways and Means Committee has been leading 
efforts to advance smart, focused solutions to improve Medicare for the 
American people. A number of these solutions are included in the bill 
before us today. These policies take action on three primary goals:
  First, expanding access to high-quality care;
  Second, increasing efficiency in the way we deliver care--a key goal 
that will help patients better receive the care they need when they 
need it; and
  Third, incorporating healthcare technologies that are focused on 
patients, such as telehealth, and eliminating barriers to coordinating 
care.
  This means providing new tools to patients that healthcare providers 
can use to better access care and deliver it and, at the same time, 
reducing red-tape burdens that now make it harder for our local doctors 
to provide the high-quality care our Americans deserve.
  So many of these provisions have support from Republicans and 
Democrats, and for good reason. These are smart, targeted improvements 
that will go a long way in helping Medicare patients in Texas and, 
frankly, throughout the country.
  Mr. Speaker, I want to thank all of the members of our committee and 
throughout the House who have worked on these provisions. Improving and 
strengthening Medicare for the long term is a major priority for the 
American people. With this bill, we have an opportunity to take 
meaningful steps toward this important goal.

  Mr. Speaker, I urge all of my colleagues to join me in supporting its 
passage.
  Mrs. LOWEY. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Ohio (Ms. Kaptur), the ranking member of the 
Appropriations Committee Subcommittee on Energy and Water Development, 
and Related Agencies.
  Ms. KAPTUR. Mr. Speaker, I thank Ranking Member Lowey and rise in 
opposition to this bill.
  Our Nation really needs to be on an even keel to produce steady 
economic growth in this country. This bill doesn't help that.
  I agree, America must have a strong defense, but a nation has to be 
strong at home to be strong abroad. You can't shortchange the home 
front. A nation at home must be secure, without wild stock market 
swings, to be strong abroad.
  A nation at home must be strong, without a massive drug epidemic here 
at home, to be strong abroad.
  This bill can't produce a steady economy with consistent job growth 
because it fails to dedicate sufficient resources here at home: to 
education, to healthcare, to employment and retraining, for Head Start, 
for energy independence, for law enforcement, and for localities 
savaged by the drug epidemic and shortchanged on treatment.
  Our ship of state needs to be on an even keel, not the wild 
fluctuations in this resolution. This bill tilts in the wind far, far 
starboard, and that is not a setting that can assure a steady ship of 
state to maintain a steady growth economy.
  Mr. Speaker, I rise in opposition to the resolution.
  Mr. FRELINGHUYSEN. Mr. Speaker, I am pleased to yield 2 minutes to 
the gentleman from Nebraska (Mr. Smith), chairman of the Subcommittee 
on Human Resources of the House Ways and Means Committee.
  Mr. SMITH of Nebraska. Mr. Speaker, I rise in support of this 
continuing resolution package.
  While I appreciate this legislation will keep government open, fund 
community health centers for 2 years, and fully fund our military while 
we continue to work toward a broader budget agreement, I would like to 
focus on the various Ways and Means Committee provisions included in 
the bill.
  This legislation includes numerous Medicare provisions important to 
rural health providers and patients, including permanently repealing 
therapy caps and extending the floor on geographic payment adjustments 
for rural providers and add-ons for rural ambulance providers.
  Just as importantly, these health provisions are paid for without 
cutting swing bed reimbursements to critical access hospitals, 
including the 55 critical access hospitals in Nebraska's Third District 
as originally proposed.
  I am particularly pleased that two important programs within the 
jurisdiction of the Subcommittee on Human Resources--which I chair--are 
included today. We have much work to do to lift Americans out of 
poverty and into prosperity, and each of these bills will play an 
important part in this effort.
  The Family First Prevention Services Act reforms our child welfare 
system to reinforce the importance of keeping children with their 
families whenever possible. We know children who stay with their 
families have better long-term outcomes than those who move to 
nonfamily settings, and our goal for every program in this space to 
demonstrate results through empirical evidence.
  I want to thank the sponsor of Family First, Mr. Buchanan, for 
working with me to address my concerns about nurse staffing 
requirements which would have been costly to implement for entities 
like Omaha-based Boys Town, while providing no tangible improvements to 
their family driven model of care.

[[Page H892]]

  The other H.R. item in this package, the supporting Social Impact 
Partnerships to Pay for Results Act, also moves our family support 
programs to a more results-driven model by incentivizing States and 
local governments to pilot new ideas and reserving Federal funding 
until they demonstrate outcomes through rigorous data-driven 
evaluation. We still have more work to do in this space, starting with 
completing the work begun by this Chamber last September when we passed 
a paid-for 5-year MIECHV reauthorization.
  But like the rest of this legislation, these provisions are a 
downpayment on the work we are committed to completing.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. FRELINGHUYSEN. I yield an additional 30 seconds to the gentleman 
from Nebraska.
  Mr. SMITH of Nebraska. Mr. Speaker, I thank the gentleman for the 
time, and I certainly urge passage of this bill.
  Mrs. LOWEY. Mr. Speaker, I am pleased to yield 2 minutes to the 
gentlewoman from Connecticut (Ms. DeLauro), the ranking member of the 
Labor, Health and Human Services, Education, and Related Agencies 
Subcommittee of the Appropriations Committee.
  Ms. DeLAURO. Mr. Speaker, I rise to strongly oppose this continuing 
resolution. I cannot support a bill that flies in the face of 
responsible governing. This is pure incompetence.
  How many times are we going to do this? This is our fifth short-term 
spending bill since September. How many times will we punt our 
priorities, lurching from one self-inflicted wound to another?
  That is exactly what the continuing resolution represents: a failure 
to govern. It is shameful that, yet again, we neglect our core 
obligation as a Congress, which is to fund government programs. We 
should be voting on new top-line spending levels for 2018, that 
alleviate sequestration from both nondefense and defense spending.
  We should have spent the last few months fulfilling our 
responsibility as legislators by writing bipartisan bills to fund 
programs that help the middle class and the vulnerable, support 
evidence-based scientific research, and help working people get the 
skills they need to find good jobs and get good wages.
  Instead, the majority forced through their tax scam for millionaires 
and billionaires. They became the first party to ever control both 
Chambers of Congress and the White House, and, yes, they shut down the 
government. And today, the President of the United States says that he 
supports a government shutdown.
  The Republican majority has failed to respond to the needs of the 
American people. Instead of working with Democrats to set budget 
numbers and ensure parity, equal for defense spending and nondefense 
spending, they have put the government on autopilot.

                              {time}  1800

  They put services and investments that are critical to our families 
and to our communities at grave risk from apprenticeships to education 
for students with disabilities, childcare, after-school programs that 
help working families make ends meet, and financial aid for students 
who are attending college. Instead, they are forcing through another 
continuing resolution, this time cutting almost $3 billion from the 
Prevention Fund over the next 10 years on top of the $750 million that 
they cut in December.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mrs. LOWEY. Mr. Speaker, I yield the gentlewoman from Connecticut an 
additional 1 minute.
  Ms. DeLAURO. We are talking about cuts to programs that improve our 
public health immunization infrastructure at a time when the flu is 
rampant in this country, as well as cuts to lead poisoning prevention 
programs that seek to prevent and ultimately eliminate childhood lead 
poisoning.
  Programs like these and dozens of others in the Prevention Fund save 
billions of taxpayer dollars by preventing illness and disease before 
they occur.
  You cut the Prevention Fund and you cause millions of Americans to 
suffer for no reason. You pit community health centers against the 
Prevention Fund.
  Take the money, the $1\1/2\ trillion that you give to the richest 
people in this country: the millionaires, the billionaires, and the 
richest corporations; don't take it from children's health, don't take 
it from the healthcare centers, and don't take it from the Prevention 
Fund. It is unacceptable, because here we are talking about people's 
lives.
  Mr. Speaker, I urge my colleagues: Reject this continuing resolution. 
It fails to meet our obligations to the American people.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Texas (Mr. Barton), who is the vice chairman of the Energy and 
Commerce Committee.
  Mr. BARTON. Mr. Speaker, I thank the distinguished Appropriations 
Committee chairman for yielding me time.
  I rise in support of this continuing resolution. Obviously, we would 
rather fund the government for the entire year before the start of the 
fiscal year, but that is in a perfect world, and one thing that the 
Congress has never been accused of is being a perfect world. So we are 
here dealing in the real world.
  To my good friend from Connecticut who just spoke, and she is my good 
friend, I would point out that the bill before us doesn't cut money 
from the Prevention Fund. It directs money from the Prevention Fund to 
spend on healthcare programs. In other words, it is taking some 
discretion from the executive branch and directing that spending that 
Congress thinks it should be spent for.
  One of the programs that we are going to fund for 2 years is the 
community health centers. Twenty-four million people each year get 
their healthcare from these community health centers, and one of them 
is in my home county, the Hope Clinic. Its main facility is in 
Waxahachie, Texas. But in my hometown of Ennis, we have the Nell Barton 
Hope Clinic Annex. These two facilities in Ellis County this year are 
providing healthcare for over 10,000 Ellis Countians.
  This is not exotic care. It is checkups, screenings, mammograms, and 
all the odds and ends that you have in your basic healthcare 
facilities. If they need more specific treatment, they are referred to 
specialists in the Dallas-Fort Worth area.
  But for the 10,000 citizens of Ellis County who depend on the Hope 
Clinic for their healthcare, this is a big bill. In fact, the executive 
director of the Hope Clinic was in my office today, saying: We want to 
expand, but we don't know if we are going to have the funds. We really 
need to get some certainty.
  That is what this bill is all about. So I rise in strong support, and 
I urge a ``yes'' vote on the CR later this evening.
  Mrs. LOWEY. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Lee), who is a senior member of the Appropriations 
Committee.
  Ms. LEE. Mr. Speaker, I want to thank the gentlewoman for yielding 
and, once again, for her tremendous leadership on so many issues as our 
ranking member.
  As a member of the Appropriations Committee and the Budget Committee, 
I rise in strong opposition to this continuing resolution. This bill 
kicks the can down the road for the fifth time--mind you, fifth time--
since October. It also shamelessly includes the stand-alone defense 
spending bill of $659 billion to an already out-of-control Pentagon 
budget.
  This bill breaks the budget caps. It includes $75 billion for wars 
that Congress has never debated or voted on. It also includes more than 
$1 billion in funds to increase troop levels in Afghanistan by 3,500, 
not to mention the millions--the billions, actually--in waste, fraud, 
and abuse that taxpayers have already lost by irresponsible Pentagon 
spending.
  This is outrageous. Republicans control the House, the Senate, and 
the White House. The least they could do is keep the government open. 
Yet here we stand, once again, with no deal on DREAMers and no 
agreement on a long-term spending bill.
  Clearly, Republicans have no strategy on funding the government. They 
would prefer to pass CR after CR after CR after CR. This is beyond 
irresponsible, Mr. Speaker.

[[Page H893]]

  How long will Republicans govern from crisis to crisis? Nobody can 
manage their household or their business like the Republicans are 
managing our government spending.
  This short-term resolution once again ignores urgent bipartisan 
priorities the Democrats have been fighting for for months with 
Republicans, the most urgent of which is passing a clean Dream Act. 
DACA recipients are American in every way except on paper, and right 
now their lives are hanging in the balance. We have less than 1 month 
until DACA expires, a deadline that the President, himself, created.
  This continuing resolution is really irresponsible, and it is morally 
bankrupt.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mrs. LOWEY. Mr. Speaker, I yield the gentlewoman from California an 
additional 1 minute.
  Ms. LEE. Mr. Speaker, this continuing resolution fails to honor the 
temporary protective status for immigrants.
  It fails to raise budget caps for defense and nondefense spending, 
and it neglects to provide desperately needed funding for hurricane- 
and wildfire-impacted communities, the opioid crisis, and our veterans.
  This bill underscores the majority's complete lack of regard for 
everyday Americans and struggling families.
  Continuing resolutions leave the American people out on a limb with 
no confidence in their Federal Government. This resolution makes it 
clear that that is just what Republicans want to do.
  The American people sent us to Congress to govern in their best 
interest. Now we have spent the last 4 months passing short-term 
spending bills one after another, and for what? Because Republicans 
refuse to do their job.
  Instead of wasting more time on this terrible CR, we should deal with 
our bipartisan priorities and fund the government for the long term. It 
is the right thing to do for our communities and our country.
  Mr. Speaker, I urge a ``no'' vote on this bill.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 1 minute to the gentleman 
from Florida (Mr. Bilirakis), who is a member of the House Energy and 
Commerce Committee.
  Mr. BILIRAKIS. Mr. Speaker, I thank the chairman for doing an 
outstanding job this year passing all 12 appropriations bills.
  Mr. Speaker, I support passage of this CR which includes three 
provisions of mine. It will reauthorize the Community Health Center 
program, providing $3.6 billion per year 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 and have long enjoyed bipartisan support because they are a 
prime example of what is working in our healthcare system.
  The CR updates the civil and criminal penalties in the Medicare and 
Medicaid programs. Many haven't been updated in over 20 years.
  It also repeals the Medicare therapy cap. This will ensure that 
patients who need physical, speech, or occupational therapy services 
can receive them without fear of losing their benefits if they hit an 
arbitrary cap. This is so important to our seniors, Mr. Speaker.
  Mr. Speaker, I encourage my colleagues to support this bill.
  Mrs. LOWEY. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Minnesota (Ms. McCollum), who is the ranking member of the Interior, 
Environment, and Related Agencies Subcommittee.
  Ms. McCOLLUM. Mr. Speaker, I thank our ranking member for yielding me 
the time.
  Mr. Speaker, I rise in opposition to this legislation, a misguided 
bill that ignores the urgent needs of the American people.
  The Federal Government's fiscal year started October 1, 2017--128 
days ago. Instead of using that time to get their work done, 
Republicans have focused solely on partisan politics. When it comes to 
the essential responsibility of funding the Federal Government, the 
Republicans can't be bothered.
  Now we are asked, today, to vote for a bill that funds the Pentagon 
for the rest of the year while funding our schools and our hospitals 
for just 43 days.
  Mr. Speaker, our national security begins at home with investments in 
the future that keep our families and our communities safe, strong, and 
moving forward. This bill ignores those needs. It provides no certainty 
for our law enforcement professionals, no long-term funding for urgent 
repairs to our crumbling infrastructure, and no confidence for 
investments in lifesaving medical research. It doesn't even provide a 
full year of funding for veterans' healthcare.
  While it is encouraging that Republicans are finally reauthorizing 
vital healthcare programs like our community health centers, paying for 
these programs with cuts to the CDC's Prevention and Public Health 
Fund, which is currently providing lifesaving vaccines in this severe 
flu season, is the height of irresponsibility.
  Discord and delay is no way to run a government, but under Republican 
control, that is exactly what we are getting.
  Mr. Speaker, unlike the President, I do not want a government 
shutdown. We need a budget agreement that keeps our government open, 
protects our national security, and meets our commitments to 
hardworking families. So let's stop playing games, get to our work, and 
get to it now.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Georgia (Mr. Carter), who is a member of the House Energy and 
Commerce Committee.
  Mr. CARTER of Georgia. Mr. Speaker, I rise today in support of this 
spending measure under consideration and what it means for our country 
and our constituents.
  This continuing resolution we are considering includes a number of 
extremely important health provisions that are desperately needed.
  Under this legislation, we will see a 2-year extension of federally 
qualified health centers that employ nearly 190,000 people and serve 
over 24 million people across the country.
  There is also a 2-year extension of public health programs such as 
the National Health Service Corps, the Teaching Health Center Graduate 
Medical Education, Family-to-Family Health Information Centers, and the 
Sexual Risk Avoidance Education Program.
  Additionally, this helps hospitals by eliminating the $5 million in 
reductions for Disproportionate Share Hospitals that were included in 
the ACA.
  Many of the good bills my colleagues on the Energy and Commerce 
Committee have worked on are included in this legislation to improve 
public health and make reforms to Medicare.

  Finally, this legislation pushes through a permanent repeal of the 
Medicare payment cap for therapy services, meaning that patients will 
have better access to important medical devices.
  All of these efforts wouldn't be possible without the work of 
Chairman Walden, Chairman Burgess, and my colleagues on both sides of 
the aisle in the Energy and Commerce Committee.
  Mr. Speaker, now is the time to work together to ensure that these 
bills are passed into law, and that is why I urge my colleagues to 
support this bill.
  Mrs. LOWEY. Mr. Speaker, I yield 2\1/2\ minutes to the gentlewoman 
from Florida (Ms. Wasserman Schultz), who is the ranking member of the 
Military Construction, Veterans Affairs, and Related Agencies 
Subcommittee.
  Ms. WASSERMAN SCHULTZ. Mr. Speaker, I thank the gentlewoman for 
yielding and for her leadership.
  Mr. Speaker, I rise in strong opposition to this continuing 
resolution which, yet again, is a complete and total abdication of our 
responsibilities as Members of Congress.
  For the fifth time so far this fiscal year, Republicans are asking us 
to fund the government for just another flip of the calendar. The last 
time Republicans dragged us down this path of budgetary incompetence, 
we had the first ever complete government shutdown when one party held 
the House, Senate, and the White House. Yet here we are again, left 
with this ludicrous approach of funding the U.S. Government month to 
month while ignoring so many of the pressing issues Americans want us 
to address.
  Today we have heard Republicans pay endless lip service to their 
devotion to military spending--and that

[[Page H894]]

funding is certainly vital--but what Republicans have not mentioned is 
that this latest stopgap gimmick is going to rob from crucial 
nondefense budgets that also keep Americans safe. That means veterans, 
homeland security, counterterrorism, and State Department programs will 
be neglected and ignored.
  That is why Democrats are asking for a simple compromise to raise the 
spending caps that are unreasonable and uncompromising. That is because 
we all want a strong national defense, but we also need equal increases 
in our domestic budget so that hardworking families can feel safe and 
financially secure.
  We also want Republicans to join us in confronting the dire shortfall 
at the VA so no veteran is denied care upon returning home.
  We want Republicans to work with us to ensure urgently needed 
recovery funds go to Texas, Florida, Puerto Rico, the U.S. Virgin 
Islands, and all areas impacted by wildfires.

                              {time}  1815

  We want Republicans to truly help us fight this opioid scourge, 
protect America's pensions, and do what the vast majority of Americans 
want us to do: pass a clean Dream Act.
  Don't tell me we don't have the funds to support those needs. This 
Congress just gave a huge handout to billionaires and giant 
corporations that exploded the deficit by $1.5 trillion.
  But this cynically crafted continuing resolution fails to address 
those real needs, the needs of the people who actually sent us here to 
stand up for them. We must end this cycle of budgetary neglect.
  Mr. Speaker, I urge my colleagues to vote ``no.''
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentleman 
from Florida (Mr. Dunn).
  Mr. DUNN. Mr. Speaker, our troops comprise the most professional, 
highly trained, and dedicated military force that the world has ever 
seen. They have pledged their lives, the well-being of their families, 
and their sacred honor to serve and protect this Nation.
  Yet here we are, over a month into 2018, and our military and 
national security are being held hostage by our colleagues across the 
aisle over unrelated issues.
  It is time for the Senate to get its act together. The House has 
passed the full defense funding three times this year. Tonight, we will 
pass it a fourth time.
  It is wrong for us to send our best young men and women into harm's 
way without the resources they need, asking them to make up with their 
efforts, and their risk, for our shortcomings.
  Mr. Speaker, I urge my colleagues to support this funding legislation 
and to prove to our troops that we have their backs.
  Mrs. LOWEY. Mr. Speaker, I yield 2 minutes to the gentleman from New 
Jersey (Mr. Pallone), the ranking member of the Committee on Energy and 
Commerce.
  Mr. PALLONE. Mr. Speaker, I rise in opposition to H.R. 1892.
  Mr. Speaker, I am disappointed that, once again, my Republican 
colleagues are playing politics with important health programs.
  Rather than bringing a stand-alone, bipartisan health extenders 
package to the floor, the Republicans have once again delayed any 
action on these extenders so that they could attach them to a CR that 
Democrats could not support.
  The strategy may hide their inability to pass a final funding bill 
for a fiscal year that began on October 1, but it has also created 
uncertainty for the millions of Americans who rely on these programs 
every day.
  I am glad that Republicans have dropped some of the harmful offsets 
that have led to months of delay and uncertainty for these health 
programs. However, our main concern is that the package excludes 
important health priorities, including the Maternal, Infant, and Early 
Childhood Home Visiting Program; the Health Profession Opportunity 
Grants program; and the increased funding that is desperately needed to 
combat the ongoing opioid crisis.
  The CR poses a serious threat to public health because it cuts $2.85 
billion from the Prevention Fund. These funds are critical to keeping 
Americans healthy. The Prevention Fund funds vaccines for children, 
lead poisoning prevention, opioid prevention, diabetes, heart disease, 
and other prevention programs.
  I am also concerned with the Medicaid cuts in this package. 
Republicans have included over $10 billion in Medicaid cuts, including 
new money from the Medicaid Improvement Fund.
  We should also reject the prioritization of funding for the Defense 
Department at the expense of all of our domestic needs.
  I urge my colleagues to vote ``no.'' It is the only way we are going 
to guarantee that, ultimately, these health programs are funded and 
that we don't rely so much on the Prevention Fund.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield 2 minutes to the gentlewoman 
from Tennessee (Mrs. Blackburn).
  Mrs. BLACKBURN. Mr. Speaker, it is so interesting to listen to this 
debate. I just want to make three points.
  First, on the military funding, I represent Fort Campbell. When you 
walk on that post and talk to the men and women in uniform and talk to 
them about their readiness training, their redeployment training, do 
you know what they tell us?
  They say: Give us certainty in funding.
  That is exactly what we are doing, is providing that certainty that 
they need to defend us, to protect us. They deserve it and they deserve 
our best efforts. So I find it so curious that there would be 
opposition to funding our military.
  The second point is the community health centers. Many of my 
colleagues may come from urban areas. I have a rural district. 
Community health centers are vitally important to my constituents, to 
Tennesseans who want the access to care and seek the education to know 
how to take better care of themselves and their families. Let's give 
them this funding for the 2 years of certainty that is necessary.
  Third, legislation that I have authored and worked on is included in 
the Medicare therapy cap provisions.
  Have you ever talked to a senior, as I have, who had a stroke, who is 
seeking speech therapy or physical therapy from a hip replacement or a 
fall?
  There is an arbitrary cap that runs out and they can no longer seek 
that medical attention that is necessary for a full and complete 
recovery and the quality of life that they desire and that they 
deserve. This is something that our committee has worked on to provide 
for seniors.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield an additional 1 minute to the 
gentlewoman from Tennessee.
  Mrs. BLACKBURN. This is something that allows them to have that 
quality of life.
  Why would you vote against lifting these caps and giving seniors what 
they deserve?

  They have paid for Medicare through their working life. What they are 
seeking is to be able to have a full recovery. It is not only the 
appropriate thing to do, this is something that adds to the quality of 
life, just as keeping these community health centers funded enriches 
our communities. It enriches rural America.
  I close with reiterating the point that, out of fairness, out of 
respect, out of loyalty to those who put on the uniform to defend us, 
let us join together and vote to fund the military and to support their 
efforts to defend this Nation.
  Mrs. LOWEY. Mr. Speaker, I reserve the balance of my time.
  Mr. FRELINGHUYSEN. Mr. Speaker, I yield such time as he may consume 
to the gentleman from Oregon (Mr. Walden), the chairman of the Energy 
and Commerce Committee.
  Mr. WALDEN. Mr. Speaker, I thank the chairman of the House 
Appropriations Committee and his great staff who have worked diligently 
all year, month after month after month. Five months ago next week, 
they approved all 12 appropriations bills, one after another, regular 
order, through the House of Representatives. But there they sit over in 
the Senate and the Democrats block them.
  What brings us here today is really important work. What brings us 
here today is that we are taking care of significant public healthcare 
issues. We are fully funding for the next 2 years community health 
centers.

[[Page H895]]

  I have heard from my colleagues about the things that aren't in this 
bill that they wish were, so that is why they are going to vote ``no,'' 
or some other thing that is not even before us and that is why they are 
going to vote ``no.''
  But let's talk about what is actually before us.
  What is before us is taking care of our men and women in uniform and 
their needs, especially when they are in harm's way, and fund really, 
really important public health programs that used to always be 
bipartisan.
  Let's talk about those. Valley Family Health Care Outreach Center in 
Ontario and Winding Waters Clinic in Wallowa County. I have visited 
both of these recently. They are on the front lines of healthcare 
prevention. They are on the front lines of saving lives and helping 
children and adults. Or La Clinica down in the Medford-Ashland area.
  In fact, in my district, we have 12 federally qualified health 
centers and 63 delivery sites that give care for 240,000 Oregonians. 
Twenty-four million nationwide are served by this.
  On November 3, this House had the opportunity to fully fund those 
community health centers for 2 years and take care of children's health 
insurance and a lot of these other programs. It was a separate bill 
brought to the House floor, and a handful of Democrats broke with their 
party and voted with us. But, unfortunately, when it got to the Senate, 
they couldn't be freed up to support it. So we had to come back in the 
last continuing resolution and fully fund the Children's Health 
Insurance Program. I am not sure many Democrats voted for that here, 
unfortunately.
  But here we are today, same process, same situation to fund community 
health centers. So we are going to do that. Your choice when you vote 
is ``yes'' or ``no,'' you want the community health centers funded or 
not, you want to shut the government down or not, you want to take care 
of our military or not.
  Then there is the disproportionate share hospitals.
  What are those?
  Those are the hospitals in our districts and States that take care 
disproportionately of more poorer people than other hospitals. Under 
the Affordable Care Act or ObamaCare, however you want to describe it, 
there was prescribed in law automatic cuts to these hospitals that take 
care of the poorest of the poor in our communities. Those cuts totaled 
$2 billion.
  In this legislation, as in the legislation we brought from the Energy 
and Commerce Committee on November 3, we turn off those cuts. We say: 
Don't do that to our DSH hospitals.
  If you are at Saint Alphonsus in Ontario, Oregon, that is the most 
affected hospital, I am told, and they will lose money and have to 
decide how they cope with that. We solve that here for 2 years at $6.8 
million in my State.
  Then we extend the special diabetes programs. For heaven's sake, we 
should be able to come together in this Chamber and in this Congress to 
take care of people with diabetes. My grandfather lost both legs due to 
diabetes. They were amputated. I have other relatives and good friends 
whose kids have dealt with diabetes and still do to this day.
  For our Native Americans and others, we have two separate programs. 
We fully fund them and tie them together. That is done in this 
legislation. Fifty thousand people in my district have diabetes. My 
hunch is all of our districts are not dissimilar from that. We take 
care of those people in this legislation.

  Then we take care of therapy caps. Since 1997, when this law was put 
in place, people who needed physical therapy--my colleague from 
Tennessee talked about it--stroke victims, seniors who need therapy, 
rather than the physical therapist or the speech therapist saying, 
``Here is the program you need to get well, get on your feet, recover 
from whatever it is that afflicts you,'' the government put an 
arbitrary cap, and that was it. You were done whether you were done or 
not.
  Everybody is different in terms of recovery. We repeal the therapy 
caps in here.
  By the way, we have heard about all these things that now won't get 
funded because a part of this funding comes out of the Public 
Prevention Fund. Mr. Speaker, $2.85 billion is not insignificant, it is 
true, but we are applying that money to help prevention and community 
health centers, as we did before for the Children's Health Insurance 
Program.
  We are providing it for diabetes health. We are removing the physical 
therapy caps so that people can get well. That seems to me to be pretty 
good use of the Prevention Fund.
  By the way, during the same period we are spending $2.85 billion out 
of that, there will still remain $12 billion left, and the talented 
folks at the Appropriations Committee will decide how that money is 
spent on vaccines and all these other issues, all these things we care 
about. There is still $12 billion left. So we are using discretionary 
funds that were set aside for that very purpose here.
  Then we heard about some Medicaid cuts. Let me tell you what those 
are. We said: If you are a big lottery winner, maybe now that you have 
won a big prize, you shouldn't be on government-funded Medicaid 
because, by the way, you won a bazillion dollars.
  So we are taking lottery winners and saying you have got to treat 
that big windfall when you calculate whether that person is poor or not 
anymore. So that is in here.
  Then, on third-party liability, we said that if insurers actually are 
responsible for the cost, insurers should pay the cost rather than the 
taxpayer. So we make a little reform here that puts the insurers first 
to pay rather than the taxpayer.
  Mr. Speaker, I thank the chairman for the marvelous work he has done.

                              {time}  1830

  Mr. FRELINGHUYSEN. Mr. Speaker, I reserve the balance of my time.
  Mrs. LOWEY. Mr. Speaker, I yield myself such time as I may consume.
  This is the latest example of Republicans being completely incapable 
of governing. We must finish our work.
  Mr. Speaker, I yield back the balance of my time.
  Mr. FRELINGHUYSEN. Mr. Speaker, I am in receipt of the Statement of 
Administration Policy, which indicates that the administration supports 
this continuing resolution and that the President's advisers would 
recommend his signature on the bill.
  Mr. Speaker, I include in the Record the Statement of Administration 
Policy dated February 6, 2018.

                   Statement of Administration Policy


     House Amendment to H.R. 1892--Further Extension of Continuing 
           Appropriations Act, 2018--Rep. Frelinghuysen, R-NJ

       The Administration supports the House Amendment to the 
     Senate Amendment to H.R. 1892, the Further Extension of 
     Continuing Appropriations Act, 2018. This bill funds most 
     Government programs at current levels through March 23, 2018, 
     while incorporating the text of the House-passed fiscal year 
     (FY) 2018 Department of Defense Appropriations Act, which 
     provides the resources the military needs to keep the Nation 
     safe. As the Administration has noted previously, the House-
     passed Department of DefenseAppropriations Act is consistent 
     with the President's pledge to undo the looming defense 
     spending reductions that are harmful to America's national 
     security and military readiness.
       The House-passed Department of Defense Appropriations Act 
     incorporated in the bill includes a total of $659 billion for 
     the Department of Defense (DOD), including $584 billion in 
     base spending and $75 billion for Overseas Contingency 
     Operations. These amounts are consistent with a total funding 
     level for DOD similar to that authorized by the National 
     Defense Authorization Act for Fiscal Year 2018, which was 
     signed into law by the President. It includes $1.2 billion 
     requested by the Administration to support increased troop 
     levels in Afghanistan, special operations forces 
     capabilities, and other urgent needs.
       The United States military's greatest asset is the men and 
     women who volunteer to serve. This bill keeps faith with 
     service members by providing a 2.4 percent military pay 
     raise. It increases end strength across the military services 
     for active duty, reserve, and National Guard personnel, and 
     includes funding for training and maintenance to ensure that 
     United States troops are properly equipped and ready to 
     fight.
       In addition to supporting the defense bill, the 
     Administration supports language in the House Amendment to 
     H.R. 1892 that provides for an extension of a variety of 
     healthcare provisions, including Community Health Centers. 
     The Administration is also appreciative that the bill 
     includes language requested by the Administration to ensure 
     continuity of operations for the 2020 Decennial Census 
     Program and the Small Business Administration's Disaster 
     Loans Program.
       The Administration supports continuing discussions over a 
     two-year budget agreement that ensures funding for national 
     defense and other priorities. As those discussions continue, 
     however, it is dangerous to

[[Page H896]]

     hold defense funding for the current fiscal year hostage to 
     arbitrary demands for lower-priority domestic programs.
       If the Further Extension of Continuing Appropriations Act, 
     2018, were presented to the President in its current form, 
     his advisors would recommend that he sign the bill into law.

  Mr. FRELINGHUYSEN. Mr. Speaker, I urge all of my colleagues in the 
House to support this continuing resolution to keep the government open 
for business until March 23 and to support our men and women in the 
armed services who do the work of freedom each and every day.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 727, the previous question is ordered.
  The question is on the motion by the gentleman from New Jersey (Mr. 
Frelinghuysen).
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. FRELINGHUYSEN. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, this 15-
minute vote on the motion to concur will be followed by a 5-minute vote 
on the motion to suspend the rules and pass H.R. 219, if ordered.
  The vote was taken by electronic device, and there were--yeas 245, 
nays 182, not voting 3, as follows:

                             [Roll No. 60]

                               YEAS--245

     Abraham
     Aderholt
     Allen
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (GA)
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Bustos
     Byrne
     Calvert
     Carbajal
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Cooper
     Costa
     Costello (PA)
     Cramer
     Crawford
     Crist
     Culberson
     Curtis
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Dunn
     Emmer
     Estes (KS)
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Frelinghuysen
     Gaetz
     Gallagher
     Garamendi
     Garrett
     Gianforte
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gottheimer
     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)
     Johnson, Sam
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lawson (FL)
     Lewis (MN)
     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.
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Ruiz
     Russell
     Rutherford
     Scalise
     Schneider
     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
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Vela
     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

                               NAYS--182

     Adams
     Aguilar
     Amash
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brown (MD)
     Brownley (CA)
     Butterfield
     Capuano
     Cardenas
     Carson (IN)
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Correa
     Courtney
     Crowley
     Cuellar
     Curbelo (FL)
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Duncan (TN)
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty (CT)
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Gomez
     Gonzalez (TX)
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Jones
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Labrador
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lee
     Levin
     Lewis (GA)
     Lieu, Ted
     Lipinski
     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
     Peters
     Pingree
     Pocan
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Ros-Lehtinen
     Rosen
     Roybal-Allard
     Ruppersberger
     Rush
     Ryan (OH)
     Sanchez
     Sanford
     Sarbanes
     Schakowsky
     Schiff
     Schrader
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sires
     Slaughter
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Tsongas
     Vargas
     Veasey
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                             NOT VOTING--3

     Bridenstine
     Cummings
     Walz

                              {time}  1855

  Mr. GROTHMAN changed his vote from ``nay'' to ``yea.''
  So the motion to concur was agreed to.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________