[Congressional Record Volume 164, Number 195 (Tuesday, December 11, 2018)]
[House]
[Pages H10043-H10052]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      IMPROVING MEDICAID PROGRAMS AND OPPORTUNITIES FOR ELIGIBLE 
                           BENEFICIARIES ACT

  Mr. BARTON. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 7217) to amend title XIX of the Social Security Act to 
provide States with the option of providing coordinated care for 
children with complex medical conditions through a health home, and for 
other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 7217

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Improving Medicaid Programs 
     and Opportunities for Eligible Beneficiaries Act'' or the 
     ``IMPROVE Act''.

                           TITLE I--ACE KIDS

     SEC. 101. STATE OPTION TO PROVIDE COORDINATED CARE THROUGH A 
                   HEALTH HOME FOR CHILDREN WITH MEDICALLY COMPLEX 
                   CONDITIONS.

       Title XIX of the Social Security Act (42 U.S.C. 1396 et 
     seq.) is amended by inserting after section 1945 the 
     following new section:

     ``SEC. 1945A. STATE OPTION TO PROVIDE COORDINATED CARE 
                   THROUGH A HEALTH HOME FOR CHILDREN WITH 
                   MEDICALLY COMPLEX CONDITIONS.

       ``(a) In General.--Notwithstanding section 1902(a)(1) 
     (relating to statewideness) and section 1902(a)(10)(B) 
     (relating to comparability), beginning October 1, 2022, a 
     State, at its option as a State plan amendment, may provide 
     for medical assistance under this title to children with 
     medically complex conditions who choose to enroll in a health 
     home under this section by selecting a designated provider, a 
     team of health care professionals operating with such a 
     provider, or a health team as the child's health home for 
     purposes of providing the child with health home services.
       ``(b) Health Home Qualification Standards.--The Secretary 
     shall establish standards for qualification as a health home 
     for purposes of this section. Such standards shall include 
     requiring designated providers, teams of health care 
     professionals operating with such providers, and health teams 
     to demonstrate to the State the ability to do the following:
       ``(1) Coordinate prompt care for children with medically 
     complex conditions, including access to pediatric emergency 
     services at all times.
       ``(2) Develop an individualized comprehensive pediatric 
     family-centered care plan for children with medically complex 
     conditions that accommodates patient preferences.
       ``(3) Work in a culturally and linguistically appropriate 
     manner with the family of a child with medically complex 
     conditions to develop and incorporate into such child's care 
     plan, in a manner consistent with the needs of the child and 
     the choices of the child's family, ongoing home care, 
     community-based pediatric primary care, pediatric inpatient 
     care, social support services, and local hospital pediatric 
     emergency care.
       ``(4) Coordinate access to--
       ``(A) subspecialized pediatric services and programs for 
     children with medically complex conditions, including the 
     most intensive diagnostic, treatment, and critical care 
     levels as medically necessary; and
       ``(B) palliative services if the State provides such 
     services under the State plan (or a waiver of such plan).
       ``(5) Coordinate care for children with medically complex 
     conditions with out-of-State providers furnishing care to 
     such children to the maximum extent practicable for the 
     families of such children and where medically necessary, in 
     accordance with guidance issued under subsection (e)(1) and 
     section 431.52 of title 42, Code of Federal Regulations.
       ``(6) Collect and report information under subsection 
     (g)(1).
       ``(c) Payments.--
       ``(1) In general.--A State shall provide a designated 
     provider, a team of health care professionals operating with 
     such a provider, or a health team with payments for the 
     provision of health home services to each child with 
     medically complex conditions that selects such provider, team 
     of health care professionals, or health team as the child's 
     health home. Payments made to a designated provider, a team 
     of health care professionals operating with such a provider, 
     or a health team for such services shall be treated as 
     medical assistance for purposes of section 1903(a), except 
     that, during the first 2 fiscal year quarters that the State 
     plan amendment is in effect, the Federal medical assistance 
     percentage applicable to such payments shall be increased by 
     15 percentage points, but in no case may exceed 90 percent.
       ``(2) Methodology.--
       ``(A) In general.--The State shall specify in the State 
     plan amendment the methodology the State will use for 
     determining payment for the provision of health home 
     services. Such methodology for determining payment--
       ``(i) may be tiered to reflect, with respect to each child 
     with medically complex conditions provided such services by a 
     designated provider, a team of health care professionals 
     operating with such a provider, or a health team, the 
     severity or number of each such child's chronic conditions, 
     life-threatening illnesses, disabilities, or rare diseases, 
     or the specific capabilities of the provider, team of health 
     care professionals, or health team; and

[[Page H10044]]

       ``(ii) shall be established consistent with section 
     1902(a)(30)(A).
       ``(B) Alternate models of payment.--The methodology for 
     determining payment for provision of health home services 
     under this section shall not be limited to a per-member per-
     month basis and may provide (as proposed by the State and 
     subject to approval by the Secretary) for alternate models of 
     payment.
       ``(3) Planning grants.--
       ``(A) In general.--Beginning October 1, 2022, the Secretary 
     may award planning grants to States for purposes of 
     developing a State plan amendment under this section. A 
     planning grant awarded to a State under this paragraph shall 
     remain available until expended.
       ``(B) State contribution.--A State awarded a planning grant 
     shall contribute an amount equal to the State percentage 
     determined under section 1905(b) (without regard to section 
     5001 of Public Law 111-5) for each fiscal year for which the 
     grant is awarded.
       ``(C) Limitation.--The total amount of payments made to 
     States under this paragraph shall not exceed $5,000,000.
       ``(d) Coordinating Care.--
       ``(1) Hospital notification.--A State with a State plan 
     amendment approved under this section shall require each 
     hospital that is a participating provider under the State 
     plan (or a waiver of such plan) to establish procedures for, 
     in the case of a child with medically complex conditions who 
     is enrolled in a health home pursuant to this section and 
     seeks treatment in the emergency department of such hospital, 
     notifying the health home of such child of such treatment.
       ``(2) Education with respect to availability of health home 
     services.--In order for a State plan amendment to be approved 
     under this section, a State shall include in the State plan 
     amendment a description of the State's process for educating 
     providers participating in the State plan (or a waiver of 
     such plan) on the availability of health home services for 
     children with medically complex conditions, including the 
     process by which such providers can refer such children to a 
     designated provider, team of health care professionals 
     operating such a provider, or health team for the purpose of 
     establishing a health home through which such children may 
     receive such services.
       ``(3) Family education.--In order for a State plan 
     amendment to be approved under this section, a State shall 
     include in the State plan amendment a description of the 
     State's process for educating families with children eligible 
     to receive health home services pursuant to this section of 
     the availability of such services. Such process shall include 
     the participation of family-to-family entities or other 
     public or private organizations or entities who provide 
     outreach and information on the availability of health care 
     items and services to families of individuals eligible to 
     receive medical assistance under the State plan (or a waiver 
     of such plan).
       ``(4) Mental health coordination.--A State with a State 
     plan amendment approved under this section shall consult and 
     coordinate, as appropriate, with the Secretary in addressing 
     issues regarding the prevention and treatment of mental 
     illness and substance use among children with medically 
     complex conditions receiving health home services under this 
     section.
       ``(e) Guidance on Coordinating Care From Out-of-State 
     Providers.--
       ``(1) In general.--Not later than October 1, 2020, the 
     Secretary shall issue (and update as the Secretary determines 
     necessary) guidance to State Medicaid directors on--
       ``(A) best practices for using out-of-State providers to 
     provide care to children with medically complex conditions;
       ``(B) coordinating care for such children provided by such 
     out-of-State providers (including when provided in emergency 
     and non-emergency situations);
       ``(C) reducing barriers for such children receiving care 
     from such providers in a timely fashion; and
       ``(D) processes for screening and enrolling such providers 
     in the respective State plan (or a waiver of such plan), 
     including efforts to streamline such processes or reduce the 
     burden of such processes on such providers.
       ``(2) Stakeholder input.--In carrying out paragraph (1), 
     the Secretary shall issue a request for information to seek 
     input from children with medically complex conditions and 
     their families, States, providers (including children's 
     hospitals, hospitals, pediatricians, and other providers), 
     managed care plans, children's health groups, family and 
     beneficiary advocates, and other stakeholders with respect to 
     coordinating the care for such children provided by out-of-
     State providers.
       ``(f) Monitoring.--A State shall include in the State plan 
     amendment--
       ``(1) a methodology for tracking avoidable hospital 
     readmissions and calculating savings that result from 
     improved care coordination and management under this section;
       ``(2) a proposal for use of health information technology 
     in providing health home services under this section and 
     improving service delivery and coordination across the care 
     continuum (including the use of wireless patient technology 
     to improve coordination and management of care and patient 
     adherence to recommendations made by their provider); and
       ``(3) a methodology for tracking prompt and timely access 
     to medically necessary care for children with medically 
     complex conditions from out-of-State providers.
       ``(g) Data Collection.--
       ``(1) Provider reporting requirements.--In order to receive 
     payments from a State under subsection (c), a designated 
     provider, a team of health care professionals operating with 
     such a provider, or a health team shall report to the State, 
     at such time and in such form and manner as may be required 
     by the State, the following information:
       ``(A) With respect to each such provider, team of health 
     care professionals, or health team, the name, National 
     Provider Identification number, address, and specific health 
     care services offered to be provided to children with 
     medically complex conditions who have selected such provider, 
     team of health care professionals, or health team as the 
     health home of such children.
       ``(B) Information on all applicable measures for 
     determining the quality of health home services provided by 
     such provider, team of health care professionals, or health 
     team, including, to the extent applicable, child health 
     quality measures and measures for centers of excellence for 
     children with complex needs developed under this title, title 
     XXI, and section 1139A.
       ``(C) Such other information as the Secretary shall specify 
     in guidance.

     When appropriate and feasible, such provider, team of health 
     care professionals, or health team, as the case may be, shall 
     use health information technology in providing the State with 
     such information.
       ``(2) State reporting requirements.--
       ``(A) Comprehensive report.--A State with a State plan 
     amendment approved under this section shall report to the 
     Secretary (and, upon request, to the Medicaid and CHIP 
     Payment and Access Commission), at such time and in such form 
     and manner determined by the Secretary to be reasonable and 
     minimally burdensome, the following information:
       ``(i) Information reported under paragraph (1).
       ``(ii) The number of children with medically complex 
     conditions who have selected a health home pursuant to this 
     section.
       ``(iii) The nature, number, and prevalence of chronic 
     conditions, life-threatening illnesses, disabilities, or rare 
     diseases that such children have.
       ``(iv) The type of delivery systems and payment models used 
     to provide services to such children under this section.
       ``(v) The number and characteristics of designated 
     providers, teams of health care professionals operating with 
     such providers, and health teams selected as health homes 
     pursuant to this section, including the number and 
     characteristics of out-of-State providers, teams of health 
     care professionals operating with such providers, and health 
     teams who have provided health care items and services to 
     such children.
       ``(vi) The extent to which such children receive health 
     care items and services under the State plan.
       ``(vii) Quality measures developed specifically with 
     respect to health care items and services provided to 
     children with medically complex conditions.
       ``(B) Report on best practices.--Not later than 90 days 
     after a State has a State plan amendment approved under this 
     section, such State shall submit to the Secretary, and make 
     publicly available on the appropriate State website, a report 
     on how the State is implementing guidance issued under 
     subsection (e)(1), including through any best practices 
     adopted by the State.
       ``(h) Rule of Construction.--Nothing in this section may be 
     construed--
       ``(1) to require a child with medically complex conditions 
     to enroll in a health home under this section;
       ``(2) to limit the choice of a child with medically complex 
     conditions in selecting a designated provider, team of health 
     care professionals operating with such a provider, or health 
     team that meets the health home qualification standards 
     established under subsection (b) as the child's health home; 
     or
       ``(3) to reduce or otherwise modify--
       ``(A) the entitlement of children with medically complex 
     conditions to early and periodic screening, diagnostic, and 
     treatment services (as defined in section 1905(r)); or
       ``(B) the informing, providing, arranging, and reporting 
     requirements of a State under section 1902(a)(43).
       ``(i) Definitions.--In this section:
       ``(1) Child with medically complex conditions.--
       ``(A) In general.--Subject to subparagraph (B), the term 
     `child with medically complex conditions' means an individual 
     under 21 years of age who--
       ``(i) is eligible for medical assistance under the State 
     plan (or under a waiver of such plan); and
       ``(ii) has at least--

       ``(I) one or more chronic conditions that cumulatively 
     affect three or more organ systems and severely reduces 
     cognitive or physical functioning (such as the ability to 
     eat, drink, or breathe independently) and that also requires 
     the use of medication, durable medical equipment, therapy, 
     surgery, or other treatments; or
       ``(II) one life-limiting illness or rare pediatric disease 
     (as defined in section 529(a)(3) of the Federal Food, Drug, 
     and Cosmetic Act (21 U.S.C. 360ff(a)(3))).

       ``(B) Rule of construction.--Nothing in this paragraph 
     shall prevent the Secretary from establishing higher levels 
     as to the

[[Page H10045]]

     number or severity of chronic, life threatening illnesses, 
     disabilities, rare diseases or mental health conditions for 
     purposes of determining eligibility for receipt of health 
     home services under this section.
       ``(2) Chronic condition.--The term `chronic condition' 
     means a serious, long-term physical, mental, or developmental 
     disability or disease, including the following:
       ``(A) Cerebral palsy.
       ``(B) Cystic fibrosis.
       ``(C) HIV/AIDS.
       ``(D) Blood diseases, such as anemia or sickle cell 
     disease.
       ``(E) Muscular dystrophy.
       ``(F) Spina bifida.
       ``(G) Epilepsy.
       ``(H) Severe autism spectrum disorder.
       ``(I) Serious emotional disturbance or serious mental 
     health illness.
       ``(3) Health home.--The term `health home' means a 
     designated provider (including a provider that operates in 
     coordination with a team of health care professionals) or a 
     health team selected by a child with medically complex 
     conditions (or the family of such child) to provide health 
     home services.
       ``(4) Health home services.--
       ``(A) In general.--The term `health home services' means 
     comprehensive and timely high-quality services described in 
     subparagraph (B) that are provided by a designated provider, 
     a team of health care professionals operating with such a 
     provider, or a health team.
       ``(B) Services described.--The services described in this 
     subparagraph shall include--
       ``(i) comprehensive care management;
       ``(ii) care coordination, health promotion, and providing 
     access to the full range of pediatric specialty and 
     subspecialty medical services, including services from out-
     of-State providers, as medically necessary;
       ``(iii) comprehensive transitional care, including 
     appropriate follow-up, from inpatient to other settings;
       ``(iv) patient and family support (including authorized 
     representatives);
       ``(v) referrals to community and social support services, 
     if relevant; and
       ``(vi) use of health information technology to link 
     services, as feasible and appropriate.
       ``(5) Designated provider.--The term `designated provider' 
     means a physician (including a pediatrician or a pediatric 
     specialty or subspecialty provider), children's hospital, 
     clinical practice or clinical group practice, prepaid 
     inpatient health plan or prepaid ambulatory health plan (as 
     defined by the Secretary), rural clinic, community health 
     center, community mental health center, home health agency, 
     or any other entity or provider that is determined by the 
     State and approved by the Secretary to be qualified to be a 
     health home for children with medically complex conditions on 
     the basis of documentation evidencing that the entity has the 
     systems, expertise, and infrastructure in place to provide 
     health home services. Such term may include providers who are 
     employed by, or affiliated with, a children's hospital.
       ``(6) Team of health care professionals.--The term `team of 
     health care professionals' means a team of health care 
     professionals (as described in the State plan amendment under 
     this section) that may--
       ``(A) include--
       ``(i) physicians and other professionals, such as 
     pediatricians or pediatric specialty or subspecialty 
     providers, nurse care coordinators, dietitians, 
     nutritionists, social workers, behavioral health 
     professionals, physical therapists, occupational therapists, 
     speech pathologists, nurses, individuals with experience in 
     medical supportive technologies, or any professionals 
     determined to be appropriate by the State and approved by the 
     Secretary;
       ``(ii) an entity or individual who is designated to 
     coordinate such a team; and
       ``(iii) community health workers, translators, and other 
     individuals with culturally-appropriate expertise; and
       ``(B) be freestanding, virtual, or based at a children's 
     hospital, hospital, community health center, community mental 
     health center, rural clinic, clinical practice or clinical 
     group practice, academic health center, or any entity 
     determined to be appropriate by the State and approved by the 
     Secretary.
       ``(7) Health team.--The term `health team' has the meaning 
     given such term for purposes of section 3502 of Public Law 
     111-148.''.

                        TITLE II--OTHER MEDICAID

     SEC. 201. EXTENSION OF MONEY FOLLOWS THE PERSON REBALANCING 
                   DEMONSTRATION.

       (a) General Funding.--Section 6071(h) of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (D), by striking ``and'' after the 
     semicolon;
       (B) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following:
       ``(F) subject to paragraph (3), $112,000,000 for fiscal 
     year 2019.'';
       (2) in paragraph (2)--
       (A) by striking ``Amounts made'' and inserting ``Subject to 
     paragraph (3), amounts made''; and
       (B) by striking ``September 30, 2016'' and inserting 
     ``September 30, 2021''; and
       (3) by adding at the end the following new paragraph:
       ``(3) Special rule for fy 2019.--Funds appropriated under 
     paragraph (1)(F) shall be made available for grants to States 
     only if such States have an approved MFP demonstration 
     project under this section as of December 31, 2018.''.
       (b) Funding for Quality Assurance and Improvement; 
     Technical Assistance; Oversight.--Section 6071(f) of the 
     Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
     amended by striking paragraph (2) and inserting the 
     following:
       ``(2) Funding.--From the amounts appropriated under 
     subsection (h)(1)(F) for fiscal year 2019, $500,000 shall be 
     available to the Secretary for such fiscal year to carry out 
     this subsection.''.
       (c) Technical Amendment.--Section 6071(b) of the Deficit 
     Reduction Act of 2005 (42 U.S.C. 1396a note) is amended by 
     adding at the end the following:
       ``(10) Secretary.--The term `Secretary' means the Secretary 
     of Health and Human Services.''.

     SEC. 202. EXTENSION OF PROTECTION FOR MEDICAID RECIPIENTS OF 
                   HOME AND COMMUNITY-BASED SERVICES AGAINST 
                   SPOUSAL IMPOVERISHMENT.

       (a) In General.--Section 2404 of Public Law 111-148 (42 
     U.S.C. 1396r-5 note) is amended by striking ``the 5-year 
     period that begins on January 1, 2014,'' and inserting ``the 
     period beginning on January 1, 2014, and ending on March 31, 
     2019,''.
       (b) Rule of Construction.--
       (1) Protecting state spousal income and asset disregard 
     flexibility under waivers and plan amendments.--Nothing in 
     section 2404 of Public Law 111-148 (42 U.S.C. 1396r-5 note) 
     or section 1924 of the Social Security Act (42 U.S.C. 1396r-
     5) shall be construed as prohibiting a State from 
     disregarding an individual's spousal income and assets under 
     a State waiver or plan amendment described in paragraph (2) 
     for purposes of making determinations of eligibility for home 
     and community-based services or home and community-based 
     attendant services and supports under such waiver or plan 
     amendment.
       (2) State waiver or plan amendment described.--A State 
     waiver or plan amendment described in this paragraph is any 
     of the following:
       (A) A waiver or plan amendment to provide medical 
     assistance for home and community-based services under a 
     waiver or plan amendment under subsection (c), (d), or (i) of 
     section 1915 of the Social Security Act (42 U.S.C. 1396n) or 
     under section 1115 of such Act (42 U.S.C. 1315).
       (B) A plan amendment to provide medical assistance for home 
     and community-based services for individuals by reason of 
     being determined eligible under section 1902(a)(10)(C) of 
     such Act (42 U.S.C. 1396a(a)(10)(C)) or by reason of section 
     1902(f) of such Act (42 U.S.C. 1396a(f)) or otherwise on the 
     basis of a reduction of income based on costs incurred for 
     medical or other remedial care under which the State 
     disregarded the income and assets of the individual's spouse 
     in determining the initial and ongoing financial eligibility 
     of an individual for such services in place of the spousal 
     impoverishment provisions applied under section 1924 of such 
     Act (42 U.S.C. 1396r-5).
       (C) A plan amendment to provide medical assistance for home 
     and community-based attendant services and supports under 
     section 1915(k) of such Act (42 U.S.C. 1396n(k)).

     SEC. 203. REDUCTION IN FMAP AFTER 2020 FOR STATES WITHOUT 
                   ASSET VERIFICATION PROGRAM.

       Section 1940 of the Social Security Act (42 U.S.C. 1396w) 
     is amended by adding at the end the following new subsection:
       ``(k) Reduction in FMAP After 2020 for Non-Compliant 
     States.--
       ``(1) In general.--With respect to a calendar quarter 
     beginning on or after January 1, 2021, the Federal medical 
     assistance percentage otherwise determined under section 
     1905(b) for a non-compliant State shall be reduced--
       ``(A) for calendar quarters in 2021 and 2022, by 0.12 
     percentage points;
       ``(B) for calendar quarters in 2023, by 0.25 percentage 
     points;
       ``(C) for calendar quarters in 2024, by 0.35 percentage 
     points; and
       ``(D) for calendar quarters in 2025 and each year 
     thereafter, by 0.5 percentage points.
       ``(2) Non-compliant state defined.--For purposes of this 
     subsection, the term `non-compliant State' means a State--
       ``(A) that is one of the 50 States or the District of 
     Columbia;
       ``(B) with respect to which the Secretary has not approved 
     a State plan amendment submitted under subsection (a)(2); and
       ``(C) that is not operating, on an ongoing basis, an asset 
     verification program in accordance with this section.''.

     SEC. 204. DENIAL OF FFP FOR CERTAIN EXPENDITURES RELATING TO 
                   VACUUM ERECTION SYSTEMS AND PENILE PROSTHETIC 
                   IMPLANTS.

       (a) In General.--Section 1903(i) of the Social Security Act 
     (42 U.S.C. 1396b(i)) is amended by inserting after paragraph 
     (11) the following:
       ``(12) with respect to any amounts expended for--
       ``(A) a vacuum erection system that is not medically 
     necessary; or
       ``(B) the insertion, repair, or removal and replacement of 
     a penile prosthetic implant (unless such insertion, repair, 
     or removal and replacement is medically necessary); or''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply with respect to items and services furnished on 
     or after January 1, 2019.

[[Page H10046]]

  


     SEC. 205. MEDICAID IMPROVEMENT FUND.

       Section 1941(b)(1) of the Social Security Act (42 U.S.C. 
     1396w-1(b)(1)) is amended by striking ``$31,000,000'' and 
     inserting ``$9,000,000''.

     SEC. 206. PREVENTING THE MISCLASSIFICATION OF DRUGS UNDER THE 
                   MEDICAID DRUG REBATE PROGRAM.

       (a) Application of Civil Money Penalty for 
     Misclassification of Covered Outpatient Drugs.--
       (1) In general.--Section 1927(b)(3) of the Social Security 
     Act (42 U.S.C. 1396r-8(b)(3)) is amended--
       (A) in the paragraph heading, by inserting ``and drug 
     product'' after ``price'';
       (B) in subparagraph (A)--
       (i) in clause (ii), by striking ``; and'' at the end and 
     inserting a semicolon;
       (ii) in clause (iii), by striking the period at the end and 
     inserting a semicolon;
       (iii) in clause (iv), by striking the semicolon at the end 
     and inserting ``; and''; and
       (iv) by inserting after clause (iv) the following new 
     clause:
       ``(v) not later than 30 days after the last day of each 
     month of a rebate period under the agreement, such drug 
     product information as the Secretary shall require for each 
     of the manufacturer's covered outpatient drugs.''; and
       (C) in subparagraph (C)--
       (i) in clause (ii), by inserting ``, including information 
     related to drug pricing, drug product information, and data 
     related to drug pricing or drug product information,'' after 
     ``provides false information''; and
       (ii) by adding at the end the following new clauses:
       ``(iii) Misclassified or misreported information.--

       ``(I) In general.--Any manufacturer with an agreement under 
     this section that knowingly (as defined in section 1003.110 
     of title 42, Code of Federal Regulations (or any successor 
     regulation)) misclassifies a covered outpatient drug, such as 
     by knowingly submitting incorrect drug category information, 
     is subject to a civil money penalty for each covered 
     outpatient drug that is misclassified in an amount not to 
     exceed 2 times the amount of the difference, as determined by 
     the Secretary, between--

       ``(aa) the total amount of rebates that the manufacturer 
     paid with respect to the drug to all States for all rebate 
     periods during which the drug was misclassified; and
       ``(bb) the total amount of rebates that the manufacturer 
     would have been required to pay, as determined by the 
     Secretary, with respect to the drug to all States for all 
     rebate periods during which the drug was misclassified if the 
     drug had been correctly classified.

       ``(II) Other penalties and recovery of underpaid rebates.--
     The civil money penalties described in subclause (I) are in 
     addition to other penalties as may be prescribed by law and 
     any other recovery of the underlying underpayment for rebates 
     due under this section or the terms of the rebate agreement 
     as determined by the Secretary.

       ``(iv) Increasing oversight and enforcement.--Each year the 
     Secretary shall retain, in addition to any amount retained by 
     the Secretary to recoup investigation and litigation costs 
     related to the enforcement of the civil money penalties under 
     this subparagraph and subsection (c)(4)(B)(ii)(III), an 
     amount equal to 25 percent of the total amount of civil money 
     penalties collected under this subparagraph and subsection 
     (c)(4)(B)(ii)(III) for the year, and such retained amount 
     shall be available to the Secretary, without further 
     appropriation and until expended, for activities related to 
     the oversight and enforcement of this section and agreements 
     under this section, including--

       ``(I) improving drug data reporting systems;
       ``(II) evaluating and ensuring manufacturer compliance with 
     rebate obligations; and
       ``(III) oversight and enforcement related to ensuring that 
     manufacturers accurately and fully report drug information, 
     including data related to drug classification.''; and

       (iii) in subparagraph (D)--

       (I) in clause (iv), by striking ``, and'' and inserting a 
     comma;
       (II) in clause (v), by striking ``subsection (f).'' and 
     inserting ``subsection (f), and''; and
       (III) by inserting after clause (v) the following new 
     clause:

       ``(vi) in the case of categories of drug product or 
     classification information that were not considered 
     confidential by the Secretary on the day before the date of 
     the enactment of the IMPROVE Act.''.
       (2) Technical amendments.--
       (A) Section 1903(i)(10) of the Social Security Act (42 
     U.S.C. 1396b(i)(10)) is amended--
       (i) in subparagraph (C)--

       (I) by adjusting the left margin so as to align with the 
     left margin of subparagraph (B); and
       (II) by striking ``, and'' and inserting a semicolon;

       (ii) in subparagraph (D), by striking ``; or'' and 
     inserting ``; and''; and
       (iii) by adding at the end the following new subparagraph:
       ``(E) with respect to any amount expended for a covered 
     outpatient drug for which a suspension under section 
     1927(c)(4)(B)(ii)(II) is in effect; or''.
       (B) Section 1927(b)(3)(C)(ii) of the Social Security Act 
     (42 U.S.C. 1396r-8(b)(3)(C)(ii)) is amended by striking 
     ``subsections (a) and (b)'' and inserting ``subsections (a), 
     (b), (f)(3), and (f)(4)''.
       (b) Recovery of Unpaid Rebate Amounts Due to 
     Misclassification of Covered Outpatient Drugs.--
       (1) In general.--Section 1927(c) of the Social Security Act 
     (42 U.S.C. 1396r-8(c)) is amended by adding at the end the 
     following new paragraph:
       ``(4) Recovery of unpaid rebate amounts due to 
     misclassification of covered outpatient drugs.--
       ``(A) In general.--If the Secretary determines that a 
     manufacturer with an agreement under this section paid a 
     lower per-unit rebate amount to a State for a rebate period 
     as a result of the misclassification by the manufacturer of a 
     covered outpatient drug (without regard to whether the 
     manufacturer knowingly made the misclassification or should 
     have known that the misclassification would be made) than the 
     per-unit rebate amount that the manufacturer would have paid 
     to the State if the drug had been correctly classified, the 
     manufacturer shall pay to the State an amount equal to the 
     product of--
       ``(i) the difference between--

       ``(I) the per-unit rebate amount paid to the State for the 
     period; and
       ``(II) the per-unit rebate amount that the manufacturer 
     would have paid to the State for the period, as determined by 
     the Secretary, if the drug had been correctly classified; and

       ``(ii) the total units of the drug paid for under the State 
     plan in the period.
       ``(B) Authority to correct misclassifications.--
       ``(i) In general.--If the Secretary determines that a 
     manufacturer with an agreement under this section has 
     misclassified a covered outpatient drug (without regard to 
     whether the manufacturer knowingly made the misclassification 
     or should have known that the misclassification would be 
     made), the Secretary shall notify the manufacturer of the 
     misclassification and require the manufacturer to correct the 
     misclassification in a timely manner.
       ``(ii) Enforcement.--If, after receiving notice of a 
     misclassification from the Secretary under clause (i), a 
     manufacturer fails to correct the misclassification by such 
     time as the Secretary shall require, until the manufacturer 
     makes such correction, the Secretary may--

       ``(I) correct the misclassification on behalf of the 
     manufacturer;
       ``(II) suspend the misclassified drug and the drug's status 
     as a covered outpatient drug under the manufacturer's 
     national rebate agreement; or
       ``(III) impose a civil money penalty (which shall be in 
     addition to any other recovery or penalty which may be 
     available under this section or any other provision of law) 
     for each rebate period during which the drug is misclassified 
     not to exceed an amount equal to the product of--

       ``(aa) the total number of units of each dosage form and 
     strength of such misclassified drug paid for under any State 
     plan during such a rebate period; and
       ``(bb) 23.1 percent of the average manufacturer price for 
     the dosage form and strength of such misclassified drug.
       ``(C) Reporting and transparency.--
       ``(i) In general.--The Secretary shall submit a report to 
     Congress on at least an annual basis that includes 
     information on the covered outpatient drugs that have been 
     identified as misclassified, the steps taken to reclassify 
     such drugs, the actions the Secretary has taken to ensure the 
     payment of any rebate amounts which were unpaid as a result 
     of such misclassification, and a disclosure of expenditures 
     from the fund created in subsection (b)(3)(C)(iv), including 
     an accounting of how such funds have been allocated and spent 
     in accordance with such subsection.
       ``(ii) Public access.--The Secretary shall make the 
     information contained in the report required under clause (i) 
     available to the public on a timely basis.
       ``(D) Other penalties and actions.--Actions taken and 
     penalties imposed under this paragraph shall be in addition 
     to other remedies available to the Secretary including 
     terminating the manufacturer's rebate agreement for 
     noncompliance with the terms of such agreement and shall not 
     exempt a manufacturer from, or preclude the Secretary from 
     pursuing, any civil money penalty under this title or title 
     XI, or any other penalty or action as may be prescribed by 
     law.''.
       (2) Offset of recovered amounts against medical 
     assistance.--Section 1927(b)(1)(B) of the Social Security Act 
     (42 U.S.C. 1396r-8(b)(1)(B)) is amended by inserting ``, 
     including amounts received by a State under subsection 
     (c)(4),'' after ``in any quarter''.
       (c) Clarifying Definitions.--Section 1927(k)(7)(A) of the 
     Social Security Act (42 U.S.C. 1396r-8(k)(7)(A)) is amended--
       (1) by striking ``an original new drug application'' and 
     inserting ``a new drug application'' each place it appears;
       (2) in clause (i), by inserting ``but including a drug 
     product approved for marketing as a non-prescription drug 
     that is regarded as a covered outpatient drug under paragraph 
     (4)'' after ``drug described in paragraph (5)'';
       (3) in clause (ii), by striking ``was originally marketed'' 
     and inserting ``is marketed''; and
       (4) in clause (iv)--
       (A) by inserting ``, including a drug product approved for 
     marketing as a non-prescription drug that is regarded as a 
     covered

[[Page H10047]]

     outpatient drug under paragraph (4),'' after ``covered 
     outpatient drug''; and
       (B) by adding at the end the following new sentence: ``Such 
     term also includes a covered outpatient drug that is a 
     biological product licensed, produced, or distributed under a 
     biologics license application approved by the Food and Drug 
     Administration.''.
       (d) Exclusion of Manufacturers for Knowing 
     Misclassification of Covered Outpatient Drugs.--Section 
     1128(b) of the Social Security Act (42 U.S.C. 1320a-7(b)) is 
     amended by adding at the end the following new paragraph:
       ``(17) Knowingly misclassifying covered outpatient drugs.--
     Any manufacturer or officer, director, agent, or managing 
     employee of such manufacturer that knowingly misclassifies a 
     covered outpatient drug under an agreement under section 
     1927, knowingly fails to correct such misclassification, or 
     knowingly provides false information related to drug pricing, 
     drug product information, or data related to drug pricing or 
     drug product information.''.
       (e) Effective Date.--The amendments made by this section 
     shall take effect on the date of the enactment of this Act, 
     and shall apply to covered outpatient drugs supplied by 
     manufacturers under agreements under section 1927 of the 
     Social Security Act (42 U.S.C. 1396r-8) on or after such 
     date.

                          TITLE III--MEDICARE

     SEC. 301. EXCLUSION OF COMPLEX REHABILITATIVE MANUAL 
                   WHEELCHAIRS FROM MEDICARE COMPETITIVE 
                   ACQUISITION PROGRAM; NON-APPLICATION OF 
                   MEDICARE FEE-SCHEDULE ADJUSTMENTS FOR CERTAIN 
                   WHEELCHAIR ACCESSORIES AND CUSHIONS.

       (a) Exclusion of Complex Rehabilitative Manual Wheelchairs 
     From Competitive Acquisition Program.--Section 1847(a)(2)(A) 
     of the Social Security Act (42 U.S.C. 1395w-3(a)(2)(A)) is 
     amended--
       (1) by inserting ``, complex rehabilitative manual 
     wheelchairs (as determined by the Secretary), and certain 
     manual wheelchairs (identified, as of October 1, 2018, by 
     HCPCS codes E1235, E1236, E1237, E1238, and K0008 or any 
     successor to such codes)'' after ``group 3 or higher''; and
       (2) by striking ``such wheelchairs'' and inserting ``such 
     complex rehabilitative power wheelchairs, complex 
     rehabilitative manual wheelchairs, and certain manual 
     wheelchairs''.
       (b) Non-Application of Medicare Fee Schedule Adjustments 
     for Wheelchair Accessories and Seat and Back Cushions When 
     Furnished in Connection With Complex Rehabilitative Manual 
     Wheelchairs.--
       (1) In general.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services shall not, 
     during the period beginning on January 1, 2019, and ending on 
     June 30, 2020, use information on the payment determined 
     under the competitive acquisition programs under section 1847 
     of the Social Security Act (42 U.S.C. 1395w-3) to adjust the 
     payment amount that would otherwise be recognized under 
     section 1834(a)(1)(B)(ii) of such Act (42 U.S.C. 
     1395m(a)(1)(B)(ii)) for wheelchair accessories (including 
     seating systems) and seat and back cushions when furnished in 
     connection with complex rehabilitative manual wheelchairs (as 
     determined by the Secretary), and certain manual wheelchairs 
     (identified, as of October 1, 2018, by HCPCS codes E1235, 
     E1236, E1237, E1238, and K0008 or any successor to such 
     codes).
       (2) Implementation.--Notwithstanding any other provision of 
     law, the Secretary may implement this subsection by program 
     instruction or otherwise.
  The SPEAKER pro tempore (Mr. Simpson). Pursuant to the rule, the 
gentleman from Texas (Mr. Barton) and the gentleman from Texas (Mr. 
Gene Green) each will control 20 minutes.
  The Chair recognizes the gentleman from Texas (Mr. Barton).


                             General Leave

  Mr. BARTON. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
insert extraneous materials in the Record on the bill.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BARTON. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, we are here today, the culmination of a 6-year journey. 
The IMPROVE Act is a combination of three bills. One bill is a bill 
that allows Medicare to follow the patient; another bill is a bill for 
spousal impoverishment, to prevent that; and the third bill, and the 
primary bill in this package, is a bill that we call the ACE Kids Act.
  Mr. Speaker, there are, luckily, not a large number, about 2 million 
children in this country, who have multiple complex medical conditions 
that are life-threatening. These are the sickest of the sick of our 
young population. About 500,000 of these children are Medicaid 
eligible. In other words, their families qualify for low-income health 
insurance called Medicaid.
  Mr. Speaker, under current law, the parents of these children have to 
create the healthcare network on a case-by-case basis for their child. 
They also cannot seek healthcare across State lines that is covered by 
Medicaid. So current law makes it very difficult on these sickest-of-
the-sick children.
  The ACE Kids Act changes that, Mr. Speaker. It allows the creation of 
a medical home that can cross State lines, that can coordinate care.
  It is optional. The States do not have to participate in this 
program. The parents of the child do not have to participate in this 
program. But if they do wish to participate, you create a health home 
for the child wherein everything is coordinated.
  In the pilot programs that have been run using this model, you get 
better quality healthcare at lower cost. We think the pilot programs 
show that, over time, if we adopt this model and if the States adopt it 
and the families adopt it, we get a lot better healthcare at a lower 
cost. So this is a win-win, Mr. Speaker.
  As I said, we have worked on this for 6 years. It is a bipartisan 
bill. In the last Congress, we had a majority of the Congress that 
sponsored the bill. In this Congress, we have more than 130 cosponsors 
on a bipartisan basis.
  We have had a hearing in the committee of jurisdiction, the Committee 
on Energy and Commerce. We have had a markup in subcommittee. We have 
had a markup in full committee. Now, Mr. Speaker, we are bringing it to 
the floor.
  We hope the House, later today, will vote affirmatively to pass this 
on suspension and send it to the Senate. We have preconferenced it with 
the Senate, and we have every reason to believe, if the House passes it 
today, the Senate will take it up expeditiously and pass it, and this 
is a bill that will become law.
  Mr. Speaker, I reserve the balance of my time.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I rise today in support of H.R. 7217, the IMPROVE Act. 
This legislation contains several important policies related to 
Medicaid and Medicare.
  First, I am a proud original cosponsor of the ACE Kids Act, and I am 
happy to see it included in H.R. 7217. The ACE Kids Act aims to improve 
care coordination for children with complex medical conditions served 
by Medicaid.
  The legislation creates a Medicaid health home, State optional, 
specifically targeted for this population of children. It also requires 
the Secretary to issue best practices on coordinating out-of-State care 
for children with complex medical conditions.
  Mr. Speaker, I thank the sponsors of the ACE Kids Act, Representative 
Castor and Congressman Barton, both members of the Energy and Commerce 
Committee, for championing this issue for so many years.
  The IMPROVE Act also provides new funding for the Money Follows the 
Person, the MFP, program. The MFP program helps individuals transition 
from institutional care to care in their community, where they can live 
more independent lives.
  MFP also helps support States' home and community-based services 
infrastructure. Without this extension funding, we would start to see 
many of these MFP programs end in short order.
  Mr. Speaker, I urge support for the program, which provides thousands 
of Americans with the choice to receive services in their home or 
community rather than in an institution.

                              {time}  1245

  The committee will continue to work on providing long-term funding to 
the MFP program in the next Congress.
  I also voice my support for the extension of spousal impoverishment 
protections until April 2019. These protections will help ensure that a 
person can maintain enough income and assets to meet their basic living 
expenses while still allowing for their spouse to receive long-term 
care in their home or community under Medicaid.
  The expiration of this policy would lead to people losing their long-
term care services and the unnecessary institutionalization of people 
currently

[[Page H10048]]

receiving services in their homes or communities. The committee will 
continue to work on a long-term solution in the next Congress.
  Mr. Speaker, I urge my colleagues to support passage of H.R. 7217, 
the IMPROVE Act, and I reserve the balance of my time.
  Mr. BARTON. Mr. Speaker, I yield 3 minutes to the gentleman from 
Oregon (Mr. Walden), who is the current chairman of the Energy and 
Commerce Committee.
  Mr. WALDEN. Mr. Speaker, I thank Mr. Barton for his great leadership 
on the ACE Kids Act. I know this has been something he has been 
dedicated to for many years, and I am glad we could get this worked out 
and to the floor today. In fact, Mr. Speaker, these bills add to the 
129 that the Energy and Commerce Committee has passed across this House 
floor.
  Mr. Speaker, 92 percent of those bills have been bipartisan. I don't 
think the American people know that, because when we get along and do 
things, it doesn't get much coverage. But most of our work, 92 percent 
of our bills have been bipartisan, plus these today. 28 of those 
measures have become law.
  I rise in strong support of this bipartisan H.R. 7217, which includes 
a number of different policies to improve and bolster the Medicaid and 
Medicare programs for vulnerable patients across our country, Mr. 
Speaker.
  I recognize Joe Barton and our colleague, Kathy Castor from Florida, 
who I know is going to speak in a moment. They have just worked 
relentlessly on the ACE Kids Act. This is an important bill, and it is 
included in this package and one I am proud the House will advance 
forward today.
  They both should be commended for their work because, you see, Mr. 
Speaker, the ACE Kids Act is bipartisan. It is cost-effective 
legislation. It provides children and their families the treatment and 
coordinated care they so desperately need and deserve.
  Representative Barton, former chairman of the committee, has long 
been a champion on this issue, and, again, I thank him for his tireless 
efforts to advocate for improving care for our Nation's sickest 
children.
  This bill also extends two key Medicaid programs: the Money Follows 
the Person Demonstration Program and the spousal impoverishment rules 
in Medicaid, both of which were due to expire or be out of money by the 
end of the year.
  I am disappointed we weren't able to secure a longer term extension 
of these programs. I know many of my colleagues share that 
disappointment. Both sides negotiated in good faith, though, on how to 
pay for an extension, and I hope that the bipartisan work on the long-
term bill will continue early in the new Congress. Today, we are moving 
forward with a 3-month extension to prevent these programs from 
expiring.
  Finally, this package includes a small but critically important 
Medicare fix to ensure disabled seniors have access to necessary 
mobility devices, and that is fully offset and paid for.
  Further boosting our efforts to advance public health, we have four 
other bills before us today. Collectively, these bills reauthorize 
several important programs, promote safe motherhood, and improve 
patient care.
  Lastly, we will consider H.R. 6140. That is the Advanced Nuclear Fuel 
Availability Act. This bill, as you already know, Mr. Speaker, directs 
the Secretary of Energy to establish a program to make high-assay, low-
enriched uranium available for use in the first-of-a-kind advanced 
nuclear reactor designs. This fuel will enable the development and 
deployment of a new generation of innovative nuclear technologies.
  Nuclear energy is the largest source of emissions-free electricity in 
the United States, so a strong U.S. nuclear energy policy can ensure a 
reliable, clean U.S. energy sector for years to come and provide 
American families and businesses with affordable energy.
  In closing, Mr. Speaker, I thank Ranking Member Pallone, Mr. Green, 
and the other members of the Energy and Commerce Committee. I urge my 
colleagues to support passage of all of these bills, especially H.R. 
7217, on behalf of patients in Oregon and all across our country.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield 5 minutes to the 
gentlewoman from Florida (Ms. Castor), a cosponsor of the ACE Kids Act 
and a great member of our Energy and Commerce Committee.
  Ms. CASTOR of Florida. Mr. Speaker, I thank Congressman Green for 
being an outspoken advocate for his constituents, but especially for 
affordable healthcare for all Americans, especially children. It has 
been a privilege serving with him.
  Mr. Speaker, on behalf of the families with children with complex 
medical needs all across America, I rise to urge approval of the 
IMPROVE Act, which includes a bill that I have been working on for a 
number of years with Representative Joe Barton called the ACE Kids Act.
  We drafted the Advancing Care for Exceptional Kids Act a few years 
ago with the simple but important goal of putting families and children 
first. The bill authorizes the creation of cost-saving and time-saving 
health homes where specialized care is coordinated in a high-quality 
setting.
  Mr. Speaker, the children with complex medical conditions and their 
families are heroic.
  Caroline West in Tampa, Florida, has a rare genetic condition, also 
cerebral palsy and a seizure disorder. She can't walk. It is very 
difficult for her to speak, but she is able to attend school part-time 
and enjoys the life of a typical teenager, in many respects.

  Lucy Ferlita is the only living person in the United States with 
early onset myopathy with areflexia, respiratory distress, and 
dysphagia. Very little is known about this disease, but what we know is 
that it is very difficult for her to eat. She has to have a feeding 
tube, a ventilator to breath, and nursing care 24 hours a day, and yet 
she is a bright and social 6-year-old.
  Jaden Velasquez has a congenital heart defect. He was born with it. 
The left side of his heart is severely underdeveloped. He has undergone 
numerous surgeries, yet he is a loving and happy 10-year-old, loves 
swimming, and is enjoying life.
  Lakota Lockhart, with congenital central hypoventilation syndrome, a 
central nervous system disorder, causes him to not be able to breathe 
every time he tries to sleep.
  I met these children in Tampa, Florida, at St. Joseph's Children's 
Hospital. They have the world-renowned Chronic-Complex Clinic that was 
started 16 years ago by a passionate pediatric doctor named Dr. Daniel 
Plasencia. The ACE Kids Act is modeled after the work being done at St. 
Joe's by the professionals at the Chronic-Complex Clinic and the 700 
kids and families they currently serve and other children's hospitals 
all across the country.
  The families have shared with us how difficult it is to get quality 
healthcare. It is oftentimes so fragmented and uncoordinated that they 
have to go from one office to another, and maybe the specialist is in 
another State. That is why we put together the ACE Kids Act, to help 
coordinate care in a single setting to help give these kids a better 
quality of life, and the ACE Kids Act will do just that.
  The bill provides an incentive to States to establish health homes to 
better coordinate care for kids with medical complexities. It also 
directs HHS to provide guidance to States on best practices relating to 
providing care across State lines.
  As so many of these families know all too well, coordinating care 
across State lines can be burdensome, so that is the aim of the ACE 
Kids Act: to lift that burden.
  In addition to Congressman Joe Barton, who has worked diligently for 
so many years to get this over the finish line, I thank all of the 
families with children with complex medical challenges. They deserve 
credit for moving this bill forward, coming to Congress, and helping to 
explain the importance of coordinating care.
  I also thank Chairman Walden, Ranking Member Pallone, Chairman 
Burgess, and Ranking Member Green for their support, and our stalwart 
partners: Representatives Herrera Beutler, Eshoo, and Reichert.
  Thank you to America's children's hospitals, the March of Dimes, the 
American Academy of Pediatrics, and thanks to the professional staff at 
the committee for your dedication to these families, especially Rachel 
Pryor, Samantha Satchell, Tiffany Guarascio, and Josh Trent and Caleb 
Graff on the Republican side.

[[Page H10049]]

  Additionally, this bill would not be where it is without the stellar 
work of Representative Barton's staffers: Krista Rosenthall, Gable 
Brady, Sophie Trainor, and Jeannine Bender, and my LD, Elizabeth Brown.
  Passage of this bill will be a gift to so many families during this 
holiday season and beyond, so I urge my colleagues here in the House 
and then over in the Senate to pass the ACE Kids Act contained within 
the IMPROVE Act.
  Mr. BARTON. Mr. Speaker, before I yield to Dr. Burgess, I echo what 
Congresswoman Castor just said about the staffs that have worked so 
hard. We couldn't have done this bill without all the individuals she 
just named.
  I also thank her. When she said I have been tireless, she makes me 
look like a snail, and she is the rabbit working every day to make this 
possible.
  Mr. Speaker, I yield 3 minutes to the gentleman from Texas (Mr. 
Burgess), the distinguished subcommittee chairman of the Health 
Subcommittee, my good friend.
  Mr. BURGESS. Mr. Speaker, I rise in support of H.R. 7217. This is a 
bipartisan Medicaid package that moves forward House priorities with 
responsible offsets. The Energy and Commerce Committee has been working 
to draft and perfect the legislation before us, and it is encouraging 
to see this reach the House floor.
  Not only does this package include a new program to improve access to 
care, it reauthorizes important and effective programs from which 
Americans benefit each and every day. Title I of this package is based 
upon Representative Joe Barton and Representative Kathy Castor's ACE 
Kids Act.
  But I do want to assure families that have children with chronic 
illnesses that this legislation is intended to help them, if they want 
help, to obtain care coordination services. However, I also want to 
clarify that this legislation is not intended to limit families or 
their physicians from selecting their provider of medical services.
  There is nothing in this legislation that restricts the child's 
family and their physician from deciding who is the best provider 
amongst those accepting Medicaid and qualified to offer the medical 
services. The Center for Medicare and Medicaid Services has provided 
assurances that current freedom-of-choice rules will apply to new care 
coordination activity.
  As a doctor, I know that many children with chronic illnesses have a 
strong relationship with their doctors and with other members of their 
healthcare team. I want to make certain that this new law will help 
families coordinate their care without affecting the relationship that 
families have with their current medical care providers or with other 
providers in their communities from whom they may wish to receive their 
care.
  This package also extends funding for the Money Follows the Person 
Demonstration, an effort that was led by my Energy and Commerce 
Subcommittee on Health Vice Chair Brett Guthrie and Representative 
Debbie Dingell from Michigan.
  This Medicaid demonstration was established in 2005 for individuals 
in States across our Nation, including Texas, to receive long-term care 
services in their homes or other community settings rather than 
institutions such as nursing homes. The funding for this program has 
already expired, and a funding extension is already overdue. While it 
would have been nice to extend this for longer, it was essential to get 
this extension across the floor.

  A 3-month extension for the protection for Medicaid recipients of 
home and community-based services against spousal impoverishment was 
also included. This effort was championed by Representatives Fred Upton 
and Debbie Dingell.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BARTON. Mr. Speaker, I yield an additional 30 seconds to the 
gentleman from Texas.
  Mr. BURGESS. Mr. Speaker, in an effort to be fiscally responsible, 
this legislation includes several offsets to make this package, on net, 
a saver.
  While it is largely a Medicaid package, there is one small but 
important Medicare provision. This provision excludes complex medical 
rehabilitative wheelchairs from Medicare's Competitive Acquisition 
Program. Currently, these chairs are not included, but because the 
statute did not provide the same clear exemption that power wheelchairs 
received, there is fear that this unintended omission can lead to them 
being included.
  Mr. Speaker, I thank the gentleman for the additional time, and I 
include my full statement in the Record.

  Mr. Speaker, I rise today in support of H.R. 7217, a bipartisan 
Medicaid package that propels forward House priorities with responsible 
offsets. The Energy and Commerce Committee has been working diligently 
to draft and perfect the legislation before us, and it is encouraging 
to see this package reach the House floor. Not only does this package 
include an exciting new program to improve access to care, it 
reauthorizes important and effective programs from which Americans 
benefit each and every day.
  Title I of this package is based upon Rep. Joe Barton and Rep. Cathy 
Castor's ACE Kids Act. I want to ensure families who have children with 
chronic illnesses that this legislation is intended to help them, if 
they want help, to obtain care coordination services. However, I want 
to clarify that this legislation is not intended to limit families and 
their physicians from selecting the provider of medical services. There 
is nothing in this legislation that restricts the child's family, and 
their physician, from deciding who is the best provider among those 
accepting Medicaid and qualified to offer the medical services. CMS has 
provided assurances that current ``freedom of choice'' rules will apply 
to new care coordination activity. As a physician, I know that many 
children with chronic illnesses have a strong relationship with their 
physician and with other providers. I want to make sure that this new 
law will help families coordinate their care without affecting the 
relationship that families have with their current medical care 
providers or with other providers in their communities from whom they 
may want to receive such care from.''
  This package also extends funding for the Money Follows the Person 
demonstration, an effort led by my E&C Subcommittee on Health Vice 
Chair, Brett Guthrie, and Rep. Debbie Dingell. This Medicaid 
demonstration, which was established in 2005, has enabled eligible 
individuals in states across our nation, including Texas, to receive 
long-term care services in their homes or other community settings, 
rather than in institutions such as nursing homes. The funding for this 
program has already expired, and a funding extension is already long 
overdue. While we would have like to extend the funding for longer, it 
was essential that we get an extension across the floor, even if a 
small one.
  A 3-month extension for the Protection for Medicaid Recipients of 
Home and Community-Based Services Against Spousal Impoverishment 
program is also included. This effort was championed by Representatives 
Fred Upton and Debbie Dingell. Our seniors are among our most 
vulnerable citizens, and it is programs like this one that help to 
protect them from financial ruin.
  In an effort to be fiscally responsible, this legislation includes 
several offsets that make this package on net a saver, which is 
something that Energy & Commerce insists upon and is critically 
important.
  While this is largely a Medicaid Package, there is one small but 
important Medicare provision. This provision excludes manual Complex 
Rehabilitative wheelchairs from Medicare's Competitive Acquisition 
Program. Currently, these chairs are not included but because statute 
did not provide the same clear exemption that power wheelchairs 
received, there is fear this unintended omission could lead them to 
being included. This provision also delays the application of 
competitive bid pricing with CRT accessories used with a CRT manual 
chair for 18 months. This mirrors a similar protection last provided by 
Congress for power wheelchairs in the 21st Century Cures Act.
  This package contains must-pass provisions that the Energy and 
Commerce Committee have long fought to pass. The provisions included in 
this legislation will improve access to care for Medicaid and Medicare 
beneficiaries, which is a laudable and important goal. Not only are 
these provisions imperative, but they are responsibly offset. I would 
particularly like to thank Energy and Commerce Committee staffer Caleb 
Graff, who has spent countless hours negotiating to get this package to 
the floor. I support this legislation, and I urge my fellow members and 
our friends in the Senate to do so as well.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the 
gentlewoman from Michigan (Mrs. Dingell), another member of the Energy 
and Commerce Committee.

                              {time}  1300

  Mrs. DINGELL. Mr. Speaker, I thank my colleague, Ranking Member Gene 
Green, for yielding me the time.

[[Page H10050]]

  I rise in support of H.R. 7217, the IMPROVE Act, and I thank Chairman 
Walden, Ranking Member Pallone, and Representatives Upton and Guthrie 
for their leadership in negotiating this important bill and for 
bringing it to the floor today.
  I also thank and acknowledge my dear friend Joe Barton for all of his 
leadership on the ACE Kids Act and congratulate him on his retirement. 
Joe has been a great friend to John and me over the years, and he will 
be dearly missed in the next Congress. Getting the IMPROVE Act signed 
into the law by the end of the year will be a fitting tribute to his 
decades of service in the Congress.
  Ranking Member Green has also been critical to so many measures. 
Texas has had two valuable public servants.
  Improving long-term care has been one of my top priorities since 
coming to Congress, and our system is completely broken. We need a 
broader overhaul of long-term care financing, and we also need to build 
off existing programs to make sure we are doing everything we can to 
ensure that we are enhancing the opportunities for independent living 
and supporting aging with dignity.
  I am proud to have authored two important provisions in the IMPROVE 
Act that extend critical programs that are about to expire.
  The first is a 3-month extension of the Money Follows the Person 
program. This very successful program provides grants to States to 
cover transitional services for individuals who voluntarily wish to 
leave a nursing home or other institution and transition to a community 
care setting. Money Follows the Person is a win for both beneficiaries 
and taxpayers, because the program has demonstrated significant savings 
over the years while bringing a real benefit to people's lives.
  I am also pleased that legislation I authored with the gentleman from 
Michigan (Mr. Upton), my good friend, the Protecting Married Seniors 
from Impoverishment Act, is also included in this bill. Extending 
spousal impoverishment protections for seniors in Medicaid is just 
common sense. Nobody should be forced to spend down all of their 
resources and have to go bankrupt just to get the care they need.
  But these are only partial victories. Both programs are extended for 
3 months. This is enough to keep these important programs alive for 
now, but all of us have a lot of work to do when we come back in the 
new year.
  Let me be clear: I will continue to fight for long-term extensions of 
both programs in the next Congress, and I am confident that we can get 
that done with the Democratic majority. These programs clearly have 
bipartisan support, and they do so much good for so many people.
  Once again, congratulations to my two dear friends from Texas for 
their leadership. I urge my colleagues to join me in support of this 
bill.
  Mr. BARTON. Mr. Speaker, I thank the gentlewoman from Michigan for 
her kind words. I appreciate the nice gift I got yesterday from her and 
her husband, his new book, ``The Dean.'' I look forward to reading it 
over Christmas.
  Mr. Speaker, I yield 1 minute to the distinguished gentleman from 
Kentucky (Mr. Guthrie).
  Mr. GUTHRIE. Mr. Speaker, I rise in support of my legislation, the 
EMPOWER Care Act, which is included in H.R. 7217. It will ensure that 
Medicaid beneficiaries can receive the best long-term care possible in 
their communities or in their own homes.
  The EMPOWER Care Act will extend the Medicaid Money Follows the 
Person program, which allows certain Medicaid beneficiaries, such as 
the elderly or individuals with disabilities, to transition from a 
healthcare facility to receiving care in their own homes. It does not 
force patients to leave a facility if they don't want to.
  My home State of Kentucky is currently working to transition 50 
individuals from healthcare facilities back into their own communities, 
empowering these individuals who have chosen to receive care in their 
community.
  I thank my friend, Congresswoman Debbie Dingell, for working with me 
on this bipartisan bill. I look forward to working with her to make the 
Money Follows the Person program permanent in the future.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the 
gentleman from Vermont (Mr. Welch), another good member of our Energy 
and Commerce Committee.
  Mr. WELCH. Mr. Speaker, I extend my congratulations as well to Mr. 
Barton. It has been a pleasure working with you, sir. Thank you. Also, 
to Mr. Green, thank you very much for all your service. What an 
incredible career both of you have had.
  My colleagues have talked about the underlying bill, and I am in 
agreement with what everyone has said.
  I wanted to focus attention on an aspect of the bill that was 
sponsored by my colleague Kurt Schrader and me, and that is a provision 
that addresses abusive practices of drug manufacturers who 
intentionally misrepresent their brand drugs as a generic in order to 
avoid providing a larger discount to the Medicaid program.
  My colleagues, whatever our position on the best way to deliver 
healthcare, one thing we know is the case: It is too expensive. Whether 
it is taxpayers footing the bill, consumers, or employer-sponsored 
healthcare plans, it is too expensive. And one of the reasons is rip-
off pharma practices.
  This is a situation where, oftentimes, brand-name drugs try to keep 
generics off the market. But this is a case where a brand name tried to 
pretend they were a generic in order to get a lower price.
  I will give an example. In 2016, Mylan misclassified the EpiPen as a 
generic drug instead of a brand drug, and that allowed them to charge 
Medicaid a higher price for the drug. Mylan ended up paying $465 
million in a settlement to Health and Human Services, but the estimated 
malfeasance cost Medicaid--which is to say, taxpayers--more than $1 
billion.
  Simultaneously, Mylan was raising its list price on EpiPen, which 
parents have to have for their kids who have an allergic reaction, from 
$103 to $608 over 7 years, a 500 percent increase.

  Mylan is not alone. This practice of unrelenting drug price hikes is 
tried and true for manufacturers.
  So I am very pleased that we have included in this bill an end to 
this abusive practice. We have to make healthcare affordable.
  Representative Schrader and I, with this provision, are taking a 
small step. With the help of our Congress and the passage of this very 
good bill, we will be taking one more step in dealing with the cost 
crisis in our healthcare system.
  Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from 
Michigan (Mr. Upton), the former full committee chairman and the 
current subcommittee chairman of the Energy Subcommittee.
  Mr. UPTON. Mr. Speaker, I stand in support of this legislation today.
  I thank my colleague Debbie Dingell. The two of us helped cosponsor 
the spousal impoverishment bill, which is part of this bill. There was 
no objection to that, and I am delighted that we are getting it done.
  But I want to particularly take this time and just thank Joe Barton 
for his leadership on the ACE Kids Act.
  All of us come here to this House for particular causes that really 
grab our interest and attention. Joe Barton has been so good--some 
would say like a dog to a Frisbee--in getting the ACE Kids Act to the 
House floor. This bill is going to save lives.
  It was bipartisan. Frankly, I wanted to move it as part of the 21st 
Century Cures Act, but we didn't have a CBO score. We couldn't get it 
done.
  We had plenty of meetings over the last couple of years on this, and 
here it is. We are going to get it done. Hopefully, the Senate is going 
to get it done, and we are going to get it to the President's desk.
  This is probably the last time that Joe Barton is actually managing a 
bill on the House floor, and it is appropriate that this is his bill, 
that it is his engine that is moving this train that really is going to 
make a difference for families across the country. So I say thank you, 
Joe Barton.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield 3 minutes to the 
gentleman from Oregon (Mr. Schrader), a colleague from our committee.
  Mr. SCHRADER. Mr. Speaker, I rise today in support of H.R. 7217, the 
IMPROVE Act.
  I appreciate all the work that has been done on this bill over the 
years.

[[Page H10051]]

From improving care for kids with complex medical conditions to 
strengthening community-based, long-term care services for the disabled 
community, there is a lot to support in this bill.
  I want to highlight one portion of the bill that my colleague and 
good friend Peter Welch alluded to a few moments ago. A few years ago, 
families were shocked when the drug company Mylan raised the price on 
EpiPen, a common generic drug used to treat allergies in emergency 
situations, by more than 400 percent.
  While patients were facing this sticker shock for a drug necessary to 
keep them alive, investigators in the Department of Health and Human 
Services and in our own House and Senate committees were doing some 
digging of our own.
  In the course of their investigation, they found that not only was 
the manufacturer of EpiPen ripping off patients and their families, 
they were ripping off the American taxpayer, too. By misclassifying 
their drug as a generic when it was actually a brand drug, Medicaid was 
being overcharged for years.
  Further investigations by HHS found that hundreds of other drugs were 
also misclassified, and Medicaid was overcharged by more than $1 
billion in the 4 years between 2012 and 2016. By passing this bill 
today, we can put an end to this waste and abuse in our Medicaid 
system.
  Under this bill, if a drug company knowingly misclassifies their 
brand drug as a generic, CMS will have the power to fine that drug 
company double the normal rebate they would have had to pay the 
government. The bill strengthens CMS and congressional oversight of the 
program to prevent this from ever happening again.
  I thank Mr. Welch, and Senators Wyden and Grassley, for their active 
work on this one, as well as Mr. Barton, Mr. Green, Chairman Walden, 
and Mr. Pallone for including it in this great reform package.
  Mr. Speaker, I urge all Members to support the bill.
  Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from 
Florida (Mr. Bilirakis).
  Mr. BILIRAKIS. Mr. Speaker, I rise in support of H.R. 7217, the 
IMPROVE Act, which includes several important Medicaid provisions, 
including the ACE Kids Act. I have been a cosponsor of the ACE Kids Act 
since its first introduction.
  Mr. Speaker, in the Tampa area, we have St. Joseph's Children's 
Hospital. They run a Chronic-Complex Clinic for children. This medical 
home is a great model that the ACE Kids Act is trying to build on.
  This integrated care model, where the care is built around the needs 
of the patient, has made a huge difference in the lives of so many 
children. I am excited that, finally, we have reached the finish line 
on the ACE Kids Act.
  I thank former full committee chairman and also, I guess--well, I am 
not sure, but he is a great guy. Yes, he is vice chairman of the 
committee. I thank him for all of his hard work on the ACE Kids and the 
IMPROVE Acts. I also thank my colleague Kathy Castor for being 
relentless. The two of them are relentless on behalf of our children.
  I thank all the children that came up and advocated for this bill as 
well.
  So, in any case, we are going to get this done. We couldn't do it 
without these two, so thank you very much.
  Mr. GENE GREEN of Texas. Mr. Speaker, how much time do I have left?
  The SPEAKER pro tempore. The gentleman from Texas (Mr. Green) has 
4\1/2\ minutes remaining. The gentleman from Texas (Mr. Barton) has 
6\1/2\ minutes remaining.
  Mr. GENE GREEN of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  Mr. Speaker, I think this is how we need to work together, and this 
is a good example of not only inter-State but also inter-party, to be 
able to solve these three problems that this bill corrects. I hope the 
next Congress will continue that effort of Republicans and Democrats 
talking to each other, Texans talking to Oklahomans, which is sometimes 
tough, to work together for the people we represent.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BARTON. Mr. Speaker, I yield 1 minute to the distinguished 
gentleman from Georgia (Mr. Carter), a strong supporter.
  Mr. CARTER of Georgia. Mr. Speaker, I rise today in support of the 
IMPROVE Act. My colleagues on the Energy and Commerce Committee and I 
have been working to address a number of the issues that culminated 
under this legislation.
  For instance, the ACE Kids Act, an effort championed by 
Representative Barton, would make strides in addressing the challenges 
of children with medically complex conditions.
  It sets standards for health home qualifications, so as to ensure 
better coordinated care for children in need.
  It updates and streamlines the coordinated care provisions for health 
homes for children, so that they will have the system and framework in 
place to properly respond and work with health systems and 
professionals.
  Additionally, it overhauls the data collection requirements for 
providers and updates the State reporting requirements, so as to 
maintain a more comprehensive network of care for children with complex 
medical conditions.
  Mr. Speaker, this legislation is a culmination of a lot of hard work 
by my colleagues, particularly Representative Barton and the staff of 
the Energy and Commerce Committee, and represents a commonsense step 
forward in assisting needy children. I urge my colleagues to support 
this legislation.

                              {time}  1315

  Mr. BARTON. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Washington (Ms. Herrera Beutler), one of the tireless supporters of 
this bill from day one, who herself has a medically complex special 
needs child, who went through the nightmare of having to create her own 
network for her child, and who has been a cosponsor since day one.
  Ms. HERRERA BEUTLER. Mr. Speaker, I thank Chairman Barton for his 
leadership on this.
  I am so excited that we are here today to celebrate this. I have 
spent months of my life in a NICU for my own medically complex child, 
and I have stood bedside-to-bedside with many a family as they have 
faced the reality of having a sick kid and they have hit hard economic 
times. I can put too many faces and names to the reality that little 
kiddos often can't get the care they need, and today we are taking a 
step to fix it. I am so excited about this.
  One in 25 children in the U.S. is medically complex. That means they 
have diagnoses like cancer or end-stage renal disease or congenital 
heart disease or other diagnoses that require consistent critical 
medical care. They need the expertise.
  Out of those 3 million medically complex kiddos, 2 million of them 
rely on Medicaid, which means what we do with Medicaid significantly 
impacts them.
  They are also less expensive than the other folks on Medicaid, so we 
can go a long way to make sure of getting them care.
  So in order to enhance the critical care for these 2 million kiddos, 
the ACE Kids Act would create networks, anchored by children's 
hospitals, to help coordinate care, allowing families to seamlessly 
pursue the best doctors and facilities, even if it takes them out of 
State, and that is the key.
  Right now under Medicaid, you can get stuck in your ZIP Code. So 
maybe there is a specialist for your child's rare disease in another 
State. Well, if you are on Medicaid, you are limited.
  We are breaking open that limitation today to allow those kiddos to 
cross State lines and pursue the best doctors regardless of where they 
are. This just makes sense.
  Here is the great thing: the efficiency and the better coordination 
is going to improve outcomes, number one, that is the best thing. But 
the next best thing is this is even going to save money, because we are 
not going to build that expertise in every single community, we are 
going to get those kids where they need to go.
  It is really going to cut down on duplication and it is going to 
increase efficiency and it is going to be the right thing. So this is a 
win-win proposition. I am so excited about this.
  Mr. Speaker, I urge my colleagues to vote ``yes.''

[[Page H10052]]

  And, again, Mr. Speaker, I thank the chairman and Ms. Castor for 
their leadership here.
  Mr. BARTON. Mr. Speaker, I yield 1 minute to the gentleman from New 
York (Mr. Zeldin).
  Mr. ZELDIN. Mr. Speaker, I thank Mr. Barton for yielding the time.
  Mr. Speaker, today I rise to speak in support of language that was 
added to the IMPROVE Act that would protect access to critical 
equipment for individuals with disabilities.
  In November of 2014, the Centers for Medicare and Medicaid Services 
issued a rule stating that accessories used on complex rehabilitative 
wheelchairs would no longer be part of the fixed fee schedule and would 
be subject to competitive bidding pricing, decreasing access to 
customized wheelchairs and accessories relied on by adults and children 
with disabilities.
  My language included in this legislation will include a commonsense 
clarification to ensure those in the Medicare Program do not have to go 
through the difficulty of adjusting to the new rules and pricing 
arbitrarily set by CMS. This will ensure that they have reliable and 
consistent access to the equipment they need.
  Mr. Speaker, I urge my colleagues to protect those with disabilities 
and their access to the resources they rely on.
  Mr. BARTON. Mr. Speaker, may I inquire how much time I have 
remaining?
  The SPEAKER pro tempore. The gentleman from Texas has 2\1/2\ minutes 
remaining.
  Mr. BARTON. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, before I close, I want to set the record straight on one 
thing. There has been a report that this bill, the ACE Kids Act, 
expands Medicaid. That is factually incorrect.
  The children that qualify for the ACE Kids Act are already covered by 
Medicaid.
  There is no expansion. We do not create a new program. We do not 
expand an existing program. We do not change the definitions.
  We simply make it possible, if this bill becomes law, for parents of 
children that qualify and that are already covered under Medicaid, they 
can choose a healthcare home for their child, and that healthcare home 
can cross State lines. But as Dr. Burgess pointed out, it is not 
coercive. The States don't have to participate in the program, the 
families don't have to participate in the program. It is all voluntary. 
But the pilot programs that have been done on this model, they save 
money and they give better care. It has been proven.
  CBO has scored this over time that it saves money, but we put pay-
fors in the bill. If it did cost some extra money, it would be paid 
for. There is a 2-quarter, 6-month increase in the FMAP, the Federal 
matching that the Federal Government gives to States that choose to 
participate. I think it is about 15 percent extra money for 6 months. 
That is the only cost.
  Now, to close, I am going to read a list, and Congresswoman Castor 
read a lot of these, but these are the national groups that support our 
bill: the Adult Congenital Heart Association, America's 
Essential Hospitals, American Academy of Pediatrics, American 
Association of Child & Adolescent Psychiatry, American Board of 
Pediatrics, American College of Cardiology, American College of 
Surgeons, American Heart Association, American Psychological 
Association, American Society of Echocardiography, American Thoracic 
Society, Amicus Therapeutics, Association of American Medical Colleges, 
Association of Medical School Pediatric Department Chairs, Autism 
Society, Autism Speaks, ChildServe, Children's Cause for Cancer 
Advocacy, Children's Hospital Association, Epilepsy Foundation, Family 
Voices, Foundation to Eradicate Duchenne, International Pediatric 
Rehabilitation Collaborative, March of Dimes, Mended Little Hearts, 
MomsRising, National Association for Children's Behavioral Health. 
There are about seven or ten more.

  Mr. Speaker, I want to thank the staff, especially Krista Rosenthall, 
Jeannine Bender, committee staff Caleb Graff, Josh Trent, and Ryan 
Long. And, again, I thank Kathy Castor and Gene Green.
  Mr. Speaker, this has been a bipartisan effort. I ask for a strong 
``yea'' vote.
  Mr. Speaker, I yield back the balance of my time.
  Mr. SMITH of Texas. Mr. Speaker, I believe it is important to make 
very clear with this legislation that CMS should not waive any Medicaid 
state plan requirements that would limit the freedom to choose 
qualified Medicaid providers who can provide medical services to 
children with chronic conditions. Nothing in this bill modifies section 
1902(a)(23) of the Social Security Act--related to freedom of choice 
requirements. Children and their families or guardians retain the right 
to elect care from a provider or supplier who is qualified and eligible 
to receive Medicaid payment for the services. It is the intent of this 
legislation to permit and guarantee the family, in consultation with 
their physician, in all instances, to be permitted to select the best 
provider/supplier who can meet the patient's needs. While I support 
this legislation to provide care coordination for these children, the 
ultimate choice of the who will provide direct medical services must 
remain with the family.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Texas (Mr. Barton) that the House suspend the rules and 
pass the bill, H.R. 7217.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. BARTON. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________