[House Report 115-382]
[From the U.S. Government Publishing Office]
115th Congress } { Report
HOUSE OF REPRESENTATIVES
1st Session } { 115-382
======================================================================
PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 3922) TO EXTEND FUNDING
FOR CERTAIN PUBLIC HEALTH PROGRAMS, AND FOR OTHER PURPOSES
_______
November 1, 2017.--Referred to the House Calendar and ordered to be
printed
_______
Mr. Burgess, from the Committee on Rules,
submitted the following
R E P O R T
[To accompany H. Res. 601]
The Committee on Rules, having had under consideration
House Resolution 601, by a record vote of 7 to 3, report the
same to the House with the recommendation that the resolution
be adopted.
SUMMARY OF PROVISIONS OF THE RESOLUTION
The resolution provides for consideration of H.R. 3922, the
Community Health And Medical Professionals Improve Our Nation
Act of 2017, under a closed rule. The resolution provides one
hour of debate equally divided and controlled by the chair and
ranking minority member of the Committee on Energy and
Commerce. The resolution waives all points of order against
consideration of the bill. The resolution provides that the
amendment printed in part A of this Report, modified by the
amendment printed in part B of this Report, shall be considered
as adopted and the bill, as amended, shall be considered as
read. The resolution waives all points of order against
provisions in the bill, as amended. The resolution provides one
motion to recommit with or without instructions.
EXPLANATION OF WAIVERS
Although the resolution waives all points of order against
consideration of the bill, the Committee is not aware of any
points of order. The waiver is prophylactic in nature.
The waiver of all points of order against provisions in the
bill, as amended, includes a waiver of the following:
Clause 4 of rule XXI, which prohibits
reporting a bill or joint resolution carrying an
appropriation from a committee not having jurisdiction
to report an appropriation.
Clause 5(a) of rule XXI, which prohibits a
bill or joint resolution carrying a tax or tariff
measure from being reported by a committee not having
jurisdiction to report tax or tariff measures.
COMMITTEE VOTES
The results of each record vote on an amendment or motion
to report, together with the names of those voting for and
against, are printed below:
Rules Committee record vote No. 135
Motion by Ms. Slaughter to make in order and provide the
appropriate waivers to amendment # 6, offered by Rep. Pallone
Jr. (NJ), which extends funding for critically important
healthcare programs such as the Children's Health Insurance
Program (CHIP) and Community Health Centers that were last
authorized in the bipartisan Medicare Access and CHIP
Reauthorization Act of 2015. The amendment does so without
making it harder for people to keep their health insurance or
gutting funding for public health programs supported by the
Prevention Fund. Instead, it fully pays for these policies with
a commonsense offset. Defeated: 3-7
----------------------------------------------------------------------------------------------------------------
Majority Members Vote Minority Members Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole........................................ Nay Ms. Slaughter..................... Yea
Mr. Woodall..................................... Nay Mr. McGovern...................... Yea
Mr. Burgess..................................... Nay Mr. Hastings of Florida........... Yea
Mr. Collins..................................... Nay Mr. Polis......................... ............
Mr. Byrne....................................... ............
Mr. Newhouse.................................... Nay
Mr. Buck........................................ Nay
Ms. Cheney...................................... ............
Mr. Sessions, Chairman.......................... Nay
----------------------------------------------------------------------------------------------------------------
Rules Committee record vote No. 136
Motion by Mr. Cole to report the rule. Adopted: 7-3
----------------------------------------------------------------------------------------------------------------
Majority Members Vote Minority Members Vote
----------------------------------------------------------------------------------------------------------------
Mr. Cole........................................ Yea Ms. Slaughter..................... Nay
Mr. Woodall..................................... Yea Mr. McGovern...................... Nay
Mr. Burgess..................................... Yea Mr. Hastings of Florida........... Nay
Mr. Collins..................................... Yea Mr. Polis......................... ............
Mr. Byrne....................................... ............
Mr. Newhouse.................................... Yea
Mr. Buck........................................ Yea
Ms. Cheney...................................... ............
Mr. Sessions, Chairman.......................... Yea
----------------------------------------------------------------------------------------------------------------
SUMMARY OF THE AMENDMENT IN PART A CONSIDERED AS ADOPTED
Walden (OR): Reauthorizes the CHIP program and extend
various public health programs.
SUMMARY OF THE AMENDMENT IN PART B CONSIDERED AS ADOPTED
Walden (OR): Relating to the Prevention and Public Health
Fund, and adjustments to Medicare Part B and Part D premium
subsidies for higher income individuals.
PART A--TEXT OF AMENDMENT CONSIDERED AS ADOPTED
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Continuing Community Health
And Medical Professional Programs to Improve Our Nation,
Increase National Gains, and Help Ensure Access for Little
Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery
Stable Act of 2017'' or the ``CHAMPIONING HEALTHY KIDS Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
DIVISION A--CHAMPION ACT
Sec. 100. Short title.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
Sec. 101. Extension for community health centers, the National Health
Service Corps, and teaching health centers that operate GME
programs.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Extension for family-to-family health information centers.
Sec. 104. Youth empowerment program; personal responsibility education.
TITLE II--OFFSETS
Sec. 201. Providing for qualified health plan grace period requirements
for issuer receipt of advance payments of cost-sharing
reductions and premium tax credits that are more consistent
with State law grace period requirements.
Sec. 202. Prevention and Public Health Fund.
DIVISION B--HEALTHY KIDS ACT
Sec. 300. Short title.
TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS
Sec. 301. Five-year funding extension of the Children's Health Insurance
Program.
Sec. 302. Extension of certain programs and demonstration projects.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension and reduction of additional Federal financial
participation for CHIP.
Sec. 305. Modifying reductions in Medicaid DSH allotments.
Sec. 306. Puerto Rico and the Virgin Islands Medicaid payments.
TITLE II--OFFSETS
Sec. 401. Medicaid third party liability provisions.
Sec. 402. Treatment of lottery winnings and other lump-sum income for
purposes of income eligibility under Medicaid.
DIVISION A--CHAMPION ACT
SEC. 100. SHORT TITLE.
This division may be cited as the ``Community Health And
Medical Professionals Improve Our Nation Act of 2017'' or the
``CHAMPION Act''.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH
SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT
OPERATE GME PROGRAMS.
(a) Community Health Centers Funding.--Section 10503(b)(1)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(1)(E)) is amended by striking ``2017'' and inserting
``2019''.
(b) Other Community Health Centers Provisions.--Section 330
of the Public Health Service Act (42 U.S.C. 254b) is amended--
(1) in subsection (b)(1)(A)(ii), by striking
``abuse'' and inserting ``use disorder'';
(2) in subsection (b)(2)(A), by striking ``abuse''
and inserting ``use disorder'';
(3) in subsection (c)--
(A) in paragraph (1), by striking
subparagraphs (B) through (D);
(B) by striking ``(1) In general'' and all
that follows through ``The Secretary'' and
inserting the following:
``(1) Centers.--The Secretary''; and
(C) in paragraph (1), as amended, by
redesignating clauses (i) through (v) as
subparagraphs (A) through (E) and moving the
margin of each of such redesignated
subparagraph 2 ems to the left;
(4) by striking subsection (d) and inserting the
following:
``(d) Improving Quality of Care.--
``(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under
this section to implement evidence-based models for
increasing access to high-quality primary care
services, which may include models related to--
``(A) improving the delivery of care for
individuals with multiple chronic conditions;
``(B) workforce configuration;
``(C) reducing the cost of care;
``(D) enhancing care coordination;
``(E) expanding the use of telehealth and
technology-enabled collaborative learning and
capacity building models;
``(F) care integration, including integration
of behavioral health, mental health, or
substance use disorder services; and
``(G) addressing emerging public health or
substance use disorder issues to meet the
health needs of the population served by the
health center.
``(2) Sustainability.--In making supplemental awards
under this subsection, the Secretary may consider
whether the health center involved has submitted a plan
for continuing the activities funded under this
subsection after supplemental funding is expended.
``(3) Special consideration.--The Secretary may give
special consideration to applications for supplemental
funding under this subsection that seek to address
significant barriers to access to care in areas with a
greater shortage of health care providers and health
services relative to the national average.'';
(5) in subsection (e)(1)--
(A) in subparagraph (B)--
(i) by striking ``2 years'' and
inserting ``1 year''; and
(ii) by adding at the end the
following: ``The Secretary shall not
make a grant under this paragraph
unless the applicant provides
assurances to the Secretary that within
120 days of receiving grant funding for
the operation of the health center, the
applicant will submit, for approval by
the Secretary, an implementation plan
to meet the requirements of subsection
(k)(3). The Secretary may extend such
120-day period for achieving compliance
upon a demonstration of good cause by
the health center.''; and
(B) in subparagraph (C)--
(i) in the subparagraph heading, by
striking ``and plans'';
(ii) by striking ``or plan (as
described in subparagraphs (B) and (C)
of subsection (c)(1))'';
(iii) by striking ``or plan,
including the purchase'' and inserting
the following: ``including--
``(i) the purchase'';
(iv) by inserting ``, which may
include data and information systems''
after ``of equipment'';
(v) by striking the period at the end
and inserting a semicolon; and
(vi) by adding at the end the
following:
``(ii) the provision of training and
technical assistance; and
``(iii) other activities that--
``(I) reduce costs associated
with the provision of health
services;
``(II) improve access to, and
availability of, health
services provided to
individuals served by the
centers;
``(III) enhance the quality
and coordination of health
services; or
``(IV) improve the health
status of communities.'';
(6) in subsection (e)(5)(B)--
(A) in the heading of subparagraph (B), by
striking ``and plans''; and
(B) by striking ``and subparagraphs (B) and
(C) of subsection (c)(1) to a health center or
to a network or plan'' and inserting ``to a
health center or to a network'';
(7) in subsection (e), by adding at the end the
following:
``(6) New access points and expanded services.--
``(A) Approval of new access points.--
``(i) In general.--The Secretary may
approve applications for grants under
subparagraph (A) or (B) of paragraph
(1) to establish new delivery sites.
``(ii) Special consideration.--In
carrying out clause (i), the Secretary
may give special consideration to
applicants that have demonstrated the
new delivery site will be located
within a sparsely populated area, or an
area which has a level of unmet need
that is higher relative to other
applicants.
``(iii) Consideration of
applications.--In carrying out clause
(i), the Secretary shall approve
applications for grants in such a
manner that the ratio of the medically
underserved populations in rural areas
which may be expected to use the
services provided by the applicants
involved to the medically underserved
populations in urban areas which may be
expected to use the services provided
by the applicants is not less than two
to three or greater than three to two.
``(iv) Service area overlap.--If in
carrying out clause (i) the applicant
proposes to serve an area that is
currently served by another health
center funded under this section, the
Secretary may consider whether the
award of funding to an additional
health center in the area can be
justified based on the unmet need for
additional services within the
catchment area.
``(B) Approval of expanded service
applications.--
``(i) In general.--The Secretary may
approve applications for grants under
subparagraph (A) or (B) of paragraph
(1) to expand the capacity of the
applicant to provide required primary
health services described in subsection
(b)(1) or additional health services
described in subsection (b)(2).
``(ii) Priority expansion projects.--
In carrying out clause (i), the
Secretary may give special
consideration to expanded service
applications that seek to address
emerging public health or behavioral
health, mental health, or substance
abuse issues through increasing the
availability of additional health
services described in subsection (b)(2)
in an area in which there are
significant barriers to accessing care.
``(iii) Consideration of
applications.--In carrying out clause
(i), the Secretary shall approve
applications for grants in such a
manner that the ratio of the medically
underserved populations in rural areas
which may be expected to use the
services provided by the applicants
involved to the medically underserved
populations in urban areas which may be
expected to use the services provided
by such applicants is not less than two
to three or greater than three to
two.'';
(8) in subsection (h)--
(A) in paragraph (1), by striking ``and
children and youth at risk of homelessness''
and inserting ``, children and youth at risk of
homelessness, homeless veterans, and veterans
at risk of homelessness''; and
(B) in paragraph (5)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph
(C) as subparagraph (B); and
(iii) in subparagraph (B) (as so
redesignated)--
(I) in the subparagraph
heading, by striking ``abuse''
and inserting ``use disorder'';
and
(II) by striking ``abuse''
and inserting ``use disorder'';
(9) in subsection (k)--
(A) in paragraph (2)--
(i) in the paragraph heading, by
inserting ``unmet'' before ``need'';
(ii) in the matter preceding
subparagraph (A), by inserting ``or
subsection (e)(6)'' after ``subsection
(e)(1)'';
(iii) in subparagraph (A), by
inserting ``unmet'' before ``need for
health services'';
(iv) in subparagraph (B), by striking
``and'' at the end;
(v) in subparagraph (C), by striking
the period at the end and inserting ``;
and''; and
(vi) by adding after subparagraph (C)
the following:
``(D) in the case of an application for a
grant pursuant to subsection (e)(6), a
demonstration that the applicant has consulted
with appropriate State and local government
agencies, and health care providers regarding
the need for the health services to be provided
at the proposed delivery site.'';
(B) in paragraph (3)--
(i) in the matter preceding
subparagraph (A), by inserting ``or
subsection (e)(6)'' after ``subsection
(e)(1)(B)'';
(ii) in subparagraph (B), by striking
``in the catchment area of the center''
and inserting ``, including other
health care providers that provide care
within the catchment area, local
hospitals, and specialty providers in
the catchment area of the center, to
provide access to services not
available through the health center and
to reduce the non-urgent use of
hospital emergency departments'';
(iii) in subparagraph (H)(ii), by
inserting ``who shall be directly
employed by the center'' after
``approves the selection of a director
for the center'';
(iv) in subparagraph (L), by striking
``and'' at the end;
(v) in subparagraph (M), by striking
the period and inserting ``; and''; and
(vi) by inserting after subparagraph
(M), the following:
``(N) the center has written policies and
procedures in place to ensure the appropriate
use of Federal funds in compliance with
applicable Federal statutes, regulations, and
the terms and conditions of the Federal
award.''; and
(C) by striking paragraph (4);
(10) in subsection (l), by adding at the end the
following: ``Funds expended to carry out activities
under this subsection and operational support
activities under subsection (m) shall not exceed 3
percent of the amount appropriated for this section for
the fiscal year involved.'';
(11) in subsection (q)(4), by adding at the end the
following: ``A waiver provided by the Secretary under
this paragraph may not remain in effect for more than 1
year and may not be extended after such period. An
entity may not receive more than one waiver under this
paragraph in consecutive years.'';
(12) in subsection (r)(3)--
(A) by striking ``appropriate committees of
Congress a report concerning the distribution
of funds under this section'' and inserting the
following: ``Committee on Health, Education,
Labor, and Pensions of the Senate, and the
Committee on Energy and Commerce of the House
of Representatives, a report including, at a
minimum--
``(A) the distribution of funds for carrying
out this section'';
(B) by striking ``populations. Such report
shall include an assessment'' and inserting the
following: ``populations;
``(B) an assessment'';
(C) by striking ``and the rationale for any
substantial changes in the distribution of
funds.'' and inserting a semicolon; and
(D) by adding at the end the following:
``(C) the distribution of awards and funding
for new or expanded services in each of rural
areas and urban areas;
``(D) the distribution of awards and funding
for establishing new access points, and the
number of new access points created;
``(E) the amount of unexpended funding for
loan guarantees and loan guarantee authority
under title XVI;
``(F) the rationale for any substantial
changes in the distribution of funds;
``(G) the rate of closures for health centers
and access points;
``(H) the number and reason for any grants
awarded pursuant to subsection (e)(1)(B); and
``(I) the number and reason for any waivers
provided pursuant to subsection (q)(4).'';
(13) in subsection (r), by adding at the end the
following new paragraph:
``(5) Funding for participation of health centers in
all of us research program.--In addition to any amounts
made available pursuant to paragraph (1) of this
subsection, section 402A of this Act, or section 10503
of the Patient Protection and Affordable Care Act,
there is authorized to be appropriated, and there is
appropriated, out of any monies in the Treasury not
otherwise appropriated, to the Secretary $25,000,000
for fiscal year 2018 to support the participation of
health centers in the All of Us Research Program under
the Precision Medicine Initiative under section 498E of
this Act.''; and
(14) by striking subsection (s).
(c) National Health Service Corps.--Section 10503(b)(2)(E) of
the Patient Protection and Affordable Care Act (42 U.S.C. 254b-
2(b)(2)(E)) is amended by striking ``2017'' and inserting
``2019''.
(d) Teaching Health Centers That Operate Graduate Medical
Education Programs.--
(1) Payments.--Subsection (a) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended
to read as follows:
``(a) Payments.--
``(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for
direct expenses and indirect expenses to qualified
teaching health centers that are listed as sponsoring
institutions by the relevant accrediting body for, as
appropriate--
``(A) maintenance of existing approved
graduate medical residency training programs;
``(B) expansion of existing approved graduate
medical residency training programs; and
``(C) establishment of new approved graduate
medical residency training programs.
``(2) Priority.--In making payments pursuant to
paragraph (1)(C), the Secretary shall give priority to
qualified teaching health centers that--
``(A) serve a health professional shortage
area with a designation in effect under section
332 or a medically underserved community (as
defined in section 799B); or
``(B) are located in a rural area (as defined
in section 1886(d)(2)(D) of the Social Security
Act).''.
(2) Funding.--Subsection (g) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended--
(A) by striking ``To carry out'' and
inserting the following:
``(1) In general.--To carry out'';
(B) by striking ``and $15,000,000 for the
first quarter of fiscal year 2018'' and
inserting ``and $126,500,000 for each of fiscal
years 2018 and 2019, to remain available until
expended''; and
(C) by adding at the end the following:
``(2) Administrative expenses.--Of the amount made
available to carry out this section for any fiscal
year, the Secretary may not use more than 5 percent of
such amount for the expenses of administering this
section.''.
(3) Annual reporting.--Subsection (h)(1) of section
340H of the Public Health Service Act (42 U.S.C. 256h)
is amended--
(A) by redesignating subparagraph (D) as
subparagraph (H); and
(B) by inserting after subparagraph (C) the
following:
``(D) The number of patients treated by
residents described in paragraph (4).
``(E) The number of visits by patients
treated by residents described in paragraph
(4).
``(F) Of the number of residents described in
paragraph (4) who completed their residency
training at the end of such residency academic
year, the number and percentage of such
residents entering primary care practice
(meaning any of the areas of practice listed in
the definition of a primary care residency
program in section 749A).
``(G) Of the number of residents described in
paragraph (4) who completed their residency
training at the end of such residency academic
year, the number and percentage of such
residents who entered practice at a health care
facility--
``(i) primarily serving a health
professional shortage area with a
designation in effect under section 332
or a medically underserved community
(as defined in section 799B); or
``(ii) located in a rural area (as
defined in section 1886(d)(2)(D) of the
Social Security Act).''.
(4) Report on training costs.--Not later than March
31, 2019, the Secretary of Health and Human Services
shall submit to the Congress a report on the direct
graduate expenses of approved graduate medical
residency training programs, and the indirect expenses
associated with the additional costs of teaching
residents, of qualified teaching health centers (as
such terms are used or defined in section 340H of the
Public Health Service Act (42 U.S.C. 256h)).
(5) Definition.--Subsection (j) of section 340H of
the Public Health Service Act (42 U.S.C. 256h) is
amended--
(A) by redesignating paragraphs (2) and (3)
as paragraphs (3) and (4), respectively; and
(B) by inserting after paragraph (1) the
following:
``(2) New approved graduate medical residency
training program.--The term `new approved graduate
medical residency training program' means an approved
graduate medical residency training program for which
the sponsoring qualified teaching health center has not
received a payment under this section for a previous
fiscal year (other than pursuant to subsection
(a)(1)(C)).''.
(6) Technical correction.--Subsection (f) of section
340H (42 U.S.C. 256h) is amended by striking
``hospital'' each place it appears and inserting
``teaching health center''.
(7) Payments for previous fiscal years.--The
provisions of section 340H of the Public Health Service
Act (42 U.S.C. 256h), as in effect on the day before
the date of enactment of this Act, shall continue to
apply with respect to payments under such section for
fiscal years before fiscal year 2018.
(e) Application.--Amounts appropriated pursuant to this
section for fiscal year 2018 or 2019 are subject to the
requirements contained in Public Law 115-31 for funds for
programs authorized under sections 330 through 340 of the
Public Health Service Act (42 U.S.C. 254b-256).
(f) Conforming Amendments.--Section 3014(h) of title 18,
United States Code, is amended--
(1) in paragraph (1), by striking ``, as amended by
section 221 of the Medicare Access and CHIP
Reauthorization Act of 2015,''; and
(2) in paragraph (4), by inserting ``and section
101(e) of the Community Health And Medical
Professionals Improve Our Nation Act of 2017'' after
``section 221(c) of the Medicare Access and CHIP
Reauthorization Act of 2015''.
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.
(a) Special Diabetes Program for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)(C)) is amended by striking ``2017'' and inserting
``2019''.
(b) Special Diabetes Program for Indians.--Subparagraph (D)
of section 330C(c)(2) of the Public Health Service Act (42
U.S.C. 254c-3(c)(2)) is amended to read as follows:
``(D) $150,000,000 for each of fiscal years
2018 and 2019.''.
SEC. 103. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.
Section 501(c) of the Social Security Act (42 U.S.C. 701(c))
is amended--
(1) in paragraph (1)(A)--
(A) in clause (v), by striking ``and'' at the
end;
(B) in clause (vi), by striking the period at
the end and inserting ``; and''; and
(C) by adding at the end the following new
clause:
``(vii) $6,000,000 for each of fiscal years 2018 and
2019.'';
(2) in paragraph (3)(C), by inserting before the
period the following: ``, and with respect to fiscal
years 2018 and 2019, such centers shall also be
developed in all territories and at least one such
center shall be developed for Indian tribes''; and
(3) by amending paragraph (5) to read as follows:
``(5) For purposes of this subsection--
``(A) the term `Indian tribe' has the meaning given
such term in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603);
``(B) the term `State' means each of the 50 States
and the District of Columbia; and
``(C) the term `territory' means Puerto Rico, Guam,
American Samoa, the Virgin Islands, and the Northern
Mariana Islands.''.
SEC. 104. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY EDUCATION.
(a) Youth Empowerment Program.--
(1) In general.--Section 510 of the Social Security
Act (42 U.S.C. 710) is amended to read as follows:
``SEC. 510. YOUTH EMPOWERMENT PROGRAM.
``(a) In General.--
``(1) Allotments to states.--For the purpose
described in subsection (b), the Secretary shall, for
each of fiscal years 2018 and 2019, allot to each State
which has transmitted an application for the fiscal
year under section 505(a) an amount equal to the
product of--
``(A) the amount appropriated pursuant to
subsection (e)(1) for the fiscal year, minus
the amount reserved under subsection (e)(2) for
the fiscal year; and
``(B) the proportion that the number of low-
income children in the State bears to the total
of such numbers of children for all the States.
``(2) Other allotments.--
``(A) Other entities.--For the purpose
described in subsection (b), the Secretary
shall, for each of fiscal years 2018 and 2019,
for any State which has not transmitted an
application for the fiscal year under section
505(a), allot to one or more entities in the
State the amount that would have been allotted
to the State under paragraph (1) if the State
had submitted such an application.
``(B) Process.--The Secretary shall select
the recipients of allotments under subparagraph
(A) by means of a competitive grant process
under which--
``(i) not later than 30 days after
the deadline for the State involved to
submit an application for the fiscal
year under section 505(a), the
Secretary publishes a notice soliciting
grant applications; and
``(ii) not later than 120 days after
such deadline, all such applications
must be submitted.
``(b) Purpose.--
``(1) In general.--Except for research under
paragraph (5) and information collection and reporting
under paragraph (6), the purpose of an allotment under
subsection (a) to a State (or to another entity in the
State pursuant to subsection (a)(2)) is to enable the
State or other entity to implement education
exclusively on sexual risk avoidance (meaning
voluntarily refraining from sexual activity).
``(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section
shall--
``(A) ensure that the unambiguous and primary
emphasis and context for each topic described
in paragraph (3) is a message to youth that
normalizes the optimal health behavior of
avoiding nonmarital sexual activity;
``(B) be medically accurate and complete;
``(C) be age-appropriate; and
``(D) be based on adolescent learning and
developmental theories for the age group
receiving the education.
``(3) Topics.--Education on sexual risk avoidance
pursuant to an allotment under this section shall
address each of the following topics:
``(A) The holistic individual and societal
benefits associated with personal
responsibility, self-regulation, goal setting,
healthy decisionmaking, and a focus on the
future.
``(B) The advantage of refraining from
nonmarital sexual activity in order to improve
the future prospects and physical and emotional
health of youth.
``(C) The increased likelihood of avoiding
poverty when youth attain self-sufficiency and
emotional maturity before engaging in sexual
activity.
``(D) The foundational components of healthy
relationships and their impact on the formation
of healthy marriages and safe and stable
families.
``(E) How other youth risk behaviors, such as
drug and alcohol usage, increase the risk for
teen sex.
``(F) How to resist and avoid, and receive
help regarding, sexual coercion and dating
violence, recognizing that even with consent
teen sex remains a youth risk behavior.
``(4) Contraception.--Education on sexual risk
avoidance pursuant to an allotment under this section
shall ensure that--
``(A) any information provided on
contraception is medically accurate and ensures
that students understand that contraception
offers physical risk reduction, but not risk
elimination; and
``(B) the education does not include
demonstrations, simulations, or distribution of
contraceptive devices.
``(5) Research.--
``(A) In general.--A State or other entity
receiving an allotment pursuant to subsection
(a) may use up to 20 percent of such allotment
to build the evidence base for sexual risk
avoidance education by conducting or supporting
research.
``(B) Requirements.--Any research conducted
or supported pursuant to subparagraph (A) shall
be--
``(i) rigorous;
``(ii) evidence-based; and
``(iii) designed and conducted by
independent researchers who have
experience in conducting and publishing
research in peer-reviewed outlets.
``(6) Information collection and reporting.--A State
or other entity receiving an allotment pursuant to
subsection (a) shall, as specified by the Secretary--
``(A) collect information on the programs and
activities funded through the allotment; and
``(B) submit reports to the Secretary on the
data from such programs and activities.
``(c) National Evaluation.--
``(1) In general.--The Secretary shall--
``(A) in consultation with appropriate State
and local agencies, conduct one or more
rigorous evaluations of the education funded
through this section and associated data; and
``(B) submit a report to the Congress on the
results of such evaluations, together with a
summary of the information collected pursuant
to subsection (b)(6).
``(2) Consultation.--In conducting the evaluations
required by paragraph (1), including the establishment
of evaluation methodologies, the Secretary shall
consult with relevant stakeholders.
``(d) Applicability of Certain Provisions.--
``(1) Sections 503, 507, and 508 apply to allotments
under subsection (a) to the same extent and in the same
manner as such sections apply to allotments under
section 502(c).
``(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the
Secretary to be appropriate.
``(e) Funding.--
``(1) In general.--To carry out this section, there
is appropriated, out of any money in the Treasury not
otherwise appropriated, $75,000,000 for each of fiscal
years 2018 and 2019.
``(2) Reservation.--The Secretary shall reserve, for
each of fiscal years 2018 and 2019, not more than 20
percent of the amount appropriated pursuant to
paragraph (1) for administering the program under this
section, including the conducting of national
evaluations and the provision of technical assistance
to the recipients of allotments.''.
(2) Effective date.--The amendment made by this
subsection takes effect on October 1, 2017.
(b) Personal Responsibility Education.--
(1) In general.--Section 513 of the Social Security
Act (42 U.S.C. 713) is amended--
(A) in subsection (a)(1)(A), by striking
``2017'' and inserting ``2019''; and
(B) in subsection (a)(4)--
(i) in subparagraph (A), by striking
``2017'' each place it appears and
inserting ``2019''; and
(ii) in subparagraph (B)--
(I) in the subparagraph
heading, by striking ``3-year
grants'' and inserting
``Competitive prep grants'';
and
(II) in clause (i), by
striking ``solicit applications
to award 3-year grants in each
of fiscal years 2012 through
2017'' and inserting ``continue
through fiscal year 2019 grants
awarded for any of fiscal years
2015 through 2017'';
(C) in subsection (c)(1), by inserting after
``youth with HIV/AIDS,'' the following:
``victims of human trafficking,''; and
(D) in subsection (f), by striking ``2017''
and inserting ``2019''.
(2) Effective date.--The amendments made by this
subsection take effect on October 1, 2017.
TITLE II--OFFSETS
SEC. 201. PROVIDING FOR QUALIFIED HEALTH PLAN GRACE PERIOD REQUIREMENTS
FOR ISSUER RECEIPT OF ADVANCE PAYMENTS OF COST-
SHARING REDUCTIONS AND PREMIUM TAX CREDITS THAT ARE
MORE CONSISTENT WITH STATE LAW GRACE PERIOD
REQUIREMENTS.
(a) In General.--Section 1412(c) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18082(c)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (B)(iv)(II), by striking
``a 3-month grace period'' and inserting ``a
grace period specified in subparagraph (C)'';
and
(B) by adding at the end the following new
subparagraphs:
``(C) Grace period specified.--For purposes
of subparagraph (B)(iv)(II), the grace period
specified in this subparagraph is--
``(i) for plan years beginning before
January 1, 2018, a 3-month grace
period; and
``(ii) for plan years beginning on or
after January 1, 2018--
``(I) in the case of an
Exchange operating in a State
that has a State law grace
period in place, such State law
grace period; and
``(II) in the case of an
Exchange operating in a State
that does not have a State law
grace period in place, a 1-
month grace period.
``(D) State law grace period.--For purposes
of subparagraph (C), the term `State law grace
period' means, with respect to a State, a grace
period for nonpayment of premiums before
discontinuing coverage that is applicable under
the State law to health insurance coverage
offered in the individual market of the
State.''; and
(2) in paragraph (3), by adding at the end the
following new sentence: ``The requirements of paragraph
(2)(B)(iv) apply to an issuer of a qualified health
plan receiving an advanced payment under this paragraph
in the same manner and to the same extent that such
requirements apply to an issuer of a qualified health
plan receiving an advanced payment under paragraph
(2)(A).''.
(b) Report on Aligning Grace Periods for Medicaid, Medicare,
and Exchange Plans.--Not later than two years after the date of
full implementation of subsection (a), the Comptroller General
of the United States shall submit to Congress a report on--
(1) the effects on consumers of aligning grace
periods applied under the Medicaid program under title
XIX of the Social Security Act, under the Medicare
program under parts C and D of title XVIII of such Act,
and under qualified health plans offered on an Exchange
established under title I of the Patient Protection and
Affordable Care Act, including the extent to which such
an alignment of grace periods may help to avoid
enrollment status confusion for individuals under such
Medicaid program, Medicare program, and qualified
health plans; and
(2) the extent to which such an alignment of grace
periods may reduce fraud, waste, and abuse under the
Medicaid program.
SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care
Act (42 U.S.C. 300u-11(b)) is amended by striking paragraphs
(3) through (8) and inserting the following new paragraphs:
``(3) for fiscal year 2018, $900,000,000;
``(4) for fiscal year 2019, $600,000,000;
``(5) for each of fiscal years 2020 through 2026, $0;
and
``(6) for fiscal year 2027 and each fiscal year
thereafter, $2,000,000,000.''.
DIVISION B--HEALTHY KIDS ACT
SEC. 300. SHORT TITLE.
This division may be cited as the ``Helping Ensure Access for
Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance
Delivery Stable Act of 2017'' or the ``HEALTHY KIDS Act''.
TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS
SEC. 301. FIVE-YEAR FUNDING EXTENSION OF THE CHILDREN'S HEALTH
INSURANCE PROGRAM.
(a) Appropriation; Total Allotment.--Section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (19), by striking ``and'';
(2) in paragraph (20), by striking the period at the
end and inserting a semicolon; and
(3) by adding at the end the following new
paragraphs:
``(21) for fiscal year 2018, $21,500,000,000;
``(22) for fiscal year 2019, $22,600,000,000;
``(23) for fiscal year 2020, $23,700,000,000;
``(24) for fiscal year 2021, $24,800,000,000; and
``(25) for fiscal year 2022, for purposes of making 2
semi-annual allotments--
``(A) $2,850,000,000 for the period beginning
on October 1, 2021, and ending on March 31,
2022; and
``(B) $2,850,000,000 for the period beginning
on April 1, 2022, and ending on September 30,
2022.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social
Security Act (42 U.S.C. 1397dd(m)) is amended--
(A) in paragraph (2)--
(i) in the heading, by striking
``through 2016'' and inserting
``through 2022''; and
(ii) in subparagraph (B)--
(I) in the matter preceding
clause (i), by striking
``(19)'' and inserting
``(24)'';
(II) in clause (ii), in the
matter preceding subclause (I),
by inserting ``(other than
fiscal year 2022)'' after
``even-numbered fiscal year'';
and
(III) in clause (ii)(I), by
inserting ``(or, in the case of
fiscal year 2018, under
paragraph (4))'' after ``clause
(i)'';
(B) in paragraph (5)--
(i) by striking ``or (4)'' and
inserting ``(4), or (10)''; and
(ii) by striking ``or 2017'' and
inserting ``, 2017, or 2022'';
(C) in paragraph (7)--
(i) in subparagraph (A), by striking
``2017'' and inserting ``2022'';
(ii) in subparagraph (B), in the
matter preceding clause (i), by
inserting ``(or, in the case of fiscal
year 2018, by not later than the date
that is 60 days after the date of the
enactment of the HEALTHY KIDS Act)''
after ``before the August 31 preceding
the beginning of the fiscal year''; and
(iii) in the matter following
subparagraph (B), by striking ``or
fiscal year 2016'' and inserting
``fiscal year 2016, fiscal year 2018,
fiscal year 2020, or fiscal year
2022'';
(D) in paragraph (9)--
(i) in the heading, by striking
``fiscal years 2015 and 2017'' and
inserting ``certain fiscal years'';
(ii) by striking ``or (4)'' and
inserting ``, (4), or (10)''; and
(iii) by striking ``or fiscal year
2017'' and inserting ``, 2017, or
2022''; and
(E) by adding at the end the following new
paragraph:
``(10) For fiscal year 2022.--
``(A) First half.--Subject to paragraphs (5)
and (7), from the amount made available under
subparagraph (A) of paragraph (25) of
subsection (a) for the semi-annual period
described in such subparagraph, increased by
the amount of the appropriation for such period
under section 301(b)(3) of the HEALTHY KIDS
Act, the Secretary shall compute a State
allotment for each State (including the
District of Columbia and each commonwealth and
territory) for such semi-annual period in an
amount equal to the first half ratio (described
in subparagraph (D)) of the amount described in
subparagraph (C).
``(B) Second half.--Subject to paragraphs (5)
and (7), from the amount made available under
subparagraph (B) of paragraph (25) of
subsection (a) for the semi-annual period
described in such subparagraph, the Secretary
shall compute a State allotment for each State
(including the District of Columbia and each
commonwealth and territory) for such semi-
annual period in an amount equal to the amount
made available under such subparagraph,
multiplied by the ratio of--
``(i) the amount of the allotment to
such State under subparagraph (A); to
``(ii) the total of the amount of all
of the allotments made available under
such subparagraph.
``(C) Full year amount based on growth factor
updated amount.--The amount described in this
subparagraph for a State is equal to the sum
of--
``(i) the amount of the State
allotment for fiscal year 2021
determined under paragraph (2)(B)(i);
and
``(ii) the amount of any payments
made to the State under subsection (n)
for fiscal year 2021,
multiplied by the allotment increase factor
under paragraph (6) for fiscal year 2022.
``(D) First half ratio.--The first half ratio
described in this subparagraph is the ratio
of--
``(i) the sum of--
``(I) the amount made
available under subsection
(a)(25)(A); and
``(II) the amount of the
appropriation for such period
under section 301(b)(3) of the
HEALTHY KIDS Act; to
``(ii) the sum of--
``(I) the amount described in
clause (i); and
``(II) the amount made
available under subsection
(a)(25)(B).''.
(2) Technical amendment.--Section 2104(m)(2)(A) of
such Act (42 U.S.C. 1397dd(m)(2)(A)) is amended by
striking ``the allotment increase factor under
paragraph (5)'' each place it appears and inserting
``the allotment increase factor under paragraph (6)''.
(3) One-time appropriation for fiscal year 2022.--
There is appropriated to the Secretary of Health and
Human Services, out of any money in the Treasury not
otherwise appropriated, $20,200,000,000 to accompany
the allotment made for the period beginning on October
1, 2021, and ending on March 31, 2022, under paragraph
(25)(A) of section 2104(a) of the Social Security Act
(42 U.S.C. 1397dd(a)) (as added by subsection (a)(3)),
to remain available until expended. Such amount shall
be used to provide allotments to States under paragraph
(10) of section 2104(m) of such Act (as added by
subsection (b)(1)(E)) for the first 6 months of fiscal
year 2022 in the same manner as allotments are provided
under subsection (a)(25)(A) of such section 2104 and
subject to the same terms and conditions as apply to
the allotments provided from such subsection
(a)(25)(A).
(c) Extension of the Child Enrollment Contingency Fund.--
Section 2104(n) of the Social Security Act (42 U.S.C.
1397dd(n)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(ii)--
(i) by striking ``2010, 2011, 2012,
2013, 2014, and 2016'' and inserting
``2010 through 2014, 2016, and 2018
through 2021''; and
(ii) by striking ``fiscal year 2015
and fiscal year 2017'' and inserting
``fiscal years 2015, 2017, and 2022'';
and
(B) in subparagraph (B)--
(i) by striking ``2010, 2011, 2012,
2013, 2014, and 2016'' and inserting
``2010 through 2014, 2016, and 2018
through 2021''; and
(ii) by striking ``fiscal year 2015
and fiscal year 2017'' and inserting
``fiscal years 2015, 2017, and 2022'';
and
(2) in paragraph (3)(A), in the matter preceding
clause (i), by striking ``or a semi-annual allotment
period for fiscal year 2015 or 2017'' and inserting
``or in any of fiscal years 2018 through 2021 (or a
semi-annual allotment period for fiscal year 2015,
2017, or 2022)''.
(d) Extension of Qualifying States Option.--Section
2105(g)(4) of the Social Security Act (42 U.S.C. 1397ee(g)(4))
is amended--
(1) in the heading, by striking ``through 2017'' and
inserting ``through 2022''; and
(2) in subparagraph (A), by striking ``2017'' and
inserting ``2022''.
(e) Extension of Express Lane Eligibility Option.--Section
1902(e)(13)(I) of the Social Security Act (42 U.S.C.
1396a(e)(13)(I)) is amended by striking ``2017'' and inserting
``2022''.
(f) Assurance of Affordability Standard for Children and
Families.--
(1) In general.--Section 2105(d)(3) of the Social
Security Act (42 U.S.C. 1397ee(d)(3)) is amended--
(A) in the paragraph heading, by striking
``until october 1, 2019'' and inserting
``through september 30, 2022''; and
(B) in subparagraph (A), in the matter
preceding clause (i)--
(i) by striking ``2019'' and
inserting ``2022''; and
(ii) by striking ``The preceding
sentence shall not be construed as
preventing a State during such period''
and inserting ``During the period that
begins on October 1, 2019, and ends on
September 30, 2022, the preceding
sentence shall only apply with respect
to children in families whose income
does not exceed 300 percent of the
poverty line (as defined in section
2110(c)(5)) applicable to a family of
the size involved. The preceding
sentences shall not be construed as
preventing a State during any such
periods''.
(2) Conforming amendments.--Section 1902(gg)(2) of
the Social Security Act (42 U.S.C. 1396a(gg)(2)) is
amended--
(A) in the paragraph heading, by striking
``until october 1, 2019'' and inserting
``through september 30, 2022''; and
(B) by striking ``September 30, 2019,'' and
inserting ``September 30, 2022 (but during the
period that begins on October 1, 2019, and ends
on September 30, 2022, only with respect to
children in families whose income does not
exceed 300 percent of the poverty line (as
defined in section 2110(c)(5)) applicable to a
family of the size involved)''.
(g) CHIP Look-alike Plans.--
(1) Blending risk pools.--Section 2107 of the Social
Security Act (42 U.S.C. 1397gg) is amended by adding at
the end the following:
``(g) Use of Blended Risk Pools.--
``(1) In general.--Nothing in this title (or any
other provision of Federal law) shall be construed as
preventing a State from considering children enrolled
in a qualified CHIP look-alike program and children
enrolled in a State child health plan under this title
(or a waiver of such plan) as members of a single risk
pool.
``(2) Qualified chip look-alike program.--In this
subsection, the term `qualified CHIP look-alike
program' means a State program--
``(A) under which children who are under the
age of 19 and are not eligible to receive
medical assistance under title XIX or child
health assistance under this title may purchase
coverage through the State that provides
benefits that are at least identical to the
benefits provided under the State child health
plan under this title (or a waiver of such
plan); and
``(B) that is funded exclusively through non-
Federal funds, including funds received by the
State in the form of premiums for the purchase
of such coverage.''.
(2) Coverage rule.--
(A) In general.--Section 5000A(f)(1) of the
Internal Revenue Code of 1986 is amended in
subparagraph (A)(iii), by inserting ``or under
a qualified CHIP look-alike program (as defined
in section 2107(g) of the Social Security
Act)'' before the comma at the end.
(B) Effective date.--The amendment made by
subparagraph (A) shall apply with respect to
taxable years beginning after December 31,
2017.
SEC. 302. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION PROJECTS.
(a) Childhood Obesity Demonstration Project.--Section
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
9a(e)(8)) is amended--
(1) by striking ``and $10,000,000'' and inserting ``,
$10,000,000''; and
(2) by inserting after ``2017'' the following: ``,
and $25,000,000 for the period of fiscal years 2018
through 2022''.
(b) Pediatric Quality Measures Program.--Section 1139A(i) of
the Social Security Act (42 U.S.C. 1320b-9a(i)) is amended--
(1) by striking ``Out of any'' and inserting the
following:
``(1) In general.--Out of any'';
(2) by striking ``there is appropriated for each''
and inserting ``there is appropriated--
``(A) for each'';
(3) by striking ``, and there is appropriated for the
period'' and inserting ``;
``(B) for the period'';
(4) by striking ``. Funds appropriated under this
subsection shall remain available until expended.'' and
inserting ``; and''; and
(5) by adding at the end the following:
``(C) for the period of fiscal years 2018
through 2022, $75,000,000 for the purpose of
carrying out this section (other than
subsections (e), (f), and (g)).
``(2) Availability.--Funds appropriated under this
subsection shall remain available until expended.''.
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
(a) In General.--Section 2113 of the Social Security Act (42
U.S.C. 1397mm) is amended--
(1) in subsection (a)(1), by striking ``2017'' and
inserting ``2022''; and
(2) in subsection (g)--
(A) by striking ``and $40,000,000'' and
inserting ``, $40,000,000''; and
(B) by inserting after ``2017'' the
following: ``, and $100,000,000 for the period
of fiscal years 2018 through 2022''.
(b) Making Organizations That Use Parent Mentors Eligible to
Receive Grants.--Section 2113(f) of the Social Security Act (42
U.S.C. 1397mm(f)) is amended--
(1) in paragraph (1)(E), by striking ``or community-
based doula programs'' and inserting ``, community-
based doula programs, or parent mentors''; and
(2) by adding at the end the following new paragraph:
``(5) Parent mentor.--The term `parent mentor' means
an individual who--
``(A) is a parent or guardian of at least one
child who is an eligible child under this title
or title XIX; and
``(B) is trained to assist families with
children who have no health insurance coverage
with respect to improving the social
determinants of the health of such children,
including by providing--
``(i) education about health
insurance coverage, including, with
respect to obtaining such coverage,
eligibility criteria and application
and renewal processes;
``(ii) assistance with completing and
submitting applications for health
insurance coverage;
``(iii) a liaison between families
and representatives of State plans
under title XIX or State child health
plans under this title;
``(iv) guidance on identifying
medical and dental homes and community
pharmacies for children; and
``(v) assistance and referrals to
successfully address social
determinants of children's health,
including poverty, food insufficiency,
and housing.''.
(c) Exclusion From Modified Adjusted Gross Income.--Section
1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is
amended--
(1) in the first paragraph (14), relating to income
determined using modified adjusted gross income, by
adding at the end the following new subparagraph:
``(J) Exclusion of parent mentor compensation
from income determination.--Any nominal amount
received by an individual as compensation,
including a stipend, for participation as a
parent mentor (as defined in paragraph (5) of
section 2113(f)) in an activity or program
funded through a grant under such section shall
be disregarded for purposes of determining the
income eligibility of such individual for
medical assistance under the State plan or any
waiver of such plan.''; and
(2) by striking ``(14) Exclusion'' and inserting
``(15) Exclusion''.
SEC. 304. EXTENSION AND REDUCTION OF ADDITIONAL FEDERAL FINANCIAL
PARTICIPATION FOR CHIP.
Section 2105(b) of the Social Security Act (42 U.S.C.
1397ee(b)) is amended in the second sentence by inserting ``and
during the period that begins on October 1, 2019, and ends on
September 30, 2020, the enhanced FMAP determined for a State
for a fiscal year (or for any portion of a fiscal year
occurring during such period) shall be increased by 11.5
percentage points'' after ``23 percentage points,''.
SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C.
1396r-4(f)(7)(A)) is amended--
(1) in clause (i), in the matter preceding subclause
(I), by striking ``2018'' and inserting ``2020''; and
(2) in clause (ii), by striking subclauses (I)
through (VIII) and inserting the following:
``(I) $4,000,000,000 for
fiscal year 2020; and
``(II) $8,000,000,000 for
each of fiscal years 2021
through 2025.''.
SEC. 306. PUERTO RICO AND THE VIRGIN ISLANDS MEDICAID PAYMENTS.
(a) Increased Cap.--Section 1108(g) of the Social Security
Act (42 U.S.C. 1308(g)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A), by inserting ``(or,
with respect to fiscal years 2018 and 2019,
increased by such percentage increase plus one
percentage point)'' after ``beginning of the
fiscal year''; and
(B) in subparagraph (B), by inserting ``(or,
with respect to fiscal years 2018 and 2019,
increased by such percentage increase plus one
percentage point)'' after ``percentage increase
referred to in subparagraph (A)'';
(2) in paragraph (5)--
(A) in subparagraph (A), by striking
``subparagraph (B)'' and inserting
``subparagraphs (B), (C), (D), (E), and (F)'';
and
(B) by adding at the end the following new
subparagraphs:
``(C) The amount of the increase otherwise provided
under subparagraph (A) for Puerto Rico shall be further
increased by $880,000,000.
``(D)(i) For the period beginning October 1, 2017,
and ending December 31, 2019, the amount of the
increase otherwise provided under subparagraph (A) for
Puerto Rico shall be further increased by $120,000,000
if the Financial Oversight and Management Board for
Puerto Rico established under section 101 of the Puerto
Rico Oversight, Management, and Economic Stability Act
(48 U.S.C. 2121) certifies by a majority vote that
Puerto Rico has taken reasonable and appropriate steps
during such period to--
``(I) reduce fraud, waste, and abuse under
the program under title XIX;
``(II) implement strategies to reduce
unnecessary, inefficient, or excessive spending
under title XIX;
``(III) improve the use and availability of
Medicaid data for program operation and
oversight; and
``(IV) improve the quality of care and
patient experience for individuals enrolled
under the program under title XIX.
``(ii) As a condition of any additional increase
pursuant to clause (i), not later than October 1, 2018,
Puerto Rico shall submit to the Financial Oversight and
Management Board for Puerto Rico a report regarding
steps taken to achieve each of the goals described in
subclauses (I) through (IV) of clause (i).
``(E) Payments under section 1903(a)(8) for a quarter
of a fiscal year shall not be taken into account in
applying subsection (f) (as increased in accordance
with this paragraph and paragraphs (1), (2), (3), and
(4)) to Puerto Rico or the Virgin Islands for such
fiscal year.
``(F)(i) For the period beginning October 1, 2017,
and ending December 31, 2019, the amount of the
increase otherwise provided under subparagraph (A) for
the Virgin Islands shall be further increased by an
amount equal to the per capita equivalent of the total
amount of the increase provided for Puerto Rico under
subparagraphs (C) and (D) for such period.
``(ii) For purposes of clause (i), the term `per
capita equivalent' means the ratio of--
``(I) the population of the Virgin Islands,
as determined by the most recent census
estimate released by the Bureau of the Census
before September 4, 2017; to
``(II) the population of Puerto Rico, as so
determined.''.
(b) Federal Match for Medical Personnel and Fraud
Reduction.--Section 1903(a) of the Social Security Act (42
U.S.C. 1396b(a)) is amended--
(1) in paragraph (2)(A), by inserting ``subject to
paragraph (8),'' before ``an amount'';
(2) in paragraph (6)--
(A) in subparagraph (B), by inserting
``subject to paragraph (8),'' before ``75 per
centum''; and
(B) by striking at the end ``plus'';
(3) in paragraph (7), by striking at the end the
period and inserting ``; plus'' ; and
(4) by adding at the end the following new paragraph:
``(8) for quarters during the period beginning
January 1, 2018, and ending December 31, 2019,
paragraphs (2)(A) and (6) shall apply with respect to
Puerto Rico and the Virgin Islands as if--
``(A) the reference to `75 per centum' in
paragraph (2)(A) were a reference to `90 per
centum'; and
``(B) the reference to `75 per centum' in
paragraph (6)(B) were a reference to `90 per
centum'.''.
TITLE II--OFFSETS
SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS.
(a) Medicaid Third Party Liability.--
(1) Delay of bipartisan budget act of 2013 third
party liability provisions.--
(A) In general.--Section 202(c) of the
Bipartisan Budget Act of 2013 (Public Law 113-
67; 127 Stat. 1177; 42 U.S.C. 1396a note), as
amended by section 211 of the Protecting Access
to Medicare Act of 2014 (Public Law 113-93; 128
Stat. 1047; 42 U.S.C. 1396a note) and section
220 of the Medicare Access and CHIP
Reauthorization Act of 2015 (Public Law 114-
10), is amended by striking ``2017'' and
inserting ``2019''.
(B) Effective date; treatment.--The amendment
made by subparagraph (A) shall take effect on
September 30, 2017, and shall apply with
respect to any open claims, including claims
generated or filed, after such date.
(2) Clarification of definitions applicable to third
party liability.--
(A) In general.--Section 1902 of the Social
Security Act (42 U.S.C. 1396a) is amended by
adding at the end the following new subsection:
``(nn) Responsible Third Party and Health Insurer
Definitions.--For purposes of subsection (a)(25) and section
1903(d)(2)(B):
``(1) Responsible third party.--The term `responsible
third party' means a health insurer, a pharmacy benefit
manager to the extent the pharmacy benefit manager
provides information under this title for the purpose
of coordinating benefits, an accountable care
organization under section 1899, or any other party
that is, by statute, contract, or agreement, legally
responsible for payment of a claim for a health care
item or service. Such term does not include a party if
payment by such party has been made or can reasonably
be expected to be made under a workmen's compensation
law or plan of the United States or a State, or under
an automobile or liability insurance policy or plan
(including a self-insured plan), or under no fault
insurance.
``(2) Health insurer.--The term `health insurer'
means a group health plan, as defined in section 607(1)
of the Employee Retirement Income Security Act of 1974,
a self-insured plan, a fully-insured plan, a service
benefit plan, a medicaid managed care plan under
section 1903(m) or 1932, and any other health plan
determined appropriate by the Secretary.''.
(B) Conforming amendments.--Section
1902(a)(25) of the Social Security Act (42
U.S.C. 1396a(a)(25)) is amended--
(i) in subparagraph (A), in the
matter preceding clause (i), by
striking ``third parties'' and all that
follows through ``item or service)''
and inserting ``responsible third
parties'';
(ii) in subparagraph (G), by striking
``health insurer'' and all that follows
through ``item or service)'' and
inserting ``responsible third party'';
(iii) in subparagraph (I), in the
matter preceding clause (i), by
striking ``health insurers'' and all
that follows through ``item or
service'' and inserting ``responsible
third parties''; and
(iv) by inserting ``responsible''
before ``third'' each place it appears
in subparagraphs (A)(i), (A)(ii), (C),
(D), and (H).
(3) Removal of special treatment of certain types of
care and payments under medicaid third party liability
rules.--Section 1902(a)(25) of the Social Security Act
(42 U.S.C. 1396a(a)(25)), as amended by section 202(c)
of the Bipartisan Budget Act of 2013 (after application
of paragraph (1)), is amended--
(A) in subparagraph (E)--
(i) in the matter preceding clause
(i), by striking ``prenatal or
preventive'' and all that follows
through ``State plan'' and inserting
``items and services provided under the
program required under the State plan
pursuant to paragraph (62)''; and
(ii) in clause (i)--
(I) by striking ``such
service'' and inserting ``such
items and services''; and
(II) by striking each place
it appears ``such services''
and inserting ``such items and
services'' each such place; and
(B) by striking subparagraph (F).
(4) Clarification of role of health insurers with
respect to third party liability.--
(A) In general.--Section 1902(a)(25) of the
Social Security Act (42 U.S.C. 1396a(a)(25)),
as amended by paragraph (3), is further amended
by inserting after subparagraph (E) the
following new subparagraph:
``(F) that--
``(i) in the case of a State that
provides medical assistance under this
title through a contract with a health
insurer, such contract shall specify
any responsibility of such health
insurer (or other entity) with respect
to recovery of payment from responsible
third parties pursuant to the
delegation or transfer by the State to
such insurer (or other entity) of a
right described in subparagraph
(I)(ii); and
``(ii) in the case of a State that
under a contract described in clause
(i) delegates or transfers to a health
insurer (or other entity) a right
described in such clause, the State
shall provide assurances to the
Secretary that the State laws referred
to in subparagraph (I), with respect to
each responsibility of such health
insurer (or other entity) specified
under such clause, confer to such
health insurer (or other entity) the
authority of the State with respect to
the requirements specified in clauses
(i) through (iv) of such subparagraph
(I);''.
(B) Treatment of collected amounts.--Section
1903(d)(2)(B) of the Social Security Act (42
U.S.C. 1396b(d)(2)(B)) is amended by adding at
the end the following: ``For purposes of this
subparagraph, reimbursements made by a
responsible third party to health insurers (as
defined in section 1902(nn)) pursuant to
section 1902(a)(25)(F)(ii) shall be treated in
the same manner as reimbursements made to a
State under the previous sentence.''.
(5) Increasing state flexibility with respect to
third party liability.--Section 1902(a)(25)(I) of the
Social Security Act (42 U.S.C. 1396a(a)(25)(I)) is
amended--
(A) in clause (i), by striking ``medical
assistance under the State plan'' and inserting
``medical assistance under a State plan (or
under a waiver of the plan)'';
(B) by striking clause (ii) and inserting the
following new clause:
``(ii) accept--
``(I) any State's right of
recovery and the assignment to
any State of any right of an
individual or other entity to
payment from the party for an
item or service for which
payment has been made under the
respective State's plan (or
under a waiver of the plan);
and
``(II) as a valid
authorization of the
responsible third party for the
furnishing of an item or
service to an individual
eligible to receive medical
assistance under this title, an
authorization made on behalf of
such individual under the State
plan (or under a waiver of such
plan) for the furnishing of
such item or service to such
individual;'';
(C) in clause (iii)--
(i) by striking ``respond to'' and
inserting ``not later than 60 days
after receiving''; and
(ii) by striking ``; and'' at the end
and inserting ``, respond to such
inquiry; and''; and
(D) in clause (iv), by inserting ``a failure
to obtain a prior authorization,'' after
``claim form,''.
(6) State incentive to pursue third party liability
for newly eligibles.--Section 1903(d)(2)(B) of the
Social Security Act (42 U.S.C. 1396b(d)(2)(B)), as
amended by paragraph (4)(B), is further amended by
adding at the end the following: ``In the case of
expenditures for medical assistance provided during
2017 and subsequent years for individuals described in
subclause (VIII) of section 1902(a)(10)(A)(i), in
determining the amount, if any, of overpayment under
this subparagraph with respect to such medical
assistance, the Secretary shall apply the Federal
medical assistance percentage for the State under
section 1905(b), notwithstanding the application of
section 1905(y).''.
(b) Compliance With Third Party Insurance Reporting.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended by
adding at the end the following new subsection:
``(ee) Notwithstanding subsection (b), for any year beginning
after 2019, if a State fails to comply with the requirements of
section 1902(a)(25) with respect to each calendar quarter in
such year, the Secretary may reduce the Federal medical
assistance percentage by 0.1 percentage point for calendar
quarters in each subsequent year in which the State fails to so
comply.''.
(c) Application to CHIP.--
(1) In general.--Section 2107(e)(1) of the Social
Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B)
through (R) as subparagraphs (C) through (S),
respectively; and
(B) by inserting after subparagraph (A) the
following new subparagraph:
``(B) Section 1902(a)(25) (relating to third
party liability).''.
(2) Mandatory reporting.--Section 1902(a)(25)(I)(i)
of the Social Security Act (42 U.S.C.
1396a(a)(25)(I)(i)), as amended by subsection (a)(5),
is further amended--
(A) by striking ``(and, at State option,
child'' and inserting ``and child''; and
(B) by striking ``title XXI)'' and inserting
``title XXI''.
(d) Training on Third Party Liability.--Section 1936 of the
Social Security Act (42 U.S.C. 1396u-6) is amended--
(1) in subsection (b)(4), by striking ``and quality
of care'' and inserting ``, quality of care, and the
liability of responsible third parties (as defined in
section 1902(nn))''; and
(2) by adding at the end the following new
subsection:
``(f) Third Party Liability Training.--With respect to
education or training activities carried out pursuant to
subsection (b)(4) with respect to the liability of responsible
third parties (as defined in section 1902(nn) for payment for
items and services furnished under State plans (or under
waivers of such plans)) under this title, the Secretary shall--
``(1) publish (and update on an annual basis) on the
public Internet website of the Centers for Medicare &
Medicaid Services a dedicated Internet page containing
best practices to be used in assessing such liability;
``(2) monitor efforts to assess such liability and
analyze the challenges posed by that assessment;
``(3) distribute to State agencies administering the
State plan under this title information related to such
efforts and challenges; and
``(4) provide guidance to such State agencies with
respect to State oversight of efforts under a medicaid
managed care plan under section 1903(m) or 1932 to
assess such liability.''.
(e) Development of Model Uniform Fields for States To Report
Third Party Information.--Not later than January 1, 2019, the
Secretary of Health and Human Services shall, in consultation
with the States, develop and make available to the States a
model uniform reporting set of reporting fields and
accompanying guidance documentation that States shall use for
purposes of--
(1) reporting information to the Secretary within the
Transformed Medicaid Statistical Information System (T-
MSIS) (or a successor system); and
(2) collecting information that identifies
responsible third parties (as defined in subsection
(nn) of section 1902 of the Social Security Act (42
U.S.C. 1396a), as added by subsection (a)(2)(A)) and
other relevant information for ascertaining the legal
responsibility of such third parties to pay for care
and services available under the State plan (or under a
waiver of the plan) under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) or under the
State child health plan under title XXI of such Act (42
U.S.C. 1397 et seq.).
(f) Effective Date.--
(1) In general.--Except as provided in paragraph (2),
this section and the amendments made by this section
(other than as specified in the preceding provisions of
this section) shall take effect on October 1, 2019, and
shall apply to medical assistance or child health
assistance provided on or after such date.
(2) Exception if state legislation required.--In the
case of a State plan for medical assistance under title
XIX of the Social Security Act (42 U.S.C. 1396 et
seq.), or a State child health plan for child health
assistance under title XXI of such Act (42 U.S.C.
1397aa et seq.), that the Secretary of Health and Human
Services determines requires State legislation (other
than legislation appropriating funds) in order for the
plan to meet the additional requirement imposed by the
amendments made under this section, such plan shall not
be regarded as failing to comply with the requirements
of such title solely on the basis of its failure to
meet this additional requirement before the first day
of the first calendar quarter beginning after the close
of the first regular session of the State legislature
that begins after the date of the enactment of this
Act. For purposes of the previous sentence, in the case
of a State that has a 2-year legislative session, each
year of such session shall be deemed to be a separate
regular session of the State legislature.
SEC. 402. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM INCOME FOR
PURPOSES OF INCOME ELIGIBILITY UNDER MEDICAID.
(a) In General.--Section 1902 of the Social Security Act (42
U.S.C. 1396a) is amended--
(1) in subsection (a)(17), by striking ``(e)(14),
(e)(14)'' and inserting ``(e)(14), (e)(15)''; and
(2) in subsection (e)(14), as amended by section
303(c), by adding at the end the following new
subparagraph:
``(K) Treatment of certain lottery winnings
and income received as a lump sum.--
``(i) In general.--In the case of an
individual who is the recipient of
qualified lottery winnings (pursuant to
lotteries occurring on or after January
1, 2018) or qualified lump sum income
(received on or after such date) and
whose eligibility for medical
assistance is determined based on the
application of modified adjusted gross
income under subparagraph (A), a State
shall, in determining such eligibility,
include such winnings or income (as
applicable) as income received--
``(I) in the month in which
such winnings or income (as
applicable) is received if the
amount of such winnings or
income is less than $80,000;
``(II) over a period of 2
months if the amount of such
winnings or income (as
applicable) is greater than or
equal to $80,000 but less than
$90,000;
``(III) over a period of 3
months if the amount of such
winnings or income (as
applicable) is greater than or
equal to $90,000 but less than
$100,000; and
``(IV) over a period of 3
months plus 1 additional month
for each increment of $10,000
of such winnings or income (as
applicable) received, not to
exceed a period of 120 months
(for winnings or income of
$1,260,000 or more), if the
amount of such winnings or
income is greater than or equal
to $100,000.
``(ii) Counting in equal
installments.--For purposes of
subclauses (II), (III), and (IV) of
clause (i), winnings or income to which
such subclause applies shall be counted
in equal monthly installments over the
period of months specified under such
subclause.
``(iii) Hardship exemption.--An
individual whose income, by application
of clause (i), exceeds the applicable
eligibility threshold established by
the State, shall continue to be
eligible for medical assistance to the
extent that the State determines, under
procedures established by the State (in
accordance with standards specified by
the Secretary), that the denial of
eligibility of the individual would
cause an undue medical or financial
hardship as determined on the basis of
criteria established by the Secretary.
``(iv) Notifications and assistance
required in case of loss of
eligibility.--A State shall, with
respect to an individual who loses
eligibility for medical assistance
under the State plan (or a waiver of
such plan) by reason of clause (i)--
``(I) before the date on
which the individual loses such
eligibility, inform the
individual--
``(aa) of the
individual's
opportunity to enroll
in a qualified health
plan offered through an
Exchange established
under title I of the
Patient Protection and
Affordable Care Act
during the special
enrollment period
specified in section
9801(f)(3) of the
Internal Revenue Code
of 1986 (relating to
loss of Medicaid or
CHIP coverage); and
``(bb) of the date on
which the individual
would no longer be
considered ineligible
by reason of clause (i)
to receive medical
assistance under the
State plan or under any
waiver of such plan and
be eligible to reapply
to receive such medical
assistance; and
``(II) provide technical
assistance to the individual
seeking to enroll in such a
qualified health plan.
``(v) Qualified lottery winnings
defined.--In this subparagraph, the
term `qualified lottery winnings' means
winnings from a sweepstakes, lottery,
or pool described in paragraph (3) of
section 4402 of the Internal Revenue
Code of 1986 or a lottery operated by a
multistate or multijurisdictional
lottery association, including amounts
awarded as a lump sum payment.
``(vi) Qualified lump sum income
defined.--In this subparagraph, the
term `qualified lump sum income' means
income that is received as a lump sum
from one of the following sources:
``(I) Monetary winnings from
gambling (as defined by the
Secretary and including
gambling activities described
in section 1955(b)(4) of title
18, United States Code).
``(II) Damages received,
whether by suit or agreement
and whether as lump sums or as
periodic payments (other than
monthly payments), on account
of causes of action other than
causes of action arising from
personal physical injuries or
physical sickness.
``(III) Income received as
liquid assets from the estate
(as defined in section
1917(b)(4)) of a deceased
individual.''.
(b) Rules of Construction.--
(1) Interception of lottery winnings allowed.--
Nothing in the amendment made by subsection (a)(2)
shall be construed as preventing a State from
intercepting the State lottery winnings awarded to an
individual in the State to recover amounts paid by the
State under the State Medicaid plan under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) for
medical assistance furnished to the individual.
(2) Applicability limited to eligibility of recipient
of lottery winnings or lump sum income.--Nothing in the
amendment made by subsection (a)(2) shall be construed,
with respect to a determination of household income for
purposes of a determination of eligibility for medical
assistance under the State plan under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) (or a
waiver of such plan) made by applying modified adjusted
gross income under subparagraph (A) of section
1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), as
limiting the eligibility for such medical assistance of
any individual that is a member of the household other
than the individual who received qualified lottery
winnings or qualified lump-sum income (as defined in
subparagraph (K) of such section 1902(e)(14), as added
by subsection (a)(2) of this section).
----------
PART B--TEXT OF AMENDMENT CONSIDERED AS ADOPTED
Amend section 202 to read as follows:
SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care
Act (42 U.S.C. 300u-11(b)) is amended by striking paragraphs
(3) through (8) and inserting the following new paragraphs:
``(3) for fiscal year 2018, $900,000,000;
``(4) for fiscal year 2019, $500,000,000;
``(5) for fiscal year 2020, $500,000,000;
``(6) for fiscal year 2021, $500,000,000;
``(7) for fiscal year 2022, $500,000,000;
``(8) for fiscal year 2023, $500,000,000;
``(9) for fiscal year 2024, $500,000,000;
``(10) for fiscal year 2025, $750,000,000;
``(11) for fiscal year 2026, $1,000,000,000; and
``(12) for fiscal year 2027 and each fiscal year
thereafter, $2,000,000,000.''.
Add at the end of title II of division B the following (and
conform the table of contents accordingly):
SEC. 403. ADJUSTMENTS TO MEDICARE PART B AND PART D PREMIUM SUBSIDIES
FOR HIGHER INCOME INDIVIDUALS.
(a) In General.--Section 1839(i)(3)(C)(i)(II) of the Social
Security Act (42 U.S.C. 1395r(i)(3)(C)(i)(II)) is amended, in
the table, by striking the last row and inserting the following
new rows:
``More than $160,000 but less than $500,000...............80 percent
At least $500,000....................................100 percent.''.
(b) Joint Returns.--Section 1839(i)(3)(C)(ii) of the Social
Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by
inserting before the period the following: ``except, with
respect to the dollar amounts applied in the last row of the
table under subclause (II) of such clause (and the second
dollar amount specified in the second to last row of such
table), clause (i) shall be applied by substituting dollar
amounts which are 175 percent of such dollar amounts for the
calendar year''.
(c) Inflation Adjustment.--Section 1839(i) of the Social
Security Act (42 U.S.C. 1395r(i)) is amended--
(1) in paragraph (5)--
(A) in subparagraph (A), by striking ``In the
case'' and inserting ``Subject to subparagraph
(C), in the case'';
(B) in subparagraph (B), by striking
``subparagraph (A)'' and inserting
``subparagraph (A) or (C)''; and
(C) by adding at the end the following new
subparagraph:
``(C) Treatment of adjustments for certain
higher income individuals.--
``(i) In general.--Subparagraph (A)
shall not apply with respect to each
dollar amount in paragraph (3) of
$500,000.
``(ii) Adjustment beginning 2027.--In
the case of any calendar year beginning
after 2026, each dollar amount in
paragraph (3) of $500,000 shall be
increased by an amount equal to--
``(I) such dollar amount,
multiplied by
``(II) the percentage (if
any) by which the average of
the Consumer Price Index for
all urban consumers (United
States city average) for the
12-month period ending with
August of the preceding
calendar year exceeds such
average for the 12-month period
ending with August 2025.''; and
(2) in paragraph (6)(B), by inserting ``(other than
$500,000)'' after ``the dollar amounts''.
[all]