[Congressional Record Volume 164, Number 50 (Thursday, March 22, 2018)]
[Senate]
[Pages S1956-S1968]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           TEXT OF AMENDMENTS

  SA 2215. Mr. CORNYN (for Mr. Young (for himself and Mr. Donnelly)) 
proposed an amendment to the bill H.R. 4851, to establish the Kennedy-
King National Historic Site in the State of Indiana, and for other 
purposes; as follows:

       In section 3, strike subsection (d).
                                 ______
                                 
  SA 2216. Ms. COLLINS (for herself, Mr. Alexander, Mr. Graham, Mr. 
Rounds, Ms. Murkowski, Mr. Isakson, and Mr. McConnell) submitted an 
amendment intended to be proposed by her to the bill H.R. 1625, to 
amend the State Department Basic Authorities Act of 1956 to include 
severe forms of trafficking in persons within the definition of 
transnational organized crime for purposes of the rewards program of 
the Department of State, and for other purposes; which was ordered to 
lie on the table; as follows:

       In division H, after section 229, insert the following:

     SEC. 230. WAIVERS FOR STATE INNOVATION; COST-SHARING 
                   PAYMENTS.

       (a) Waivers for State Innovation.--
       (1) Streamlining the state application process.--Section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052) is amended--
       (A) in subsection (a)(1)(C), by striking ``the law'' and 
     inserting ``a law or has in effect a certification''; and
       (B) in subsection (b)(2)--
       (i) in the paragraph heading, by inserting ``or certify'' 
     after ``law'';
       (ii) in subparagraph (A)--

       (I) by striking ``A law'' and inserting the following:

[[Page S1957]]

       ``(i) Laws.--A law''; and

       (II) by adding at the end the following:

       ``(ii) Certifications.--A certification described in this 
     paragraph is a document, signed by the Governor of the State, 
     that certifies that such Governor has the authority under 
     existing Federal and State law to take action under this 
     section, including implementation of the State plan under 
     subsection (a)(1)(B).''; and
       (iii) in subparagraph (B)--

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

       ``(i) repealing a law described in subparagraph (A)(i); or
       ``(ii) terminating a certification described in 
     subparagraph (A)(ii), through a certification for such 
     termination signed by the Governor of the State.''.
       (2) Giving states more funding flexibility, to establish 
     reinsurance, invisible high risk pools, insurance stability 
     funds and other programs.--
       (A) State grants under waivers.--Section 1332(a) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18052(a)) is amended--
       (i) in paragraph (3)--

       (I) in the first sentence--

       (aa) by inserting ``or would qualify for a reduced portion 
     of'' after ``would not qualify for'';
       (bb) by inserting ``, or the State would not qualify for or 
     would qualify for a reduced portion of basic health program 
     funds under section 1331,'' after ``subtitle E'';
       (cc) by inserting ``, or basic health program funds the 
     State would have received,'' after ``this title''; and
       (dd) by inserting ``or for implementing the basic health 
     program established under section 1331'' before the period;

       (II) in the second sentence, by inserting before the period 
     ``, and with respect to participation in the basic health 
     program and funds provided to such other States under section 
     1331''; and
       (III) by adding after the second sentence the following: 
     ``A State may request that all of, or any portion of, such 
     aggregate amount of such credits, reductions, or funds be 
     paid to the State as described in the first sentence.'';

       (ii) by redesignating paragraphs (4), (5), and (6) as 
     paragraphs (5), (6), and (7), respectively; and
       (iii) by inserting after paragraph (3) the following:
       ``(4) Federal funding for invisible high-risk pool and 
     reinsurance programs.--
       ``(A) Allocations.--Not later than 45 days after the date 
     of enactment of the Department of Health and Human Services 
     Appropriations Act, 2018, the Secretary, in consultation with 
     the National Association of Insurance Commissioners, shall 
     specify an allocation methodology for determining the amount 
     of funds appropriated under section 230(a)(2)(B) of the 
     Department of Health and Human Services Appropriations Act, 
     2018 for a fiscal year to be allocated for each State for 
     purposes of subparagraph (B) and section 230(a)(2)(C) of the 
     Department of Health and Human Services Appropriations Act, 
     2018.
       ``(B) State grants.--From amounts appropriated under 
     section 230(a)(2)(B) of the Department of Health and Human 
     Services Appropriations Act, 2018 for a fiscal year, the 
     Secretary shall award grants to States for each of fiscal 
     years 2018 through 2021, in amounts determined in accordance 
     with the allocation methodology under subparagraph (A), for 
     the following purposes:
       ``(i) For fiscal year 2018, for administrative costs of the 
     State associated with preparing and submitting information 
     described in subsection (a)(1)(B) that includes an invisible 
     high-risk pool or reinsurance program that meets the 
     requirements of subsection (g)(2), or costs associated with 
     the establishment of such invisible high-risk pool or 
     reinsurance program.
       ``(ii) For each of fiscal years 2019, 2020, and 2021, for 
     the establishment or maintenance of invisible high-risk pools 
     and reinsurance programs that meet the requirements of 
     subsection (g)(2) and for which the State has received a 
     waiver under this section.
       ``(C) Budget neutrality.--Funds awarded to a State under a 
     grant awarded under subparagraph (B) shall not be taken into 
     account for purposes of determining under paragraph (1) 
     whether the State waiver is budget neutral, or determining 
     under subsection (b)(1) whether the State waiver increases 
     the Federal deficit.''.
       (B) Appropriations.--
       (i) In general.--There are authorized to be appropriated, 
     and there are appropriated, to the Secretary of Health and 
     Human Services, for the purposes described in section 
     1332(a)(4)(B) of the Patient Protection and Affordable Care 
     Act and subparagraph (C), out of any funds in the Treasury 
     not otherwise appropriated--

       (I) $500,000,000 for fiscal year 2018; and
       (II) $10,000,000,000 for each of fiscal years 2019, 2020, 
     and 2021.

       (ii) Available until expended.--Amounts appropriated under 
     this paragraph shall remain available until expended.
       (C) Default federal safeguard.--
       (i) In general.--For purposes of plan year 2019, in the 
     case of a State that does not, by a date specified by the 
     Secretary of Health and Human Services (referred to in this 
     paragraph as the ``Secretary''), in consultation with the 
     National Association of Insurance Commissioners, have in 
     effect a waiver under section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) that includes an 
     invisible high-risk pool or reinsurance program that meets 
     the requirements of subsection (g)(2) of such section 1332, 
     the Secretary shall, from amounts appropriated under 
     subparagraph (B), use the allocation determined for the State 
     under subsection (a)(4)(B) of such section 1332 for plan year 
     2019 for the purpose described in clause (ii) for such State.
       (ii) Required use for market stabilization payments to 
     issuers.--The Secretary shall use any allocation for a State 
     made pursuant to clause (i) to provide incentives to 
     appropriate entities to enter into arrangements with the 
     State to help stabilize premiums for health insurance 
     coverage in the individual market in such State by providing 
     payments to such appropriate entities using payment 
     parameters and a methodology determined by the Secretary.
       (3) Ensuring patient access to more flexible health 
     plans.--Section 1332 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18052) is amended--
       (A) in subsection (b)--
       (i) in paragraph (1)--

       (I) in subparagraph (B), by striking ``at least as 
     affordable'' and inserting ``of comparable affordability, 
     including for low-income individuals, individuals with 
     serious health needs, and other vulnerable populations,''; 
     and
       (II) by amending subparagraph (D) to read as follows:

       ``(D)(i) will not increase the Federal deficit over the 
     term of the waiver; and
       ``(ii) will not increase the Federal deficit over the term 
     of the 10-year budget plan submitted under subsection 
     (a)(1)(B)(ii).'';
       (ii) by redesignating paragraph (2) (as amended by 
     paragraph (1)) as paragraph (3); and
       (iii) by inserting after paragraph (1) the following:
       ``(2) Budgetary effect.--
       ``(A) In general.--In determining whether a State plan 
     submitted under subsection (a) meets the deficit neutrality 
     requirements of paragraph (1)(D), the Secretary may take into 
     consideration the direct budgetary effect of the provisions 
     of such plan on sources of Federal funding other than the 
     funding described in subsection (a)(3).
       ``(B) Limitation.--A determination made by the Secretary 
     under subparagraph (A)--
       ``(i) shall not be construed to affect any waiver process 
     or standards or terms and conditions in effect on the date of 
     enactment of the Department of Health and Human Services 
     Appropriations Act, 2018 under title XI, XVIII, XIX, or XXI 
     of the Social Security Act, or any other Federal law relating 
     to the provision of health care items or services; and
       ``(ii) shall be made without regard to any changes in 
     policy with respect to any waiver process or provision of 
     health care items or services described in clause (i).''; and
       (B) in subsection (a)(1)(C), by striking ``subsection 
     (b)(2)'' and inserting ``subsection (b)(3)''.
       (4) Providing expedited approval of state waivers.--Section 
     1332(d) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052(d)) is amended--
       (A) in paragraph (1) by striking ``180'' and inserting 
     ``120''; and
       (B) by adding at the end the following:
       ``(3) Expedited determination.--
       ``(A) In general.--With respect to any application under 
     subsection (a)(1) submitted on or after the date of enactment 
     of the Department of Health and Human Services Appropriations 
     Act, 2018 or any such application submitted prior to such 
     date of enactment and under review by the Secretary on such 
     date of enactment, the Secretary shall make a determination 
     on such application, using the criteria for approval 
     otherwise applicable under this section, not later than 45 
     days after the receipt of such application, and shall allow 
     the public notice and comment at the State and Federal levels 
     described under subsection (a)(5) to occur concurrently if 
     such State application--
       ``(i) is submitted in response to an urgent situation, with 
     respect to areas in the State that the Secretary determines 
     are at risk for excessive premium increases or having no 
     health plans offered in the applicable health insurance 
     market for the current or following plan year;
       ``(ii) is for a waiver that is the same or substantially 
     similar to a waiver that the Secretary already has approved 
     for another State; or
       ``(iii) is for a waiver that includes an invisible high-
     risk pool or reinsurance program described in subparagraph 
     (A), (B), or (D) of subsection (g)(2).
       ``(B) Approval.--
       ``(i) Urgent situations.--

       ``(I) Provisional approval.--A waiver approved under the 
     expedited determination process under subparagraph (A)(i) 
     shall be in effect for a period of 3 years, unless the State 
     requests a shorter duration.
       ``(II) Full approval.--Subject to the requirements for 
     approval otherwise applicable under this section, not later 
     than 1 year before the expiration of a provisional waiver 
     period described in subclause (I) with respect to an 
     application described in subparagraph (A)(i), the Secretary 
     shall make a determination on whether to extend the approval 
     of such waiver for the full term of the waiver requested by 
     the State, for a total approval

[[Page S1958]]

     period not to exceed 6 years. The Secretary may request 
     additional information as the Secretary determines 
     appropriate to make such determination.

       ``(ii) Approval of same or similar applications.--An 
     approval of a waiver under subparagraph (A)(ii) shall be 
     subject to the terms of subsection (e).
       ``(C) Gao study.--Not later than 5 years after the date of 
     enactment of the Department of Health and Human Services 
     Appropriations Act, 2018, the Comptroller General of the 
     United States shall conduct a review of all waivers approved 
     pursuant to subparagraph (A)(ii) to evaluate whether such 
     waivers met the requirements of subsection (b)(1) and whether 
     the applications should have qualified for such expedited 
     process.''.
       (5) Providing certainty for state-based reforms.--Section 
     1332(e) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052(e)) is amended by striking ``No waiver'' and all 
     that follows through the period at the end and inserting the 
     following: ``A waiver under this section--
       ``(1) shall be in effect for a period of 6 years unless the 
     State requests a shorter duration;
       ``(2) may be renewed, subject to the State meeting the 
     criteria for approval otherwise applicable under this 
     section, for unlimited additional 6-year periods upon 
     application by the State; and
       ``(3) may not be suspended or terminated, in whole or in 
     part, by the Secretary at any time before the date of 
     expiration of the waiver period (including any renewal period 
     under paragraph (2)), unless the Secretary determines that 
     the State materially failed to comply with the terms and 
     conditions of the waiver.''.
       (6) Guidance and regulations.--Section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052) is 
     amended--
       (A) by adding at the end the following:
       ``(f) Guidance and Regulations.--
       ``(1) In general.--With respect to carrying out this 
     section, the Secretary shall--
       ``(A) issue guidance, not later than 60 days after the date 
     of enactment of the Department of Health and Human Services 
     Appropriations Act, 2018, that includes initial examples of 
     model State plans that meet the requirements for approval 
     under this section; and
       ``(B) periodically review the guidance issued under 
     subparagraph (A) and when appropriate, issue additional 
     examples of model State plans that meet the requirements for 
     approval under this section, which may include--
       ``(i) State plans establishing reinsurance or invisible 
     high-risk pool arrangements for purposes of covering the cost 
     of high-risk individuals;
       ``(ii) State plans expanding insurer participation, access 
     to affordable health plans, network adequacy, and health plan 
     options over the entire applicable health insurance market in 
     the State;
       ``(iii) waivers encouraging or requiring health plans in 
     such State to deploy value-based insurance designs which 
     structure enrollee cost-sharing and other health plan design 
     elements to encourage enrollees to consume high-value 
     clinical services;
       ``(iv) State plans allowing for significant variation in 
     health plan benefit design; or
       ``(v) any other State plan as the Secretary determines 
     appropriate.
       ``(2) Rescission of previous regulations and guidance.--
     Beginning on the date of enactment of the Department of 
     Health and Human Services Appropriations Act, 2018, the 
     regulations promulgated, and the guidance issued, under this 
     section prior to the date of enactment of the Department of 
     Health and Human Services Appropriations Act, 2018 shall have 
     no force or effect.''; and
       (B) in subsection (a)(5) (as redesignated by paragraph 
     (2)(A)(ii))--
       (i) in subparagraph (A), by inserting ``, as applicable'' 
     before the period; and
       (ii) in subparagraph (B), by striking ``Not later than 180 
     days after the date of enactment of this Act, the Secretary 
     shall'' and inserting ``The Secretary may''.
       (7) Invisible high risk pools and reinsurance programs.--
     Section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052), as amended by paragraph (6), is 
     further amended by adding at the end the following:
       ``(g) Invisible High Risk Pools and Reinsurance Programs.--
       ``(1) Funding.--With respect to a State that has received a 
     waiver under this section to establish an invisible high-risk 
     pool or reinsurance program described in paragraph (2), the 
     State may fund such program, in whole or in part, using one 
     or both of the following:
       ``(A) Amounts received through a grant described in 
     subsection (a)(4)(B).
       ``(B) All of, or a portion of, the payments made to the 
     State as described in subsection (a)(3), consistent with the 
     information the State provides under subsection (a)(1)(B).
       ``(2) Program design.--An invisible high-risk pool or 
     reinsurance program described in this paragraph is a program 
     that meets any of the following:
       ``(A) An invisible high-risk pool, as defined by the State, 
     under which health insurance issuers, with respect to 
     designated individuals who experience higher than average 
     health costs as determined by the State, and are enrolled in 
     health insurance coverage offered in the individual market, 
     cede risk to the pool, without affecting the premium paid by 
     the designated individuals or their terms of coverage. With 
     respect to such pool, the State, or an entity operating the 
     pool on behalf of the State, shall establish--
       ``(i) the premium amount the ceding issuer shall pay to the 
     reinsurance pool;
       ``(ii) the applicable attachment points or coinsurance 
     percentages if the ceding issuer retains any portion of the 
     risk under ceded policies; and
       ``(iii) the mechanism by which high-risk individuals are 
     designated for cession to the pool, which may include a list 
     of designated high-cost health conditions.
       ``(B) A reinsurance program, as defined by the State, that 
     assumes a portion of the risk for individuals who experience 
     higher than average health costs as determined by the State, 
     in a manner substantially similar to the reinsurance program 
     that operated in the State in accordance with section 1341.
       ``(C) A reinsurance program established by the State not 
     otherwise described in this paragraph.
       ``(D) A program based on another State's reinsurance 
     program--
       ``(i) described in subparagraph (A), (B), or (C), for which 
     an application has been approved under this subsection; or
       ``(ii) which was implemented prior to September 1, 2017, 
     and which the Secretary determines meets the requirements of 
     subparagraph (A).''.
       (8) Applicability.--The amendments made by this Act to 
     section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052)--
       (A) with respect to applications for waivers under such 
     section 1332 submitted after the date of enactment of this 
     Act and applications for such waivers submitted prior to such 
     date of enactment and under review by the Secretary on the 
     date of enactment, shall take effect on the date of enactment 
     of this Act; and
       (B) with respect to applications for waivers approved under 
     such section 1332 before the date of enactment of this Act, 
     shall not require reconsideration of whether such 
     applications meet the requirements of such section 1332, 
     except that, at the request of a State, the Secretary shall 
     recalculate the amount of funding provided under subsection 
     (a)(3) of such section.
       (9) Clarifying budget neutrality.--Section 1332(a)(1)(B) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18052(a)(1)(B)) is amended--
       (A) in clause (i), by inserting ``, including, as 
     applicable, a description of the State's plan to use any 
     amounts awarded to the State under paragraph (4) to support 
     an invisible high-risk pool or reinsurance program consistent 
     with subsection (g) and such information about such program 
     as the Secretary may require'' before the semicolon; and
       (B) in clause (ii), by inserting ``over both the term of 
     the proposed waiver and the term of the 10-year budget plan'' 
     after ``Government''.
       (b) Cost-sharing Payments.--
       (1) In general.--There is appropriated to the Secretary of 
     Health and Human Services (referred to in this section as the 
     ``Secretary''), out of any funds in the Treasury not 
     otherwise obligated, such sums as may be necessary for 
     payments for cost-sharing reductions, as authorized by 
     section 1402 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18071) for the portion of plan year 2017 that 
     begins on October 1, 2017, and ends on December 31, 2017, and 
     for plan years 2019, 2020, and 2021.
       (2) Special rules for cost-sharing reductions.--
       (A) Basic health plan.--For plan year 2018, there is 
     appropriated to the Secretary, out of any funds in the 
     Treasury not otherwise obligated, such sums as may be 
     necessary for, with respect to States that have in effect a 
     basic health plan on January 1, 2018, the portion of 
     transfers pursuant to section 1331(d) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18051(d)) 
     attributable to the cost-sharing reductions under section 
     1402 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18071) that would have been provided for plan year 
     2018 with respect to eligible individuals enrolled in 
     standard health plans in such States.
       (B) Hold harmless.--
       (i) In general.--For plan year 2018, there is appropriated 
     to the Secretary, out of any funds in the Treasury not 
     otherwise obligated, such sums as may be necessary for 
     payments for cost-sharing reductions authorized by section 
     1402 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18071) with respect to qualified health plans 
     described in clause (ii).
       (ii) Qualified health plans described.--A qualified health 
     plan described in this clause is a qualified health plan for 
     which the Secretary determines, based on a certification and 
     appropriate documentation from the issuer of such plan and a 
     certification from the applicable State regulator, that the 
     health insurance issuer of such plan has not increased 
     premium rates for plan year 2018 on account of the issuer 
     assuming, or being instructed by applicable State regulators 
     to assume, that the issuer would receive payments under such 
     section 1402.
       (C) Clarification of obligations.--
       (i) No requirements to make payments.--Notwithstanding any 
     other provision of law, there shall be no obligation under 
     this Act or any other Act, including the Patient Protection 
     and Affordable Care Act (Public Law 111-148), to make 
     payments for cost-sharing reductions under section 1402(c)(3) 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     18071(c)(3)) or advance payments for such cost-sharing 
     reductions under section

[[Page S1959]]

     1412 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18082) for plan year 2018, except for such payments 
     for which amounts are appropriated under subparagraphs (A) 
     and (B). Nothing in this clause shall be construed as 
     affecting the requirements under section 1402 of the Patient 
     Protection and Affordable Care Act for issuers to reduce 
     cost-sharing.
       (ii) No obligation to reconcile payments.--Notwithstanding 
     any other provision of law, there shall be no obligation 
     under this Act or any other Act, including the Patient 
     Protection and Affordable Care Act (Public Law 111-148), to 
     make payments on or after October 1, 2017, for the purpose of 
     reconciling any cost-sharing reduction payments by the 
     Secretary under section 1402(c)(3) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18071(c)(3)) made for plan 
     year 2016 or the plan year beginning January 1, 2017, through 
     September 30, 2017.
       (D) Treatment of previous payments.--Notwithstanding any 
     other provision of law, payments made for cost-sharing 
     reductions under section 1402 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18071) during the period 
     beginning on January 1, 2014, and ending on September 30, 
     2017, shall be treated in the same manner as a refund due 
     from the credit allowed under section 36B of the Internal 
     Revenue Code of 1986 for the purposes of section 1324 of 
     title 31, United States Code.
       (c) Health Benefits Coverage.--Notwithstanding any other 
     provision of law, including any other definition of ``health 
     benefits coverage'' for purposes of subsection (b) and (c) of 
     section 506, any use made of funds appropriated under 
     subsection (b) starting in plan year 2019, and subsection 
     (a)(2)(B) starting in plan year 2018, and any program, 
     activity, plan, or coverage funded or supported by such 
     funds, shall constitute ``health benefits coverage''.
       (d) Limitations.--The following shall apply:
       (1) Nothing in this section shall be construed to limit the 
     applicability of subsection (a), (b), or (d) of section 507.
       (2) For purposes of this section, a health insurance issuer 
     expending State, local, or private funds, shall be treated in 
     the same manner as a managed care provider described in 
     section 507(c).

     SEC. 231. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH 
                   INSURANCE IN THE INDIVIDUAL MARKET THE OPTION 
                   TO PURCHASE A LOWER PREMIUM COPPER PLAN.

       (a) In General.--Section 1302(e) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(e)) is amended--
       (1) in paragraph (1)--
       (A) by redesignating clauses (i) and (ii) of subparagraph 
     (B) as subparagraphs (A) and (B), respectively, and adjusting 
     the margins accordingly;
       (B) by striking ``plan year if--'' and all that follows 
     through ``the plan provides--'' and inserting ``plan year if 
     the plan provides--''; and
       (C) in subparagraph (A), as redesignated by paragraph (1), 
     by striking ``clause (ii)'' and inserting ``subparagraph 
     (B)'';
       (2) by striking paragraph (2); and
       (3) by redesignating paragraph (3) as paragraph (2).
       (b) Risk Pools.--Section 1312(c)(1) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18032(c)) is 
     amended by inserting ``and including enrollees in 
     catastrophic plans described in section 1302(e)'' after 
     ``Exchange''.
       (c) Conforming Amendment.--Section 1312(d)(3)(C) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18032(d)(3)(C)) is amended by striking ``, except that in the 
     case of a catastrophic plan described in section 1302(e), a 
     qualified individual may enroll in the plan only if the 
     individual is eligible to enroll in the plan under section 
     1302(e)(2)''.
       (d) Effective Date.--The amendments made by subsections 
     (a), (b), and (c) shall apply with respect to plan years 
     beginning on or after January 1, 2019.

     SEC. 232. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

       (a) Open Enrollment Reports.--For plan years 2019 and 2020, 
     the Secretary of Health and Human Services (referred to in 
     this section as the ``Secretary''), in coordination with the 
     Secretary of the Treasury and the Secretary of Labor, shall 
     issue biweekly public reports during the annual open 
     enrollment period on the performance of the Federal Exchange 
     and the Small Business Health Options Program (SHOP) 
     Marketplace. Each such report shall include a summary, 
     including information on a State-by-State basis where 
     available, of--
       (1) the number of unique website visits;
       (2) the number of individuals who create an account;
       (3) the number of calls to the call center;
       (4) the average wait time for callers contacting the call 
     center;
       (5) the number of individuals who enroll in a qualified 
     health plan; and
       (6) the percentage of individuals who enroll in a qualified 
     health plan through each of--
       (A) the website;
       (B) the call center;
       (C) navigators;
       (D) agents and brokers;
       (E) the enrollment assistant program;
       (F) directly from issuers or web brokers; and
       (G) other means.
       (b) Open Enrollment After Action Report.--For plan years 
     2019 and 2020, the Secretary, in coordination with the 
     Secretary of the Treasury and the Secretary of Labor, shall 
     publish an after action report not later than 3 months after 
     the completion of the annual open enrollment period regarding 
     the performance of the Federal Exchange and the Small 
     Business Health Options Program (SHOP) Marketplace for the 
     applicable plan year. Each such report shall include a 
     summary, including information on a State-by-State basis 
     where available, of--
       (1) the open enrollment data reported under subsection (a) 
     for the entirety of the enrollment period; and
       (2) activities related to patient navigators described in 
     section 1311(i) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18031(i)), including--
       (A) the performance objectives established by the Secretary 
     for such patient navigators;
       (B) the number of consumers enrolled by such a patient 
     navigator;
       (C) an assessment of how such patient navigators have met 
     established performance metrics, including a detailed list of 
     all patient navigators, funding received by patient 
     navigators, and whether established performance objectives of 
     patient navigators were met; and
       (D) with respect to the performance objectives described in 
     subparagraph (A)--
       (i) whether such objectives assess the full scope of 
     patient navigator responsibilities, including general 
     education, plan selection, and determination of eligibility 
     for tax credits, cost-sharing reductions, or other coverage;
       (ii) how the Secretary worked with patient navigators to 
     establish such objectives; and
       (iii) how the Secretary adjusted such objectives for case 
     complexity and other contextual factors.
       (c) Report on Advertising and Consumer Outreach.--Not later 
     than 3 months after the completion of the annual open 
     enrollment period for the 2019 plan year, the Secretary shall 
     issue a report on advertising and outreach to consumers for 
     the open enrollment period for the 2019 plan year. Such 
     report shall include a description of--
       (1) the division of spending on individual advertising 
     platforms, including television and radio advertisements and 
     digital media, to raise consumer awareness of open 
     enrollment;
       (2) the division of spending on individual outreach 
     platforms, including email and text messages, to raise 
     consumer awareness of open enrollment; and
       (3) whether the Secretary conducted targeted outreach to 
     specific demographic groups and geographic areas.
       (d) Outreach and Enrollment Activities.--
       (1) Open enrollment.--Of the amounts collected through the 
     user fees on participating health insurance issuers pursuant 
     to section 156.50 of title 45, Code of Federal Regulations 
     (or any successor regulations), the Secretary shall obligate 
     $105,800,000 for outreach and enrollment activities for each 
     of the open enrollment periods for plan years 2019 and 2020.
       (2) Outreach and enrollment activities.--
       (A) In general.--For purposes of this subsection, the term 
     ``outreach and enrollment activities'' means--
       (i) activities to educate consumers about coverage options 
     or to encourage consumers to enroll in or maintain health 
     insurance coverage (excluding allocations to the call center 
     for the Federal Exchange); and
       (ii) activities conducted by an in-person consumer 
     assistance program that does not have a conflict of interest 
     and that, among other activities, facilitates enrollment of 
     individuals through the Federal Exchange, and distributes 
     fair and impartial information concerning enrollment through 
     such Exchange and the availability of tax credits and cost-
     sharing reductions.
       (B) Connection with federal exchange.--Activities conducted 
     under this subsection shall be in connection with the 
     operation of the Federal Exchange, to provide special 
     benefits to health insurance issuers participating in the 
     Federal Exchange.
       (3) Contract authority.--The Secretary may contract with a 
     State to conduct outreach and enrollment activities for plan 
     years 2019 and 2020. Any outreach and enrollment activities 
     conducted by a State or other entity at the direction of the 
     State, in accordance with such a contract, shall be treated 
     as Federal activities to provide special benefits to 
     participating health insurance issuers consistent with OMB 
     Circular No. A-25R.
       (4) Clarifications.--
       (A) Prior funding.--Nothing in this subsection should be 
     construed as rescinding or cancelling any funds already 
     obligated on the date of enactment of this Act for outreach 
     and enrollment activities for plan year 2019.
       (B) Availability of funding.--The Secretary shall ensure 
     that outreach and enrollment activities are conducted in all 
     applicable States, including, as necessary, by providing for 
     such activities through contracts described in paragraph (3).

     SEC. 233. OFFERING HEALTH PLANS IN MORE THAN ONE STATE.

       Not later than 1 year after the date of enactment of this 
     Act, the Secretary of Health and Human Services, in 
     consultation with the National Association of Insurance 
     Commissioners, shall issue regulations for the implementation 
     of health care choice compacts established under section 1333 
     of the Patient Protection and Affordable Care Act

[[Page S1960]]

     (42 U.S.C. 18053) to allow for the offering of health plans 
     in more than one State.

     SEC. 234. CONSUMER NOTIFICATION.

       In addition to any applicable Federal requirements with 
     respect to short-term limited duration insurance, a State 
     insurance commissioner shall require the issuer of short-
     term, limited duration insurance approved for sale in the 
     State to display prominently in marketing materials, the 
     contract, and application materials provided in connection 
     with enrollment in such insurance a notice to consumers that 
     includes such information as the State insurance commissioner 
     determines sufficient to inform the individual that coverage 
     and benefits under such insurance differ from coverage and 
     benefits under qualified health plans.
                                 ______
                                 
  SA 2217. Mr. McCONNELL proposed an amendment to the bill H.R. 1625, 
to amend the State Department Basic Authorities Act of 1956 to include 
severe forms of trafficking in persons within the definition of 
transnational organized crime for purposes of the rewards program of 
the Department of State, and for other purposes; as follows:

       At the end add the following.
       ``This Act shall take effect 1 day after the date of 
     enactment.''
                                 ______
                                 
  SA 2218. Mr. McCONNELL proposed an amendment to amendment SA 2217 
proposed by Mr. McConnell to the bill H.R. 1625, to amend the State 
Department Basic Authorities Act of 1956 to include severe forms of 
trafficking in persons within the definition of transnational organized 
crime for purposes of the rewards program of the Department of State, 
and for other purposes; as follows:

       Strike ``1 day'' and insert ``2 days''
                                 ______
                                 
  SA 2219. Mr. McCONNELL proposed an amendment to the bill H.R. 1625, 
to amend the State Department Basic Authorities Act of 1956 to include 
severe forms of trafficking in persons within the definition of 
transnational organized crime for purposes of the rewards program of 
the Department of State, and for other purposes; as follows:

       At the end add the following.
       ``This Act shall take effect 3 days after the date of 
     enactment.''
                                 ______
                                 
  SA 2220. Mr. McCONNELL proposed an amendment to amendment SA 2219 
proposed by Mr. McConnell to the bill H.R. 1625, to amend the State 
Department Basic Authorities Act of 1956 to include severe forms of 
trafficking in persons within the definition of transnational organized 
crime for purposes of the rewards program of the Department of State, 
and for other purposes; as follows:

       Strike ``3 days'' and insert ``4 days''
                                 ______
                                 
  SA 2221. Mr. McCONNELL proposed an amendment to amendment SA 2220 
proposed by Mr. McConnell to the amendment SA 2219 proposed by Mr. 
McConnell to the bill H.R. 1625, to amend the State Department Basic 
Authorities Act of 1956 to include severe forms of trafficking in 
persons within the definition of transnational organized crime for 
purposes of the rewards program of the Department of State, and for 
other purposes; as follows:

       Strike ``4'' and insert ``5''
                                 ______
                                 
  SA 2222. Mrs. MURRAY submitted an amendment intended to be proposed 
by her to the bill H.R. 1625, to amend the State Department Basic 
Authorities Act of 1956 to include severe forms of trafficking in 
persons within the definition of transnational organized crime for 
purposes of the rewards program of the Department of State, and for 
other purposes; which was ordered to lie on the table; as follows:

       At the end, add the following:

            DIVISION W--BIPARTISAN HEALTH CARE STABILIZATION

     SECTION 1. SHORT TITLE.

       This division may be cited as the ``Bipartisan Health Care 
     Stabilization Act of 2018''.

     SEC. 2. WAIVERS FOR STATE INNOVATION; COST-SHARING PAYMENTS.

       (a) Waivers for State Innovation.--
       (1) Streamlining the state application process.--Section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052) is amended--
       (A) in subsection (a)(1)(C), by striking ``the law'' and 
     inserting ``a law or has in effect a certification''; and
       (B) in subsection (b)(2)--
       (i) in the paragraph heading, by inserting ``or certify'' 
     after ``law'';
       (ii) in subparagraph (A)--

       (I) by striking ``A law'' and inserting the following:

       ``(i) Laws.--A law''; and

       (II) by adding at the end the following:

       ``(ii) Certifications.--A certification described in this 
     paragraph is a document, signed by the Governor of the State, 
     that certifies that such Governor has the authority under 
     existing Federal and State law to take action under this 
     section, including implementation of the State plan under 
     subsection (a)(1)(B).''; and
       (iii) in subparagraph (B)--

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

       ``(i) repealing a law described in subparagraph (A)(i); or
       ``(ii) terminating a certification described in 
     subparagraph (A)(ii), through a certification for such 
     termination signed by the Governor of the State.''.
       (2) Giving states more funding flexibility, to establish 
     reinsurance, high risk pools, invisible high risk pools, 
     insurance stability funds and other programs.--
       (A) State grants under waivers.--Section 1332(a) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18052(a)) is amended--
       (i) in paragraph (3)--

       (I) in the first sentence--

       (aa) by inserting ``or would qualify for a reduced portion 
     of'' after ``would not qualify for'';
       (bb) by inserting ``, or the State would not qualify for or 
     would qualify for a reduced portion of basic health program 
     funds under section 1331,'' after ``subtitle E'';
       (cc) by inserting ``, or basic health program funds the 
     State would have received,'' after ``this title''; and
       (dd) by inserting ``or for implementing the basic health 
     program established under section 1331'' before the period;

       (II) in the second sentence, by inserting before the period 
     ``, and with respect to participation in the basic health 
     program and funds provided to such other States under section 
     1331''; and
       (III) by adding after the second sentence the following: 
     ``A State may request that all of, or any portion of, such 
     aggregate amount of such credits, reductions, or funds be 
     paid to the State as described in the first sentence.'';

       (ii) by redesignating paragraphs (4), (5), and (6) as 
     paragraphs (5), (6), and (7), respectively; and
       (iii) by inserting after paragraph (3) the following:
       ``(4) Federal funding for invisible high-risk pool and 
     reinsurance programs.--
       ``(A) Allocations.--Not later than 45 days after the date 
     of enactment of the Bipartisan Health Care Stabilization Act 
     of 2018, the Secretary, in consultation with the National 
     Association of Insurance Commissioners, shall specify an 
     allocation methodology for determining the amount of funds 
     appropriated under section 2(a)(2)(B) of the Bipartisan 
     Health Care Stabilization Act of 2018 for a fiscal year to be 
     allocated for each State for purposes of subparagraph (B). 
     Such methodology shall allocate funds in a manner that would 
     yield a similar level of premium reduction in all States if 
     all States applied for and received funding, taking into 
     account market stability and competition in the various 
     States. If not all States apply for and receive funding under 
     subparagraph (B), remaining funds shall be used to carry out 
     section 2(a)(2)(C) of the Bipartisan Health Care 
     Stabilization Act of 2018.
       ``(B) State grants.--From amounts appropriated under 
     section 2(a)(2)(B) of the Bipartisan Health Care 
     Stabilization Act of 2018 for a fiscal year, the Secretary 
     shall award grants to States for each of fiscal years 2018 
     through 2021, in amounts determined in accordance with the 
     allocation methodology under subparagraph (A), for the 
     following purposes:
       ``(i) For fiscal year 2018, for administrative costs of the 
     State associated with preparing and submitting information 
     described in subsection (a)(1)(B) that includes an invisible 
     high-risk pool or reinsurance program that meets the 
     requirements of subsection (g)(2), or costs associated with 
     the establishment of such invisible high-risk pool or 
     reinsurance program.
       ``(ii) For each of fiscal years 2019, 2020, and 2021, for 
     the establishment or maintenance of invisible high-risk pools 
     and reinsurance programs that meet the requirements of 
     subsection (g)(2) and for which the State has received a 
     waiver under this section.
       ``(C) Budget neutrality.--Funds awarded to a State under a 
     grant awarded under subparagraph (B) shall not be taken into 
     account for purposes of determining under paragraph (1) 
     whether the State waiver is budget neutral, or determining 
     under subsection (b)(1) whether the State waiver increases 
     the Federal deficit.''.
       (B) Appropriations.--
       (i) In general.--There are authorized to be appropriated, 
     and there are appropriated, to the Secretary of Health and 
     Human Services, for the purposes described in section 
     1332(a)(4)(B) of the Patient Protection and Affordable Care 
     Act and subparagraph (C), out of any funds in the Treasury 
     not otherwise appropriated--

       (I) $500,000,000 for fiscal year 2018; and
       (II) $10,000,000,000 for each of fiscal years 2019, 2020, 
     and 2021.

       (ii) Available until expended.--Amounts appropriated under 
     this paragraph shall remain available until expended.
       (C) Default federal safeguard.--
       (i) In general.--For purposes of plan years 2019 through 
     2021, in the case of a State that

[[Page S1961]]

     does not, by a date specified by the Secretary of Health and 
     Human Services (referred to in this subparagraph as the 
     ``Secretary''), in consultation with the National Association 
     of Insurance Commissioners, have in effect a waiver under 
     section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052) that includes an invisible high-risk 
     pool or reinsurance program that meets the requirements of 
     subsection (g)(2) of such section 1332, the Secretary shall, 
     from amounts appropriated under subparagraph (B), use the 
     allocation determined for the State under subsection 
     (a)(4)(B) of such section 1332 for plan years 2019 through 
     2021 for the purpose described in clause (ii) for such State.
       (ii) Required use for market stabilization payments to 
     issuers.--The Secretary shall enter into arrangements with 
     the State or appropriate non-profit entities to help 
     stabilize premiums for health insurance coverage in the 
     individual market, by providing payments to insurers with 
     respect to enrollees whose claims exceed a dollar amount 
     established by the Secretary, in an amount equal to 80 
     percent of the amount of such claims.
       (3) Ensuring patient access to more flexible health 
     plans.--Section 1332 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18052) is amended--
       (A) in subsection (b)--
       (i) in paragraph (1)--

       (I) in subparagraph (B), by striking ``at least as 
     affordable'' and inserting ``of comparable affordability, 
     including for low-income individuals, individuals with 
     serious health needs, and other vulnerable populations,''; 
     and
       (II) by amending subparagraph (D) to read as follows:

       ``(D)(i) will not increase the Federal deficit over the 
     term of the waiver; and
       ``(ii) will not increase the Federal deficit over the term 
     of the 10-year budget plan submitted under subsection 
     (a)(1)(B)(ii).'';
       (ii) by redesignating paragraph (2) (as amended by 
     paragraph (1)) as paragraph (3); and
       (iii) by inserting after paragraph (1) the following:
       ``(2) Budgetary effect.--
       ``(A) In general.--In determining whether a State plan 
     submitted under subsection (a) meets the deficit neutrality 
     requirements of paragraph (1)(D), the Secretary may take into 
     consideration the direct budgetary effect of the provisions 
     of such plan on sources of Federal funding other than the 
     funding described in subsection (a)(3).
       ``(B) Limitation.--A determination made by the Secretary 
     under subparagraph (A)--
       ``(i) shall not be construed to affect any waiver process 
     or standards or terms and conditions in effect on the date of 
     enactment of the Bipartisan Health Care Stabilization Act of 
     2018 under title XI, XVIII, XIX, or XXI of the Social 
     Security Act, or any other Federal law relating to the 
     provision of health care items or services; and
       ``(ii) shall be made without regard to any changes in 
     policy with respect to any waiver process or provision of 
     health care items or services described in clause (i).''; and
       (B) in subsection (a)(1)(C), by striking ``subsection 
     (b)(2)'' and inserting ``subsection (b)(3)''.
       (4) Providing expedited approval of state waivers.--Section 
     1332(d) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052(d)) is amended--
       (A) in paragraph (1) by striking ``180'' and inserting 
     ``120''; and
       (B) by adding at the end the following:
       ``(3) Expedited determination.--
       ``(A) In general.--With respect to any application under 
     subsection (a)(1) submitted on or after the date of enactment 
     of the Bipartisan Health Care Stabilization Act of 2018 or 
     any such application submitted prior to such date of 
     enactment and under review by the Secretary on such date of 
     enactment, the Secretary shall make a determination on such 
     application, using the criteria for approval otherwise 
     applicable under this section, not later than 45 days after 
     the receipt of such application, and shall allow the public 
     notice and comment at the State and Federal levels described 
     under subsection (a)(5) to occur concurrently if such State 
     application--
       ``(i) is submitted in response to an urgent situation, with 
     respect to areas in the State that the Secretary determines 
     are at risk for excessive premium increases or having no 
     health plans offered in the applicable health insurance 
     market for the current or following plan year; or
       ``(ii) is for a waiver that is the same or substantially 
     similar to a waiver that the Secretary already has approved 
     for another State.
       ``(B) Approval.--
       ``(i) Urgent situations.--

       ``(I) Provisional approval.--A waiver approved under the 
     expedited determination process under subparagraph (A)(i) 
     shall be in effect for a period of 3 years, unless the State 
     requests a shorter duration.
       ``(II) Full approval.--Subject to the requirements for 
     approval otherwise applicable under this section, not later 
     than 1 year before the expiration of a provisional waiver 
     period described in subclause (I) with respect to an 
     application described in subparagraph (A)(i), the Secretary 
     shall make a determination on whether to extend the approval 
     of such waiver for the full term of the waiver requested by 
     the State, for a total approval period not to exceed 6 years. 
     The Secretary may request additional information as the 
     Secretary determines appropriate to make such determination.

       ``(ii) Approval of same or similar applications.--An 
     approval of a waiver under subparagraph (A)(ii) shall be 
     subject to the terms of subsection (e).
       ``(C) Gao study.--Not later than 5 years after the date of 
     enactment of the Bipartisan Health Care Stabilization Act of 
     2018, the Comptroller General of the United States shall 
     conduct a review of all waivers approved pursuant to 
     subparagraph (A)(ii) to evaluate whether such waivers met the 
     requirements of subsection (b)(1) and whether the 
     applications should have qualified for such expedited 
     process.''.
       (5) Providing certainty for state-based reforms.--Section 
     1332(e) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052(e)) is amended by striking ``No waiver'' and all 
     that follows through the period at the end and inserting the 
     following: ``A waiver under this section--
       ``(1) shall be in effect for a period of 6 years unless the 
     State requests a shorter duration;
       ``(2) may be renewed, subject to the State meeting the 
     criteria for approval otherwise applicable under this 
     section, for unlimited additional 6-year periods upon 
     application by the State; and
       ``(3) may not be suspended or terminated, in whole or in 
     part, by the Secretary at any time before the date of 
     expiration of the waiver period (including any renewal period 
     under paragraph (2)), unless the Secretary determines that 
     the State materially failed to comply with the terms and 
     conditions of the waiver.''.
       (6) Guidance and regulations.--Section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052) is 
     amended--
       (A) by adding at the end the following:
       ``(f) Guidance and Regulations.--
       ``(1) In general.--With respect to carrying out this 
     section, the Secretary shall--
       ``(A) issue guidance, not later than 60 days after the date 
     of enactment of the Bipartisan Health Care Stabilization Act 
     of 2018, that includes initial examples of model State plans 
     that meet the requirements for approval under this section; 
     and
       ``(B) periodically review the guidance issued under 
     subparagraph (A) and when appropriate, issue additional 
     examples of model State plans that meet the requirements for 
     approval under this section, which may include--
       ``(i) State plans establishing reinsurance or invisible 
     high-risk pool arrangements for purposes of covering the cost 
     of high-risk individuals;
       ``(ii) State plans expanding insurer participation, access 
     to affordable health plans, network adequacy, and health plan 
     options over the entire applicable health insurance market in 
     the State;
       ``(iii) waivers encouraging or requiring health plans in 
     such State to deploy value-based insurance designs which 
     structure enrollee cost-sharing and other health plan design 
     elements to encourage enrollees to consume high-value 
     clinical services;
       ``(iv) State plans allowing for significant variation in 
     health plan benefit design; or
       ``(v) any other State plan as the Secretary determines 
     appropriate.
       ``(2) Rescission of previous regulations and guidance.--
     Beginning on the date of enactment of the Bipartisan Health 
     Care Stabilization Act of 2018, the regulations promulgated, 
     and the guidance issued, under this section prior to the date 
     of enactment of the Bipartisan Health Care Stabilization Act 
     of 2018 shall have no force or effect.''; and
       (B) in subsection (a)(5) (as redesignated by paragraph 
     (2)(A)(ii))--
       (i) in subparagraph (A), by inserting ``, as applicable'' 
     before the period; and
       (ii) in subparagraph (B), by striking ``Not later than 180 
     days after the date of enactment of this Act, the Secretary 
     shall'' and inserting ``The Secretary may''.
       (7) Invisible high risk pools and reinsurance programs.--
     Section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052), as amended by paragraph (6), is 
     further amended by adding at the end the following:
       ``(g) Invisible High Risk Pools and Reinsurance Programs.--
       ``(1) Funding.--With respect to a State that has received a 
     waiver under this section to establish an invisible high-risk 
     pool or reinsurance program described in paragraph (2), the 
     State may fund such program, in whole or in part, using one 
     or both of the following:
       ``(A) Amounts received through a grant described in 
     subsection (a)(4)(B).
       ``(B) All of, or a portion of, the payments made to the 
     State as described in subsection (a)(3), consistent with the 
     information the State provides under subsection (a)(1)(B).
       ``(2) Program design.--An invisible high-risk pool or 
     reinsurance program described in this paragraph is a program 
     that meets any of the following:
       ``(A) An invisible high-risk pool, as defined by the State, 
     under which health insurance issuers, with respect to 
     designated individuals who experience higher than average 
     health costs as determined by the State, and are enrolled in 
     health insurance coverage offered in the individual market, 
     cede risk to the pool, without affecting the premium paid by 
     the designated individuals or their terms of coverage. With 
     respect to such pool, the State, or an entity operating the 
     pool on behalf of the State, shall establish--
       ``(i) the premium amount the ceding issuer shall pay to the 
     reinsurance pool;

[[Page S1962]]

       ``(ii) the applicable attachment points or coinsurance 
     percentages if the ceding issuer retains any portion of the 
     risk under ceded policies; and
       ``(iii) the mechanism by which high-risk individuals are 
     designated for cession to the pool, which may include a list 
     of designated high-cost health conditions.
       ``(B) A reinsurance program, as defined by the State, that 
     assumes a portion of the risk for individuals who experience 
     higher than average health costs as determined by the State, 
     in a manner substantially similar to the reinsurance program 
     that operated in the State in accordance with section 1341.
       ``(C) A reinsurance program established by the State not 
     otherwise described in this paragraph.
       ``(D) A program based on another State's reinsurance 
     program--
       ``(i) described in subparagraph (A), (B), or (C), for which 
     an application has been approved under this subsection; or
       ``(ii) which was implemented prior to the date of enactment 
     of the Bipartisan Health Care Stabilization Act of 2018, and 
     which the Secretary determines meets the requirements of 
     subparagraph (A).
       ``(3) Single risk pool.--An invisible high-risk pool or 
     reinsurance program established in accordance with this 
     subsection shall not be considered a separate risk pool for 
     purposes of section 1312(c).''.
       (8) Applicability.--The amendments made by this Act to 
     section 1332 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18052)--
       (A) with respect to applications for waivers under such 
     section 1332 submitted after the date of enactment of this 
     Act and applications for such waivers submitted prior to such 
     date of enactment and under review by the Secretary on the 
     date of enactment, shall take effect on the date of enactment 
     of this Act; and
       (B) with respect to applications for waivers approved under 
     such section 1332 before the date of enactment of this Act, 
     shall not require reconsideration of whether such 
     applications meet the requirements of such section 1332, 
     except that, at the request of a State, the Secretary shall 
     recalculate the amount of funding provided under subsection 
     (a)(3) of such section.
       (9) Clarifying budget neutrality.--Section 1332(a)(1)(B) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18052(a)(1)(B)) is amended--
       (A) in clause (i), by inserting ``, including, as 
     applicable, a description of the State's plan to use any 
     amounts awarded to the State under paragraph (4) to support 
     an invisible high-risk pool or reinsurance program consistent 
     with subsection (g) and such information about such program 
     as the Secretary may require'' before the semicolon; and
       (B) in clause (ii), by inserting ``over both the term of 
     the proposed waiver and the term of the 10-year budget plan'' 
     after ``Government''.
       (b) Cost-sharing Payments.--
       (1) In general.--There is appropriated to the Secretary of 
     Health and Human Services (referred to in this section as the 
     ``Secretary''), out of any funds in the Treasury not 
     otherwise obligated, such sums as may be necessary for 
     payments for cost-sharing reductions, as authorized by 
     section 1402 of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18071) for plan years 2017, 2019, 2020, and 
     2021.
       (2) Special rules for cost-sharing reductions.--
       (A) Basic health plan.--For plan year 2018, there is 
     appropriated to the Secretary, out of any funds in the 
     Treasury not otherwise obligated, such sums as may be 
     necessary for, with respect to States that have in effect a 
     basic health plan on January 1, 2018, the portion of 
     transfers pursuant to section 1331(d) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18051(d)) 
     attributable to the cost-sharing reductions under section 
     1402 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18071) that would have been provided for plan year 
     2018 with respect to eligible individuals enrolled in 
     standard health plans in such States.
       (B) Hold harmless.--
       (i) In general.--For plan year 2018, there is appropriated 
     to the Secretary, out of any funds in the Treasury not 
     otherwise obligated, such sums as may be necessary for 
     payments for cost-sharing reductions authorized by section 
     1402 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18071) with respect to specified qualified health 
     plans described in clause (ii).
       (ii) Specified qualified health plans described.--A 
     specified qualified health plan described in this clause is a 
     qualified health plan--

       (I) offered in a State that--

       (aa) prohibited increasing premium rates to account for 
     non-payment of cost-sharing reductions under section 1402 of 
     the Patient Protection and Affordable Care Act; or
       (bb) did not provide guidance on whether to increase 
     premiums to account for non-payment of cost-sharing reduction 
     under such section 1402; and

       (II) for which the Secretary determines, based on a 
     certification and appropriate documentation from the issuer 
     of such plan and a certification from the applicable State 
     regulator, that the health insurance issuer of such plan has 
     not increased premium rates for plan year 2018 on account of 
     the issuer assuming, or being instructed by applicable State 
     regulators to assume, that the issuer would receive payments 
     under such section 1402.

       (3) Protecting consumers from increased out-of-pocket 
     costs.--Section 1402 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18071) is amended by adding at the end, 
     the following:
       ``(g) Additional Reduction.--
       ``(1) Reduction for low income insureds.--For plan years 
     2019 through 2021, in addition to the cost-sharing reductions 
     under subsection (c), the Secretary shall establish 
     procedures under which the issuer of a qualified health plan 
     to which this section applies shall further reduce cost-
     sharing under the plan in a manner sufficient to--
       ``(A) in the case of an eligible insured whose household 
     income is not less than 150 percent but not more than 250 
     percent of the poverty line for a family of the size 
     involved, increase the plan's share of the total allowed 
     costs of benefits provided under the plan to 87 percent of 
     such costs; and
       ``(B) in the case of an eligible insured whose household 
     income is not less than 250 percent but not more than 400 
     percent of the poverty line for a family of the size 
     involved, increase the plan's share of the total allowed 
     costs of benefits provided under the plan to 80 percent of 
     such costs.''.
       ``(2) Conforming amendment.--For plan years 2019 through 
     2021, in addition to the coordination with actuarial value 
     limits under subsection (c)(1)(B),the Secretary shall ensure 
     that the reductions under subsection (c)(1) do not result in 
     an increase in the plan's share of the total allowed costs of 
     benefits provided under the plan above--
       ``(A) 87 percent, in the case of an eligible insured 
     described in paragraph (1)(A); and
       ``(B) 80 percent, in the case of an eligible insured 
     described in paragraph (1)(B).''.

     SEC. 3. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE 
                   IN THE INDIVIDUAL MARKET THE OPTION TO PURCHASE 
                   A LOWER PREMIUM COPPER PLAN.

       (a) In General.--Section 1302(e) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(e)) is amended--
       (1) in paragraph (1)--
       (A) by redesignating clauses (i) and (ii) of subparagraph 
     (B) as subparagraphs (A) and (B), respectively, and adjusting 
     the margins accordingly;
       (B) by striking ``plan year if--'' and all that follows 
     through ``the plan provides--'' and inserting ``plan year if 
     the plan provides--''; and
       (C) in subparagraph (A), as redesignated by paragraph (1), 
     by striking ``clause (ii)'' and inserting ``subparagraph 
     (B)'';
       (2) by striking paragraph (2); and
       (3) by redesignating paragraph (3) as paragraph (2).
       (b) Risk Pools.--Section 1312(c)(1) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18032(c)) is 
     amended by inserting ``and including enrollees in 
     catastrophic plans described in section 1302(e)'' after 
     ``Exchange''.
       (c) Conforming Amendment.--Section 1312(d)(3)(C) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18032(d)(3)(C)) is amended by striking ``, except that in the 
     case of a catastrophic plan described in section 1302(e), a 
     qualified individual may enroll in the plan only if the 
     individual is eligible to enroll in the plan under section 
     1302(e)(2)''.
       (d) Effective Date.--The amendments made by subsections 
     (a), (b), and (c) shall apply with respect to plan years 
     beginning on or after January 1, 2019.

     SEC. 4. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

       (a) Open Enrollment Reports.--For plan years 2019 through 
     2021, the Secretary of Health and Human Services (referred to 
     in this section as the ``Secretary''), in coordination with 
     the Secretary of the Treasury and the Secretary of Labor, 
     shall issue biweekly public reports during the annual open 
     enrollment period on the performance of the Federal Exchange 
     and the Small Business Health Options Program (SHOP) 
     Marketplace. Each such report shall include a summary, 
     including information on a State-by-State basis where 
     available, of--
       (1) the number of unique website visits;
       (2) the number of individuals who create an account;
       (3) the number of calls to the call center;
       (4) the average wait time for callers contacting the call 
     center;
       (5) the number of individuals who enroll in a qualified 
     health plan; and
       (6) the percentage of individuals who enroll in a qualified 
     health plan through each of--
       (A) the website;
       (B) the call center;
       (C) navigators;
       (D) agents and brokers;
       (E) the enrollment assistant program;
       (F) directly from issuers or web brokers; and
       (G) other means.
       (b) Open Enrollment After Action Report.--For plan years 
     2019 through 2021, the Secretary, in coordination with the 
     Secretary of the Treasury and the Secretary of Labor, shall 
     publish an after action report not later than 3 months after 
     the completion of the annual open enrollment period regarding 
     the performance of the Federal Exchange and the Small 
     Business Health Options Program (SHOP) Marketplace for the 
     applicable plan year. Each such report shall include a 
     summary, including information on a State-by-State basis 
     where available, of--

[[Page S1963]]

       (1) the open enrollment data reported under subsection (a) 
     for the entirety of the enrollment period; and
       (2) activities related to patient navigators described in 
     section 1311(i) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18031(i)), including--
       (A) the performance objectives established by the Secretary 
     for such patient navigators;
       (B) the number of consumers enrolled by such a patient 
     navigator;
       (C) an assessment of how such patient navigators have met 
     established performance metrics, including a detailed list of 
     all patient navigators, funding received by patient 
     navigators, and whether established performance objectives of 
     patient navigators were met; and
       (D) with respect to the performance objectives described in 
     subparagraph (A)--
       (i) whether such objectives assess the full scope of 
     patient navigator responsibilities, including general 
     education, plan selection, and determination of eligibility 
     for tax credits, cost-sharing reductions, or other coverage;
       (ii) how the Secretary worked with patient navigators to 
     establish such objectives; and
       (iii) how the Secretary adjusted such objectives for case 
     complexity and other contextual factors.
       (c) Report on Advertising and Consumer Outreach.--Not later 
     than 3 months after the completion of the annual open 
     enrollment period for the 2019 plan year, the Secretary shall 
     issue a report on advertising and outreach to consumers for 
     the open enrollment period for the 2019 plan year. Such 
     report shall include a description of--
       (1) the division of spending on individual advertising 
     platforms, including television and radio advertisements and 
     digital media, to raise consumer awareness of open 
     enrollment;
       (2) the division of spending on individual outreach 
     platforms, including email and text messages, to raise 
     consumer awareness of open enrollment; and
       (3) whether the Secretary conducted targeted outreach to 
     specific demographic groups and geographic areas.
       (d) Outreach and Enrollment Activities.--
       (1) Open enrollment.--Of the amounts collected through the 
     user fees on participating health insurance issuers pursuant 
     to section 156.50 of title 45, Code of Federal Regulations 
     (or any successor regulations), the Secretary shall obligate 
     $105,800,000 for outreach and enrollment activities for each 
     of the open enrollment periods for plan years 2019 through 
     2021.
       (2) Outreach and enrollment activities.--
       (A) In general.--For purposes of this subsection, the term 
     ``outreach and enrollment activities'' means--
       (i) activities to educate consumers about coverage options 
     or to encourage consumers to enroll in or maintain health 
     insurance coverage (excluding allocations to the call center 
     for the Federal Exchange); and
       (ii) activities conducted by an in-person consumer 
     assistance program that does not have a conflict of interest 
     and that, among other activities, facilitates enrollment of 
     individuals through the Federal Exchange, and distributes 
     fair and impartial information concerning enrollment through 
     such Exchange and the availability of tax credits and cost-
     sharing reductions.
       (B) Connection with federal exchange.--Activities conducted 
     under this subsection shall be in connection with the 
     operation of the Federal Exchange, to provide special 
     benefits to health insurance issuers participating in the 
     Federal Exchange.
       (3) Contract authority.--The Secretary may contract with a 
     State to conduct outreach and enrollment activities for plan 
     years 2019 through 2021. Any outreach and enrollment 
     activities conducted by a State or other entity at the 
     direction of the State, in accordance with such a contract, 
     shall be treated as Federal activities to provide special 
     benefits to participating health insurance issuers consistent 
     with OMB Circular No. A-25R.
       (4) Clarifications.--
       (A) Prior funding.--Nothing in this subsection should be 
     construed as rescinding or cancelling any funds already 
     obligated on the date of enactment of this Act for outreach 
     and enrollment activities for plan year 2019.
       (B) Availability of funding.--The Secretary shall ensure 
     that outreach and enrollment activities are conducted in all 
     applicable States, including, as necessary, by providing for 
     such activities through contracts described in paragraph (3).

     SEC. 5. OFFERING HEALTH PLANS IN MORE THAN ONE STATE.

       Not later than 1 year after the date of enactment of this 
     Act, the Secretary of Health and Human Services, in 
     consultation with the National Association of Insurance 
     Commissioners, shall issue regulations for the implementation 
     of health care choice compacts established under section 1333 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     18053) to allow for the offering of health plans in more than 
     one State.

     SEC. 6. SHORT-TERM LIMITED DURATION HEALTH INSURANCE 
                   POLICIES.

       (a) Prohibition on Proposed Rule.--Notwithstanding any 
     other provision of law, the Secretary of Health and Human 
     Services, the Secretary of the Treasury, and the Secretary of 
     Labor may not take any action to implement, enforce, or 
     otherwise give effect to the proposed rule relating to the 
     definition of short-term limited-duration insurance (83 Fed. 
     Reg. 7437-7447, February 21, 2018), insofar as such proposed 
     rule relates to a revised definition of the term ``short-term 
     limited duration insurance'' and the Secretaries shall 
     implement, enforce, and otherwise give effect to the 
     definition of such term as applied by the Secretaries under 
     the regulations in effect on the date of enactment of this 
     Act (81 Fed. Reg. 75316), and such regulations shall continue 
     in effect with respect to policies until the effective date 
     described in subsection (b)(2).
       (b) Standards.--
       (1) In general.--Section 2791(b) of the Public Health 
     Service Act (42 U.S.C. 300gg-91) is amended by adding at the 
     end the following:
       ``(6) Short-term limited duration insurance.--The term 
     `short-term limited duration insurance' means health 
     insurance coverage provided pursuant to a contract with a 
     health insurance issuer that--
       ``(A) has a specified, limited duration not to exceed 93 
     days after the original effective date of the contract, 
     except that the health plan may permit coverage to continue 
     until the end of the period of hospitalization for a 
     condition for which the covered person was hospitalized on 
     the day that coverage would otherwise have ended;
       ``(B) is non-renewable and issued only to individuals who 
     have not been covered under a short-term limited duration 
     insurance policy from any health insurance issuer within the 
     prior 12 months;
       ``(C) displays prominently in marketing materials, the 
     contract, and in any application materials provided in 
     connection with enrollment in such insurance a notice to 
     consumers that includes such information which the State 
     insurance commissioner deems sufficient to inform the 
     individual that coverage and benefits are limited;
       ``(D) covers essential health benefits as set forth in 
     section 1302 of the Patient Protection and Affordable Care 
     Act;
       ``(E) meets the following requirements for individual 
     health insurance coverage as set forth in this title--
       ``(i) section 2701 (relating to fair health insurance 
     premiums);
       ``(ii) section 2702 (relating to guaranteed availability of 
     coverage), except as provided in paragraph (1) consistent 
     with the limitations of subsection (c);
       ``(iii) section 2704 (relating to the prohibition of pre-
     existing condition exclusions or other discrimination based 
     on health status);
       ``(iv) section 2705 (relating to the prohibition of 
     discrimination against individual participants and 
     beneficiaries based on health status);
       ``(v) section 2706 (relating to nondiscrimination in health 
     care);
       ``(vi) section 2707 (relating to comprehensive health 
     insurance coverage);
       ``(vii) section 2711 (prohibiting lifetime and annual 
     limits);
       ``(viii) section 2712 (prohibiting rescissions);
       ``(ix) section 2713 (coverage of preventive health 
     services);
       ``(x) section 2714 (relating to coverage of dependents); 
     and
       ``(xi) section 2719 (relating to appeals); and
       ``(F) upon the issuance of a health insurance plan that an 
     issuer asserts to be short-term limited duration insurance, 
     the issuer of such plan shall provide documentation to the 
     Secretary and the State insurance commissioner, in a form 
     determined by the Secretary, regarding the individuals 
     covered by the plan and the duration of the plan which shall 
     be reviewed by the entity responsible for enforcement under 
     section 2722, together with documentation submitted by other 
     issuers, to determine whether the plan satisfies the 
     requirement under subparagraph (B) and, if not, such entity 
     shall take appropriate enforcement action.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall apply to plan years beginning on or after January 1, 
     2019.

     SEC. 7. FUNDING.

       Notwithstanding any other provision of law related to the 
     services described in subsection (b)(1)(B) of section 1303 of 
     Public Law 111-148, amounts appropriated under this division 
     are subject to no requirements or limitations related to such 
     services other than the requirements or limitations 
     established under such section 1303, and, in the case of 
     amounts appropriated under section 2(a)(2)(B), such section 
     1303 shall apply to such amounts in the same manner and to 
     the same extent as if the purposes for which such amounts are 
     appropriated under section 2(a)(2)(B) were purposes specified 
     in subsection (b)(2)(A) of such section 1303.
                                 ______
                                 
  SA 2223. Mr. McCONNELL (for Mr. Hoeven) proposed an amendment to the 
bill S. 607, to establish a business incubators program within the 
Department of the Interior to promote economic development in Indian 
reservation communities; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Native American Business 
     Incubators Program Act''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1) entrepreneurs face specific challenges when 
     transforming ideas into profitable business enterprises;

[[Page S1964]]

       (2) entrepreneurs that want to provide products and 
     services in reservation communities face an additional set of 
     challenges that requires special knowledge;
       (3) a business incubator is an organization that assists 
     entrepreneurs in navigating obstacles that prevent innovative 
     ideas from becoming viable businesses by providing services 
     that include--
       (A) workspace and facilities resources;
       (B) access to capital, business education, and counseling;
       (C) networking opportunities;
       (D) mentorship opportunities; and
       (E) an environment intended to help establish and expand 
     business operations;
       (4) the business incubator model is suited to accelerating 
     entrepreneurship in reservation communities because the 
     business incubator model promotes collaboration to address 
     shared challenges and provides individually tailored services 
     for the purpose of overcoming obstacles unique to each 
     participating business; and
       (5) business incubators will stimulate economic development 
     by providing Native entrepreneurs with the tools necessary to 
     grow businesses that offer products and services to 
     reservation communities.

     SEC. 3. DEFINITIONS.

       In this Act:
       (1) Business incubator.--The term ``business incubator'' 
     means an organization that--
       (A) provides physical workspace and facilities resources to 
     startups and established businesses; and
       (B) is designed to accelerate the growth and success of 
     businesses through a variety of business support resources 
     and services, including--
       (i) access to capital, business education, and counseling;
       (ii) networking opportunities;
       (iii) mentorship opportunities; and
       (iv) other services intended to aid in developing a 
     business.
       (2) Eligible applicant.--The term ``eligible applicant'' 
     means an applicant eligible to apply for a grant under 
     section 4(b).
       (3) Indian tribe.--The term ``Indian tribe'' has the 
     meaning given the term in section 4 of the Indian Self-
     Determination and Education Assistance Act (25 U.S.C. 5304).
       (4) Institution of higher education.--The term 
     ``institution of higher education'' has the meaning given the 
     term in section 101 of the Higher Education Act of 1965 (20 
     U.S.C. 1001).
       (5) Native american; native.--The terms ``Native American'' 
     and ``Native'' have the meaning given the term ``Indian'' in 
     section 4 of the Indian Self-Determination and Education 
     Assistance Act (25 U.S.C. 5304).
       (6) Native business.--The term ``Native business'' means a 
     business concern that is at least 51-percent owned and 
     controlled by 1 or more Native Americans.
       (7) Native entrepreneur.--The term ``Native entrepreneur'' 
     means an entrepreneur who is a Native American.
       (8) Program.--The term ``program'' means the program 
     established under section 4(a).
       (9) Reservation.--The term ``reservation'' has the meaning 
     given the term in section 3 of the Indian Financing Act of 
     1974 (25 U.S.C. 1452).
       (10) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.
       (11) Tribal college or university.--The term ``tribal 
     college or university'' has the meaning given the term 
     ``Tribal College or University'' in section 316(b) of the 
     Higher Education Act of 1965 (20 U.S.C. 1059c(b)).

     SEC. 4. ESTABLISHMENT OF PROGRAM.

       (a) In General.--The Secretary shall establish a program in 
     the Office of Indian Energy and Economic Development under 
     which the Secretary shall provide financial assistance in the 
     form of competitive grants to eligible applicants for the 
     establishment and operation of business incubators that serve 
     reservation communities by providing business incubation and 
     other business services to Native businesses and Native 
     entrepreneurs.
       (b) Eligible Applicants.--
       (1) In general.--To be eligible to receive a grant under 
     the program, an applicant shall--
       (A) be--
       (i) an Indian tribe;
       (ii) a tribal college or university;
       (iii) an institution of higher education; or
       (iv) a private nonprofit organization or tribal nonprofit 
     organization that--

       (I) provides business and financial technical assistance; 
     and
       (II) will commit to serving 1 or more reservation 
     communities;

       (B) be able to provide the physical workspace, equipment, 
     and connectivity necessary for Native businesses and Native 
     entrepreneurs to collaborate and conduct business on a local, 
     regional, national, and international level; and
       (C) in the case of an entity described in clauses (ii) 
     through (iv) of subparagraph (A), have been operational for 
     not less than 1 year before receiving a grant under the 
     program.
       (2) Joint project.--
       (A) In general.--Two or more entities may submit a joint 
     application for a project that combines the resources and 
     expertise of those entities at a physical location dedicated 
     to assisting Native businesses and Native entrepreneurs under 
     the program.
       (B) Contents.--A joint application submitted under 
     subparagraph (A) shall--
       (i) contain a certification that each participant of the 
     joint project is one of the eligible entities described in 
     paragraph (1)(A); and
       (ii) demonstrate that together the participants meet the 
     requirements of subparagraphs (B) and (C) of paragraph (1).
       (c) Application and Selection Process.--
       (1) Application requirements.--Each eligible applicant 
     desiring a grant under the program shall submit to the 
     Secretary an application at such time, in such manner, and 
     containing such information as the Secretary may require, 
     including--
       (A) a certification that the applicant--
       (i) is an eligible applicant;
       (ii) will designate an executive director or program 
     manager, if such director or manager has not been designated, 
     to manage the business incubator; and
       (iii) agrees--

       (I) to a site evaluation by the Secretary as part of the 
     final selection process;
       (II) to an annual programmatic and financial examination 
     for the duration of the grant; and
       (III) to the maximum extent practicable, to remedy any 
     problems identified pursuant to the site evaluation under 
     subclause (I) or an examination under subclause (II);

       (B) a description of the 1 or more reservation communities 
     to be served by the business incubator;
       (C) a 3-year plan that describes--
       (i) the number of Native businesses and Native 
     entrepreneurs to be participating in the business incubator;
       (ii) whether the business incubator will focus on a 
     particular type of business or industry;
       (iii) a detailed breakdown of the services to be offered to 
     Native businesses and Native entrepreneurs participating in 
     the business incubator; and
       (iv) a detailed breakdown of the services, if any, to be 
     offered to Native businesses and Native entrepreneurs not 
     participating in the business incubator;
       (D) information demonstrating the effectiveness and 
     experience of the eligible applicant in--
       (i) conducting financial, management, and marketing 
     assistance programs designed to educate or improve the 
     business skills of current or prospective businesses;
       (ii) working in and providing services to Native American 
     communities;
       (iii) providing assistance to entities conducting business 
     in reservation communities;
       (iv) providing technical assistance under Federal business 
     and entrepreneurial development programs for which Native 
     businesses and Native entrepreneurs are eligible; and
       (v) managing finances and staff effectively; and
       (E) a site description of the location at which the 
     eligible applicant will provide physical workspace, including 
     a description of the technologies, equipment, and other 
     resources that will be available to Native businesses and 
     Native entrepreneurs participating in the business incubator.
       (2) Evaluation considerations.--
       (A) In general.--In evaluating each application, the 
     Secretary shall consider--
       (i) the ability of the eligible applicant--

       (I) to operate a business incubator that effectively 
     imparts entrepreneurship and business skills to Native 
     businesses and Native entrepreneurs, as demonstrated by the 
     experience and qualifications of the eligible applicant;
       (II) to commence providing services within a minimum period 
     of time, to be determined by the Secretary; and
       (III) to provide quality incubation services to a 
     significant number of Native businesses and Native 
     entrepreneurs;

       (ii) the experience of the eligible applicant in providing 
     services in Native American communities, including in the 1 
     or more reservation communities described in the application; 
     and
       (iii) the proposed location of the business incubator.
       (B) Priority.--
       (i) In general.--In evaluating the proposed location of the 
     business incubator under subparagraph (A)(iii), the Secretary 
     shall--

       (I) consider the program goal of achieving broad geographic 
     distribution of business incubators; and
       (II) except as provided in clause (ii), give priority to 
     eligible applicants that will provide business incubation 
     services on or near the reservation of the 1 or more 
     communities that were described in the application.

       (ii) Exception.--The Secretary may give priority to an 
     eligible applicant that is not located on or near the 
     reservation of the 1 or more communities that were described 
     in the application if the Secretary determines that--

       (I) the location of the business incubator will not prevent 
     the eligible applicant from providing quality business 
     incubation services to Native businesses and Native 
     entrepreneurs from the 1 or more reservation communities to 
     be served; and
       (II) siting the business incubator in the identified 
     location will serve the interests of the 1 or more 
     reservation communities to be served.

       (3) Site evaluation.--
       (A) In general.--Before making a grant to an eligible 
     applicant, the Secretary shall conduct a site visit, evaluate 
     a video submission, or evaluate a written site proposal (if 
     the applicant is not yet in possession of the

[[Page S1965]]

     site) of the proposed site to ensure the proposed site will 
     permit the eligible applicant to meet the requirements of the 
     program.
       (B) Written site proposal.--A written site proposal shall 
     meet the requirements described in paragraph (1)(E) and 
     contain--
       (i) sufficient detail for the Secretary to ensure in the 
     absence of a site visit or video submission that the proposed 
     site will permit the eligible applicant to meet the 
     requirements of the program; and
       (ii) a timeline describing when the eligible applicant will 
     be--

       (I) in possession of the proposed site; and
       (II) operating the business incubator at the proposed site.

       (C) Followup.--Not later than 1 year after awarding a grant 
     to an eligible applicant that submits an application with a 
     written site proposal, the Secretary shall conduct a site 
     visit or evaluate a video submission of the site to ensure 
     the site is consistent with the written site proposal.
       (d) Administration.--
       (1) Duration.--Each grant awarded under the program shall 
     be for a term of 3 years.
       (2) Payment.--
       (A) In general.--Except as provided in subparagraph (B), 
     the Secretary shall disburse grant funds awarded to an 
     eligible applicant in annual installments.
       (B) More frequent disbursements.--On request by the 
     applicant, the Secretary may make disbursements of grant 
     funds more frequently than annually, on the condition that 
     disbursements shall be made not more frequently than 
     quarterly.
       (3) Non-federal contributions for initial assistance.--
       (A) In general.--Except as provided in subparagraph (B), an 
     eligible applicant that receives a grant under the program 
     shall provide non-Federal contributions in an amount equal to 
     not less than 25 percent of the grant amount disbursed each 
     year.
       (B) Waiver.--The Secretary may waive, in whole or in part, 
     the requirements of subparagraph (A) with respect to an 
     eligible applicant if, after considering the ability of the 
     eligible applicant to provide non-Federal contributions, the 
     Secretary determines that--
       (i) the proposed business incubator will provide quality 
     business incubation services; and
       (ii) the 1 or more reservation communities to be served are 
     unlikely to receive similar services because of remoteness or 
     other reasons that inhibit the provision of business and 
     entrepreneurial development services.
       (4) Renewals.--
       (A) In general.--The Secretary may renew a grant award 
     under the program for a term not to exceed 3 years.
       (B) Considerations.--In determining whether to renew a 
     grant award, the Secretary shall consider with respect to the 
     eligible applicant--
       (i) the results of the annual evaluations of the eligible 
     applicant under subsection (f)(1);
       (ii) the performance of the business incubator of the 
     eligible applicant, as compared to the performance of other 
     business incubators receiving assistance under the program;
       (iii) whether the eligible applicant continues to be 
     eligible for the program; and
       (iv) the evaluation considerations for initial awards under 
     subsection (c)(2).
       (C) Non-federal contributions for renewals.--An eligible 
     applicant that receives a grant renewal under subparagraph 
     (A) shall provide non-Federal contributions in an amount 
     equal to not less than 33 percent of the total amount of the 
     grant.
       (5) No duplicative grants.--An eligible applicant shall not 
     be awarded a grant under the program that is duplicative of 
     existing Federal funding from another source.
       (e) Program Requirements.--
       (1) Use of funds.--An eligible applicant receiving a grant 
     under the program may use grant amounts--
       (A) to provide physical workspace and facilities for Native 
     businesses and Native entrepreneurs participating in the 
     business incubator;
       (B) to establish partnerships with other institutions and 
     entities to provide comprehensive business incubation 
     services to Native businesses and Native entrepreneurs 
     participating in the business incubator; and
       (C) for any other uses typically associated with business 
     incubators that the Secretary determines to be appropriate 
     and consistent with the purposes of the program.
       (2) Minimum requirements.--Each eligible applicant 
     receiving a grant under the program shall--
       (A) offer culturally tailored incubation services to Native 
     businesses and Native entrepreneurs;
       (B) use a competitive process for selecting Native 
     businesses and Native entrepreneurs to participate in the 
     business incubator;
       (C) provide physical workspace that permits Native 
     businesses and Native entrepreneurs to conduct business and 
     collaborate with other Native businesses and Native 
     entrepreneurs;
       (D) provide entrepreneurship and business skills training 
     and education to Native businesses and Native entrepreneurs 
     including--
       (i) financial education, including training and counseling 
     in--

       (I) applying for and securing business credit and 
     investment capital;
       (II) preparing and presenting financial statements; and
       (III) managing cash flow and other financial operations of 
     a business;

       (ii) management education, including training and 
     counseling in planning, organization, staffing, directing, 
     and controlling each major activity or function of a business 
     or startup; and
       (iii) marketing education, including training and 
     counseling in--

       (I) identifying and segmenting domestic and international 
     market opportunities;
       (II) preparing and executing marketing plans;
       (III) locating contract opportunities;
       (IV) negotiating contracts; and
       (V) using varying public relations and advertising 
     techniques;

       (E) provide direct mentorship or assistance finding mentors 
     in the industry in which the Native business or Native 
     entrepreneur operates or intends to operate; and
       (F) provide access to networks of potential investors, 
     professionals in the same or similar fields, and other 
     business owners with similar businesses.
       (3) Technology.--Each eligible applicant shall leverage 
     technology to the maximum extent practicable to provide 
     Native businesses and Native entrepreneurs with access to the 
     connectivity tools needed to compete and thrive in 21st-
     century markets.
       (f) Oversight.--
       (1) Annual evaluations.--Not later than 1 year after the 
     date on which the Secretary awards a grant to an eligible 
     applicant under the program, and annually thereafter for the 
     duration of the grant, the Secretary shall conduct an 
     evaluation of, and prepare a report on, the eligible 
     applicant, which shall--
       (A) describe the performance of the eligible applicant; and
       (B) be used in determining the ongoing eligibility of the 
     eligible applicant.
       (2) Annual report.--
       (A) In general.--Not later than 1 year after the date on 
     which the Secretary awards a grant to an eligible applicant 
     under the program, and annually thereafter for the duration 
     of the grant, each eligible applicant receiving an award 
     under the program shall submit to the Secretary a report 
     describing the services the eligible applicant provided under 
     the program during the preceding year.
       (B) Report content.--The report described in subparagraph 
     (A) shall include--
       (i) a detailed breakdown of the Native businesses and 
     Native entrepreneurs receiving services from the business 
     incubator, including, for the year covered by the report--

       (I) the number of Native businesses and Native 
     entrepreneurs participating in or receiving services from the 
     business incubator and the types of services provided to 
     those Native businesses and Native entrepreneurs;
       (II) the number of Native businesses and Native 
     entrepreneurs established and jobs created or maintained; and
       (III) the performance of Native businesses and Native 
     entrepreneurs while participating in the business incubator 
     and after graduation or departure from the business 
     incubator; and

       (ii) any other information the Secretary may require to 
     evaluate the performance of a business incubator to ensure 
     appropriate implementation of the program.
       (C) Limitations.--To the maximum extent practicable, the 
     Secretary shall not require an eligible applicant to report 
     under subparagraph (A) information provided to the Secretary 
     by the eligible applicant under other programs.
       (D) Coordination.--The Secretary shall coordinate with the 
     heads of other Federal agencies to ensure that, to the 
     maximum extent practicable, the report content and form under 
     subparagraphs (A) and (B) are consistent with other reporting 
     requirements for Federal programs that provide business and 
     entrepreneurial assistance.
       (3) Report to congress.--
       (A) In general.--Not later than 2 years after the date on 
     which the Secretary first awards funding under the program, 
     and biennially thereafter, the Secretary shall submit to the 
     Committee on Indian Affairs of the Senate and the Committee 
     on Natural Resources of the House of Representatives a report 
     on the performance and effectiveness of the program.
       (B) Contents.--Each report submitted under subparagraph (A) 
     shall--
       (i) account for each program year; and
       (ii) include with respect to each business incubator 
     receiving grant funds under the program--

       (I) the number of Native businesses and Native 
     entrepreneurs that received business incubation or other 
     services;
       (II) the number of businesses established with the 
     assistance of the business incubator;
       (III) the number of jobs established or maintained by 
     Native businesses and Native entrepreneurs receiving business 
     incubation services, including a description of where the 
     jobs are located with respect to reservation communities;
       (IV) to the maximum extent practicable, the amount of 
     capital investment and loan financing accessed by Native 
     businesses and Native entrepreneurs receiving business 
     incubation services; and
       (V) an evaluation of the overall performance of the 
     business incubator.

     SEC. 5. REGULATIONS.

       Not later than 180 days after the date of enactment of this 
     Act, the Secretary shall promulgate regulations to implement 
     the program.

     SEC. 6. SCHOOLS TO BUSINESS INCUBATOR PIPELINE.

       The Secretary shall facilitate the establishment of 
     relationships between eligible

[[Page S1966]]

     applicants receiving funds through the program and 
     educational institutions serving Native American communities, 
     including tribal colleges and universities.

     SEC. 7. AGENCY PARTNERSHIPS.

       The Secretary shall coordinate with the Secretary of 
     Agriculture, the Secretary of Commerce, the Secretary of the 
     Treasury, and the Administrator of the Small Business 
     Administration to ensure, to the maximum extent practicable, 
     that business incubators receiving grant funds under the 
     program have the information and materials needed to provide 
     Native businesses and Native entrepreneurs with the 
     information and assistance necessary to apply for business 
     and entrepreneurial development programs administered by the 
     Department of Agriculture, the Department of Commerce, the 
     Department of the Treasury, and the Small Business 
     Administration.

     SEC. 8. AUTHORIZATIONS OF APPROPRIATIONS.

       There are authorized to be appropriated to carry out the 
     program $5,000,000 for each of fiscal years 2019 through 
     2023.
                                 ______
                                 
  SA 2224. Mr. McCONNELL (for Mr. Hoeven) proposed an amendment to the 
bill S. 1116, to amend the Native American Business Development, Trade 
Promotion, and Tourism Act of 2000, the Buy Indian Act, and the Native 
American Programs Act of 1974 to provide industry and economic 
development opportunities to Indian communities; as follows:

       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Indian Community Economic 
     Enhancement Act of 2018''.

     SEC. 2. FINDINGS.

       Congress finds that--
       (1)(A) to bring industry and economic development to Indian 
     communities, Indian tribes must overcome a number of 
     barriers, including--
       (i) geographical location;
       (ii) lack of infrastructure or capacity;
       (iii) lack of sufficient collateral and capital; and
       (iv) regulatory bureaucracy relating to--
       (I) development; and
       (II) access to services provided by the Federal Government; 
     and
       (B) the barriers described in subparagraph (A) often add to 
     the cost of doing business in Indian communities;
       (2) Indian tribes--
       (A) enact laws and exercise sovereign governmental powers;
       (B) determine policy for the benefit of tribal members; and
       (C) produce goods and services for consumers;
       (3) the Federal Government has--
       (A) an important government-to-government relationship with 
     Indian tribes; and
       (B) a role in facilitating healthy and sustainable tribal 
     economies;
       (4) the input of Indian tribes in developing Federal policy 
     and programs leads to more meaningful and effective measures 
     to assist Indian tribes and Indian entrepreneurs in building 
     tribal economies;
       (5)(A) many components of tribal infrastructure need 
     significant repair or replacement; and
       (B) access to private capital for projects in Indian 
     communities--
       (i) may not be available; or
       (ii) may come at a higher cost than such access for other 
     projects;
       (6)(A) Federal capital improvement programs, such as those 
     that facilitate tax-exempt bond financing and loan 
     guarantees, are tools that help improve or replace crumbling 
     infrastructure;
       (B) lack of parity in treatment of an Indian tribe as a 
     governmental entity under Federal tax and certain other 
     regulatory laws impedes, in part, the ability of Indian 
     tribes to raise capital through issuance of tax exempt debt, 
     invest as an accredited investor, and benefit from other 
     investment incentives accorded to State and local 
     governmental entities; and
       (C) as a result of the disparity in treatment of Indian 
     tribes described in subparagraph (B), investors may avoid 
     financing, or demand a premium to finance, projects in Indian 
     communities, making the projects more costly or inaccessible;
       (7) there are a number of Federal loan guarantee programs 
     available to facilitate financing of business, energy, 
     economic, housing, and community development projects in 
     Indian communities, and those programs may support public-
     private partnerships for infrastructure development, but 
     improvements and support are needed for those programs 
     specific to Indian communities to facilitate more effectively 
     private financing for infrastructure and other urgent 
     development needs; and
       (8)(A) most real property held by Indian tribes is trust or 
     restricted land that essentially cannot be held as 
     collateral; and
       (B) while creative solutions, such as leasehold mortgages, 
     have been developed in response to the problem identified in 
     subparagraph (A), some solutions remain subject to review and 
     approval by the Bureau of Indian Affairs, adding additional 
     costs and delay to tribal projects.

     SEC. 3. NATIVE AMERICAN BUSINESS DEVELOPMENT, TRADE 
                   PROMOTION, AND TOURISM ACT OF 2000.

       (a) Findings; Purposes.--Section 2 of the Native American 
     Business Development, Trade Promotion, and Tourism Act of 
     2000 (25 U.S.C. 4301) is amended by adding at the end the 
     following:
       ``(c) Applicability to Indian-Owned Businesses.--The 
     findings and purposes in subsections (a) and (b) shall apply 
     to any Indian-owned business governed--
       ``(1) by tribal laws regulating trade or commerce on Indian 
     lands; or
       ``(2) pursuant to section 5 of the Act of August 15, 1876 
     (19 Stat. 200, chapter 289; 25 U.S.C. 261).''.
       (b) Definitions.--Section 3 of the Native American Business 
     Development, Trade Promotion, and Tourism Act of 2000 (25 
     U.S.C. 4302) is amended--
       (1) by redesignating paragraphs (1) through (6) and 
     paragraphs (7) through (9), as paragraphs (2) through (7) and 
     paragraphs (9) through (11), respectively;
       (2) by inserting before paragraph (2) (as redesignated by 
     paragraph (1)) the following:
       ``(1) Director.--The term `Director' means the Director of 
     Native American Business Development appointed pursuant to 
     section 4(a)(2).''; and
       (3) by inserting after paragraph (7) (as redesignated by 
     paragraph (1)) the following:
       ``(8) Office.--The term `Office' means the Office of Native 
     American Business Development established by section 
     4(a)(1).''.
       (c) Office of Native American Business Development.--
     Section 4 of the Native American Business Development, Trade 
     Promotion, and Tourism Act of 2000 (25 U.S.C. 4303) is 
     amended--
       (1) in subsection (a)--
       (A) in paragraph (1)--
       (i) by striking ``Department of Commerce'' and inserting 
     ``Office of the Secretary''; and
       (ii) by striking ``(referred to in this Act as the 
     `Office')''; and
       (B) in paragraph (2), in the first sentence, by striking 
     ``(referred to in this Act as the `Director')''; and
       (2) by adding at the end the following:
       ``(c) Duties of Director.--
       ``(1) In general.--The Director shall serve as--
       ``(A) the program and policy advisor to the Secretary with 
     respect to the trust and governmental relationship between 
     the United States and Indian tribes; and
       ``(B) the point of contact for Indian tribes, tribal 
     organizations, and Indians regarding--
       ``(i) policies and programs of the Department of Commerce; 
     and
       ``(ii) other matters relating to economic development and 
     doing business in Indian lands.
       ``(2) Departmental coordination.--The Director shall 
     coordinate with all offices and agencies within the 
     Department of Commerce to ensure that each office and agency 
     has an accountable process to ensure--
       ``(A) meaningful and timely coordination and assistance, as 
     required by this Act; and
       ``(B) consultation with Indian tribes regarding the 
     policies, programs, assistance, and activities of the offices 
     and agencies.
       ``(3) Office operations.--There are authorized to be 
     appropriated to carry out this section not more than 
     $2,000,000 for each fiscal year.''.
       (d) Indian Community Development Initiatives.--The Native 
     American Business Development, Trade Promotion, and Tourism 
     Act of 2000 is amended--
       (1) by redesignating section 8 (25 U.S.C. 4307) as section 
     10; and
       (2) by inserting after section 7 (25 U.S.C. 4306) the 
     following:

     ``SEC. 8. INDIAN COMMUNITY DEVELOPMENT INITIATIVES.

       ``(a) Interagency Coordination.--Not later than 1 year 
     after the enactment of this section, the Secretary, the 
     Secretary of the Interior, and the Secretary of the Treasury 
     shall coordinate--
       ``(1) to develop initiatives that--
       ``(A) encourage, promote, and provide education regarding 
     investments in Indian communities through--
       ``(i) the loan guarantee program of Bureau of Indian 
     Affairs under section 201 of the Indian Financing Act of 1974 
     (25 U.S.C. 1481);
       ``(ii) programs carried out using amounts in the Community 
     Development Financial Institutions Fund established under 
     section 104(a) of the Community Development Banking and 
     Financial Institutions Act of 1994 (12 U.S.C. 4703(a)); and
       ``(iii) other capital development programs;
       ``(B) examine and develop alternatives that would qualify 
     as collateral for financing in Indian communities; and
       ``(C) provide entrepreneur and other training relating to 
     economic development through tribally controlled colleges and 
     universities and other Indian organizations with experience 
     in providing such training;
       ``(2) to consult with Indian tribes and with the Securities 
     and Exchange Commission to study, and collaborate to 
     establish, regulatory changes necessary to qualify an Indian 
     tribe as an accredited investor for the purposes of sections 
     230.500 through 230.508 of title 17, Code of Federal 
     Regulations (or successor regulations), consistent with the 
     goals of promoting capital formation and ensuring qualifying 
     Indian tribes have the ability to withstand investment loss, 
     on a basis comparable to other legal entities that qualify as 
     accredited investors who are not natural persons;
       ``(3) to identify regulatory, legal, or other barriers to 
     increasing investment, business, and economic development, 
     including qualifying or approving collateral structures, 
     measurements of economic strength, and

[[Page S1967]]

     contributions of Indian economies in Indian communities 
     through the Authority established under section 4 of the 
     Indian Tribal Regulatory Reform and Business Development Act 
     of 2000 (25 U.S.C. 4301 note);
       ``(4) to ensure consultation with Indian tribes regarding 
     increasing investment in Indian communities and the 
     development of the report required in paragraph (5); and
       ``(5) not less than once every 2 years, to provide a report 
     to Congress regarding--
       ``(A) improvements to Indian communities resulting from 
     such initiatives and recommendations for promoting sustained 
     growth of the tribal economies;
       ``(B) results of the study and collaboration regarding the 
     necessary changes referenced in paragraph (2) and the impact 
     of allowing Indian tribes to qualify as an accredited 
     investor; and
       ``(C) the identified regulatory, legal, and other barriers 
     referenced in paragraph (3).
       ``(b) Waiver.--For assistance provided pursuant to section 
     108 of the Community Development Banking and Financial 
     Institutions Act of 1994 (12 U.S.C. 4707) to benefit Native 
     Community Development Financial Institutions, as defined by 
     the Secretary of the Treasury, section 108(e) of such Act 
     shall not apply.
       ``(c) Indian Economic Development Feasibility Study.--
       ``(1) In general.--The Government Accountability Office 
     shall conduct a study and, not later than 18 months after the 
     date of enactment of this subsection, submit to the Committee 
     on Indian Affairs of the Senate and the Committee on Natural 
     Resources of the House of Representatives a report on the 
     findings of the study and recommendations.
       ``(2) Contents.--The study shall include an assessment of 
     each of the following:
       ``(A) In general.--The study shall assess current Federal 
     capitalization and related programs and services that are 
     available to assist Indian communities with business and 
     economic development, including manufacturing, physical 
     infrastructure (such as telecommunications and broadband), 
     community development, and facilities construction for such 
     purposes. For each of the Federal programs and services 
     identified, the study shall assess the current use and demand 
     by Indian tribes, individuals, businesses, and communities of 
     the programs, the capital needs of Indian tribes, businesses, 
     and communities related to economic development, and the 
     extent that similar programs have been used to assist non-
     Indian communities compared to the extent used for Indian 
     communities.
       ``(B) Financing assistance.--The study shall assess and 
     quantify the extent of assistance provided to non-Indian 
     borrowers and to Indian (both tribal and individual) 
     borrowers (including information about such assistance as a 
     percentage of need for Indian borrowers and for non-Indian 
     borrowers, assistance to Indian borrowers and to non-Indian 
     borrowers as a percentage of total applicants, and such 
     assistance to Indian borrowers as individuals as compared to 
     such assistance to Indian tribes) through the loan programs, 
     the loan guarantee programs, or bond guarantee programs of 
     the--
       ``(i) Department of the Interior;
       ``(ii) Department of Agriculture;
       ``(iii) Department of Housing and Urban Development;
       ``(iv) Department of Energy;
       ``(v) Small Business Administration; and
       ``(vi) Community Development Financial Institutions Fund of 
     the Department of the Treasury.
       ``(C) Tax incentives.--The study shall assess and quantify 
     the extent of the assistance and allocations afforded for 
     non-Indian projects and for Indian projects pursuant to each 
     of the following tax incentive programs:
       ``(i) New market tax credit.
       ``(ii) Low income housing tax credit.
       ``(iii) Investment tax credit.
       ``(iv) Renewable energy tax incentives.
       ``(v) Accelerated depreciation.
       ``(D) Tribal investment incentive.--The study shall assess 
     various alternative incentives that could be provided to 
     enable and encourage tribal governments to invest in an 
     Indian community development investment fund or bank.''.

     SEC. 4. BUY INDIAN ACT.

       Section 23 of the Act of June 25, 1910 (commonly known as 
     the ``Buy Indian Act'') (36 Stat. 861, chapter 431; 25 U.S.C. 
     47), is amended to read as follows:

     ``SEC. 23. EMPLOYMENT OF INDIAN LABOR AND PURCHASE OF 
                   PRODUCTS OF INDIAN INDUSTRY; PARTICIPATION IN 
                   MENTOR-PROTEGE PROGRAM.

       ``(a) Definitions.--In this section:
       ``(1) Indian economic enterprise.--The term `Indian 
     economic enterprise' has the meaning given the term in 
     section 1480.201 of title 48, Code of Federal Regulations (or 
     successor regulations).
       ``(2) Mentor firm; protege firm.--The terms `mentor firm' 
     and `protege firm' have the meanings given those terms in 
     section 831(c) of the National Defense Authorization Act for 
     Fiscal Year 1991 (10 U.S.C. 2302 note; Public Law 101-510).
       ``(3) Secretaries.--The term `Secretaries' means--
       ``(A) the Secretary of the Interior; and
       ``(B) the Secretary of Health and Human Services.
       ``(b) Enterprise Development.--
       ``(1) In general.--Unless determined by one of the 
     Secretaries to be impracticable and unreasonable--
       ``(A) Indian labor shall be employed; and
       ``(B) purchases of Indian industry products (including 
     printing and facilities construction, notwithstanding any 
     other provision of law) may be made in open market by the 
     Secretaries.
       ``(2) Mentor-protege program.--
       ``(A) In general.--Participation in the Mentor-Protege 
     Program established under section 831(a) of the National 
     Defense Authorization Act for Fiscal Year 1991 (10 U.S.C. 
     2302 note; Public Law 101-510) or receipt of assistance under 
     a developmental assistance agreement under that program shall 
     not render any individual or entity involved in the provision 
     of Indian labor or an Indian industry product ineligible to 
     receive assistance under this section.
       ``(B) Treatment.--For purposes of this section, no 
     determination of affiliation or control (whether direct or 
     indirect) may be found between a protege firm and a mentor 
     firm on the basis that the mentor firm has provided, or 
     agreed to provide, to the protege firm, pursuant to a mentor-
     protege agreement, any form of developmental assistance 
     described in section 831(f) of the National Defense 
     Authorization Act for Fiscal Year 1991 (10 U.S.C. 2302 note; 
     Public Law 101-510).
       ``(c) Implementation.--In carrying out this section, the 
     Secretaries shall--
       ``(1) conduct outreach to Indian industrial entities;
       ``(2) provide training;
       ``(3) promulgate regulations in accordance with this 
     section and with the regulations under part 1480 of title 48, 
     Code of Federal Regulations (or successor regulations), to 
     harmonize the procurement procedures of the Department of the 
     Interior and the Department of Health and Human Services, to 
     the maximum extent practicable;
       ``(4) require regional offices of the Bureau of Indian 
     Affairs and the Indian Health Service to aggregate data 
     regarding compliance with this section;
       ``(5) require procurement management reviews by their 
     respective Departments to include a review of the 
     implementation of this section; and
       ``(6) consult with Indian tribes, Indian industrial 
     entities, and other stakeholders regarding methods to 
     facilitate compliance with--
       ``(A) this section; and
       ``(B) other small business or procurement goals.
       ``(d) Report.--
       ``(1) In general.--Not later than 1 year after the date of 
     enactment of this subsection, and not less frequently than 
     once every 2 years thereafter, each of the Secretaries shall 
     submit to the Committee on Indian Affairs of the Senate and 
     the Committee on Natural Resources of the House of 
     Representatives a report describing, during the period 
     covered by the report, the implementation of this section by 
     each of the respective Secretaries.
       ``(2) Contents.--Each report under this subsection shall 
     include, for each fiscal year during the period covered by 
     the report--
       ``(A) the names of each agency under the respective 
     jurisdiction of each of the Secretaries to which this section 
     has been applied, and efforts made by additional agencies 
     within the Secretaries' respective Departments to use the 
     procurement procedures under this Act;
       ``(B) a summary of the types of purchases made from, and 
     contracts (including any relevant modifications, extensions, 
     or renewals) awarded to, Indian economic enterprises, 
     expressed by agency region;
       ``(C) a description of the percentage increase or decrease 
     in total dollar value and number of purchases and awards made 
     within each agency region, as compared to the totals of the 
     region for the preceding fiscal year;
       ``(D) a description of the methods used by applicable 
     contracting officers and employees to conduct market searches 
     to identify qualified Indian economic enterprises;
       ``(E) a summary of all deviations granted under section 
     1480.403 of title 48, Code of Federal Regulations (or 
     successor regulations), including a description of--
       ``(i) the types of alternative procurement methods used, 
     including any Indian owned businesses reported under other 
     procurement goals; and
       ``(ii) the dollar value of any awards made pursuant to 
     those deviations;
       ``(F) a summary of all determinations made to provide 
     awards to Indian economic enterprises, including a 
     description of the dollar value of the awards;
       ``(G) a description or summary of the total number and 
     value of all purchases of, and contracts awarded for, 
     supplies, services, and construction (including the 
     percentage increase or decrease, as compared to the preceding 
     fiscal year) from--
       ``(i) Indian economic enterprises; and
       ``(ii) non-Indian economic enterprises;
       ``(H) any administrative, procedural, legal, or other 
     barriers to achieving the purposes of this section, together 
     with recommendations for legislative or administrative 
     actions to address those barriers; and
       ``(I) for each agency region--
       ``(i) the total amount spent on purchases made from, and 
     contracts awarded to, Indian economic enterprises; and
       ``(ii) a comparison of the amount described in clause (i) 
     to the total amount that the agency region would likely have 
     spent on the same purchases made from a non-Indian economic 
     enterprise or contracts awarded to a non-Indian economic 
     enterprise.

[[Page S1968]]

       ``(e) Goals.--Each agency shall establish an annual minimum 
     percentage goal for procurement in compliance with this 
     section.''.

     SEC. 5. NATIVE AMERICAN PROGRAMS ACT OF 1974.

       (a) Financial Assistance for Native American Projects.--
     Section 803 of the Native American Programs Act of 1974 (42 
     U.S.C. 2991b) is amended--
       (1) by redesignating subsections (b) through (d) as 
     subsections (c) through (e), respectively; and
       (2) by inserting after subsection (a) the following:
       ``(b) Economic Development.--
       ``(1) In general.--The Commissioner may provide assistance 
     under subsection (a) for projects relating to the purposes of 
     this title to a Native community development financial 
     institution, as defined by the Secretary of the Treasury.
       ``(2) Priority.--With regard to not less than 50 percent of 
     the total amount available for assistance under this section, 
     the Commissioner shall give priority to any application 
     seeking assistance for--
       ``(A) the development of a tribal code or court system for 
     purposes of economic development, including commercial codes, 
     training for court personnel, regulation pursuant to section 
     5 of the Act of August 15, 1876 (19 Stat. 200, chapter 289; 
     25 U.S.C. 261), and the development of nonprofit subsidiaries 
     or other tribal business structures;
       ``(B) the development of a community development financial 
     institution, including training and administrative expenses; 
     or
       ``(C) the development of a tribal master plan for community 
     and economic development and infrastructure.''.
       (b) Technical Assistance and Training.--Section 804 of the 
     Native American Programs Act of 1974 (42 U.S.C. 2991c) is 
     amended--
       (1) in the matter preceding paragraph (1), by striking 
     ``The Commissioner'' and inserting the following:
       ``(a) In General.--The Commissioner''; and
       (2) by adding at the end the following:
       ``(b) Priority.--In providing assistance under subsection 
     (a), the Commissioner shall give priority to any application 
     described in section 803(b)(2).''.
       (c) Authorization of Appropriations.--Section 816 of the 
     Native American Programs Act of 1974 (42 U.S.C. 2992d) is 
     amended--
       (1) by striking ``803(d)'' each place it appears and 
     inserting ``803(e)''; and
       (2) in subsection (a)--
       (A) by striking ``such sums as may be necessary'' and 
     inserting ``$34,000,000''; and
       (B) by striking ``1999, 2000, 2001, and 2002'' and 
     inserting ``2019 through 2023''.
                                 ______
                                 
  SA 2225. Mr. McCONNELL (for Mr. Lankford) proposed an amendment to 
the bill S. 943, to direct the Secretary of the Interior to conduct an 
accurate comprehensive student count for the purposes of calculating 
formula allocations for programs under the Johnson-O'Malley Act, and 
for other purposes; as follows:

       On page 27, strike lines 11 through 17.
       On page 27, line 18, strike ``(2)'' and insert ``(1)''.
       On page 28, line 7, strike ``(3)'' and insert ``(2)''.
       On page 29, lines 5 and 6, strike ``and local educational 
     agencies'' and insert ``, local educational agencies, and 
     Alaska Native organizations''.
       On page 29, lines 8 through 10, strike ``Indian tribes and 
     State educational agencies and local educational agencies'' 
     and insert ``Indian tribes, State educational agencies, local 
     educational agencies, and Alaska Native organizations''.
                                 ______
                                 
  SA 2226. Mr. McCONNELL (for Mr. Risch) proposed an amendment to the 
concurrent resolution H. Con. Res. 116, Official Title Not Available; 
as follows:

       At the end add the following:
       ``On page 749, line 12, strike `and' through line 14 `are' 
     and insert `is'''

                          ____________________