[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1892 Engrossed Amendment House (EAH)]
<DOC>
In the House of Representatives, U. S.,
February 6, 2018.
Resolved, That the House agree to the amendment of the Senate to
the bill (H.R. 1892) entitled ``An Act to amend title 4, United States
Code, to provide for the flying of the flag at half-staff in the event
of the death of a first responder in the line of duty.'', with the
following
HOUSE AMENDMENT TO SENATE AMENDMENT:
At the end of the matter inserted by the Senate amendment,
insert the following:
DIVISION B--FURTHER EXTENSION OF CONTINUING APPROPRIATIONS ACT, 2018
Sec. 1001. The Continuing Appropriations Act, 2018 (division D of
Public Law 115-56) is further amended--
(1) by striking the date specified in section 106(3) and
inserting ``March 23, 2018''; and
(2) by adding after section 155 the following:
``Sec. 156. Notwithstanding section 101, amounts are provided for
`Department of Commerce--Bureau of the Census--Periodic Censuses and
Programs' at a rate for operations of $1,251,000,000, and such amounts
may be apportioned up to the rate for operations necessary to maintain
the schedule and deliver the required data according to statutory
deadlines in the 2020 Decennial Census Program.
``Sec. 157. Notwithstanding section 101, the matter preceding the
first proviso and the first proviso under the heading `Power Marketing
Administrations--Operation and Maintenance, Southeastern Power
Administration' in division D of Public Law 115-31 shall be applied by
substituting `$6,379,000' for `$1,000,000' each place it appears.
``Sec. 158. As authorized by section 404 of the Bipartisan Budget
Act of 2015 (Public Law 114-74; 42 U.S.C. 6239 note), the Secretary of
Energy shall draw down and sell not to exceed $350,000,000 of crude oil
from the Strategic Petroleum Reserve in fiscal year 2018: Provided,
That the proceeds from such drawdown and sale shall be deposited into
the `Energy Security and Infrastructure Modernization Fund' (in this
section referred to as the `Fund') during fiscal year 2018: Provided
further, That in addition to amounts otherwise made available by
section 101, and notwithstanding section 104, any amounts deposited in
the Fund shall be made available and shall remain available until
expended at a rate for operations of $350,000,000, for necessary
expenses in carrying out the Life Extension II project for the
Strategic Petroleum Reserve.
``Sec. 159. Amounts made available by section 101 for `The
Judiciary--Courts of Appeals, District Courts, and Other Judicial
Services--Fees of Jurors and Commissioners' may be apportioned up to
the rate for operations necessary to accommodate increased juror usage.
``Sec. 160. (a) In addition to amounts otherwise made available by
section 101, there is appropriated for an additional amount for the
`Small Business Administration--Disaster Loans Program Account'
$225,000,000, to remain available until expended, for the cost of
direct loans authorized by section 7(b) of the Small Business Act:
Provided, That such amount is designated by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of the
Balanced Budget and Emergency Deficit Control Act of 1985.
``(b) The amount designated in subsection (a) by the Congress as an
emergency requirement pursuant to section 251(b)(2)(A)(i) of the
Balanced Budget and Emergency Deficit Control Act of 1985 shall be
available only if the President subsequently so designates such amount
and transmits such designation to the Congress.''.
This division may be cited as the ``Further Extension of
Continuing Appropriations Act, 2018''.
DIVISION C--DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2018
That the following sums are appropriated, out of any money in the
Treasury not otherwise appropriated, for the fiscal year ending
September 30, 2018, for military functions administered by the
Department of Defense and for other purposes, namely:
TITLE I
MILITARY PERSONNEL
Military Personnel, Army
For pay, allowances, individual clothing, subsistence, interest on
deposits, gratuities, permanent change of station travel (including all
expenses thereof for organizational movements), and expenses of
temporary duty travel between permanent duty stations, for members of
the Army on active duty (except members of reserve components provided
for elsewhere), cadets, and aviation cadets; for members of the Reserve
Officers' Training Corps; and for payments pursuant to section 156 of
Public Law 97-377, as amended (42 U.S.C. 402 note), and to the
Department of Defense Military Retirement Fund, $41,427,054,000.
Military Personnel, Navy
For pay, allowances, individual clothing, subsistence, interest on
deposits, gratuities, permanent change of station travel (including all
expenses thereof for organizational movements), and expenses of
temporary duty travel between permanent duty stations, for members of
the Navy on active duty (except members of the Reserve provided for
elsewhere), midshipmen, and aviation cadets; for members of the Reserve
Officers' Training Corps; and for payments pursuant to section 156 of
Public Law 97-377, as amended (42 U.S.C. 402 note), and to the
Department of Defense Military Retirement Fund, $28,707,918,000
(reduced by $2,000,000) (increased by $2,000,000).
Military Personnel, Marine Corps
For pay, allowances, individual clothing, subsistence, interest on
deposits, gratuities, permanent change of station travel (including all
expenses thereof for organizational movements), and expenses of
temporary duty travel between permanent duty stations, for members of
the Marine Corps on active duty (except members of the Reserve provided
for elsewhere); and for payments pursuant to section 156 of Public Law
97-377, as amended (42 U.S.C. 402 note), and to the Department of
Defense Military Retirement Fund, $13,165,714,000.
Military Personnel, Air Force
For pay, allowances, individual clothing, subsistence, interest on
deposits, gratuities, permanent change of station travel (including all
expenses thereof for organizational movements), and expenses of
temporary duty travel between permanent duty stations, for members of
the Air Force on active duty (except members of reserve components
provided for elsewhere), cadets, and aviation cadets; for members of
the Reserve Officers' Training Corps; and for payments pursuant to
section 156 of Public Law 97-377, as amended (42 U.S.C. 402 note), and
to the Department of Defense Military Retirement Fund, $28,738,320,000.
Reserve Personnel, Army
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Army Reserve on active duty under
sections 10211, 10302, and 3038 of title 10, United States Code, or
while serving on active duty under section 12301(d) of title 10, United
States Code, in connection with performing duty specified in section
12310(a) of title 10, United States Code, or while undergoing reserve
training, or while performing drills or equivalent duty or other duty,
and expenses authorized by section 16131 of title 10, United States
Code; and for payments to the Department of Defense Military Retirement
Fund, $4,721,128,000.
Reserve Personnel, Navy
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Navy Reserve on active duty under
section 10211 of title 10, United States Code, or while serving on
active duty under section 12301(d) of title 10, United States Code, in
connection with performing duty specified in section 12310(a) of title
10, United States Code, or while undergoing reserve training, or while
performing drills or equivalent duty, and expenses authorized by
section 16131 of title 10, United States Code; and for payments to the
Department of Defense Military Retirement Fund, $1,987,662,000.
Reserve Personnel, Marine Corps
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Marine Corps Reserve on active
duty under section 10211 of title 10, United States Code, or while
serving on active duty under section 12301(d) of title 10, United
States Code, in connection with performing duty specified in section
12310(a) of title 10, United States Code, or while undergoing reserve
training, or while performing drills or equivalent duty, and for
members of the Marine Corps platoon leaders class, and expenses
authorized by section 16131 of title 10, United States Code; and for
payments to the Department of Defense Military Retirement Fund,
$762,793,000.
Reserve Personnel, Air Force
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Air Force Reserve on active duty
under sections 10211, 10305, and 8038 of title 10, United States Code,
or while serving on active duty under section 12301(d) of title 10,
United States Code, in connection with performing duty specified in
section 12310(a) of title 10, United States Code, or while undergoing
reserve training, or while performing drills or equivalent duty or
other duty, and expenses authorized by section 16131 of title 10,
United States Code; and for payments to the Department of Defense
Military Retirement Fund, $1,808,434,000.
National Guard Personnel, Army
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Army National Guard while on duty
under sections 10211, 10302, or 12402 of title 10 or section 708 of
title 32, United States Code, or while serving on duty under section
12301(d) of title 10 or section 502(f) of title 32, United States Code,
in connection with performing duty specified in section 12310(a) of
title 10, United States Code, or while undergoing training, or while
performing drills or equivalent duty or other duty, and expenses
authorized by section 16131 of title 10, United States Code; and for
payments to the Department of Defense Military Retirement Fund,
$8,252,426,000.
National Guard Personnel, Air Force
For pay, allowances, clothing, subsistence, gratuities, travel, and
related expenses for personnel of the Air National Guard on duty under
sections 10211, 10305, or 12402 of title 10 or section 708 of title 32,
United States Code, or while serving on duty under section 12301(d) of
title 10 or section 502(f) of title 32, United States Code, in
connection with performing duty specified in section 12310(a) of title
10, United States Code, or while undergoing training, or while
performing drills or equivalent duty or other duty, and expenses
authorized by section 16131 of title 10, United States Code; and for
payments to the Department of Defense Military Retirement Fund,
$3,406,137,000.
TITLE II
OPERATION AND MAINTENANCE
Operation and Maintenance, Army
For expenses, not otherwise provided for, necessary for the
operation and maintenance of the Army, as authorized by law,
$38,483,846,000 (reduced by $5,000,000) (reduced by $5,600,000)
(reduced by $6,000,000): Provided, That not to exceed $12,478,000 can
be used for emergencies and extraordinary expenses, to be expended on
the approval or authority of the Secretary of the Army, and payments
may be made on his certificate of necessity for confidential military
purposes.
Operation and Maintenance, Navy
For expenses, not otherwise provided for, necessary for the
operation and maintenance of the Navy and the Marine Corps, as
authorized by law, $45,980,133,000 (reduced by $598,000) (reduced by
$7,000,000): Provided, That not to exceed $15,055,000 can be used for
emergencies and extraordinary expenses, to be expended on the approval
or authority of the Secretary of the Navy, and payments may be made on
his certificate of necessity for confidential military purposes.
Operation and Maintenance, Marine Corps
For expenses, not otherwise provided for, necessary for the
operation and maintenance of the Marine Corps, as authorized by law,
$6,885,884,000.
Operation and Maintenance, Air Force
For expenses, not otherwise provided for, necessary for the
operation and maintenance of the Air Force, as authorized by law,
$38,592,745,000: Provided, That not to exceed $7,699,000 can be used
for emergencies and extraordinary expenses, to be expended on the
approval or authority of the Secretary of the Air Force, and payments
may be made on his certificate of necessity for confidential military
purposes.
Operation and Maintenance, Defense-Wide
(including transfer of funds)
For expenses, not otherwise provided for, necessary for the
operation and maintenance of activities and agencies of the Department
of Defense (other than the military departments), as authorized by law,
$33,771,769,000 (increased by $5,000,000) (reduced by $10,000,000)
(reduced by $100,000) (increased by $100,000) (reduced by $194,897,000)
(increased by $194,897,000) (reduced by $26,200,000) (reduced by
$20,000,000) (reduced by $6,000,000) (reduced by $4,000,000) (reduced
by $20,000,000) (reduced by $1,000,000) (reduced by $10,000,000)
(reduced by $2,500,000) (reduced by $2,000,000) (reduced by $8,000,000)
(reduced by $6,250,000) (reduced by $10,000,000) (reduced by
$10,000,000) (reduced by $30,000,000) (reduced by $34,734,000) (reduced
by $60,000,000): Provided, That not more than $15,000,000 may be used
for the Combatant Commander Initiative Fund authorized under section
166a of title 10, United States Code: Provided further, That not to
exceed $36,000,000 can be used for emergencies and extraordinary
expenses, to be expended on the approval or authority of the Secretary
of Defense, and payments may be made on his certificate of necessity
for confidential military purposes: Provided further, That of the
funds provided under this heading, not less than $38,458,000 shall be
made available for the Procurement Technical Assistance Cooperative
Agreement Program, of which not less than $3,600,000 shall be available
for centers defined in 10 U.S.C. 2411(1)(D): Provided further, That
none of the funds appropriated or otherwise made available by this Act
may be used to plan or implement the consolidation of a budget or
appropriations liaison office of the Office of the Secretary of
Defense, the office of the Secretary of a military department, or the
service headquarters of one of the Armed Forces into a legislative
affairs or legislative liaison office: Provided further, That
$9,385,000, to remain available until expended, is available only for
expenses relating to certain classified activities, and may be
transferred as necessary by the Secretary of Defense to operation and
maintenance appropriations or research, development, test and
evaluation appropriations, to be merged with and to be available for
the same time period as the appropriations to which transferred:
Provided further, That any ceiling on the investment item unit cost of
items that may be purchased with operation and maintenance funds shall
not apply to the funds described in the preceding proviso: Provided
further, That of the funds provided under this heading, $415,000,000,
of which $100,000,000 to remain available until September 30, 2019,
shall be available to provide support and assistance to foreign
security forces or other groups or individuals to conduct, support or
facilitate counterterrorism, crisis response, or other Department of
Defense security cooperation programs: Provided further, That the
transfer authority provided under this heading is in addition to any
other transfer authority provided elsewhere in this Act.
Operation and Maintenance, Army Reserve
For expenses, not otherwise provided for, necessary for the
operation and maintenance, including training, organization, and
administration, of the Army Reserve; repair of facilities and
equipment; hire of passenger motor vehicles; travel and transportation;
care of the dead; recruiting; procurement of services, supplies, and
equipment; and communications, $2,870,163,000.
Operation and Maintenance, Navy Reserve
For expenses, not otherwise provided for, necessary for the
operation and maintenance, including training, organization, and
administration, of the Navy Reserve; repair of facilities and
equipment; hire of passenger motor vehicles; travel and transportation;
care of the dead; recruiting; procurement of services, supplies, and
equipment; and communications, $1,038,507,000.
Operation and Maintenance, Marine Corps Reserve
For expenses, not otherwise provided for, necessary for the
operation and maintenance, including training, organization, and
administration, of the Marine Corps Reserve; repair of facilities and
equipment; hire of passenger motor vehicles; travel and transportation;
care of the dead; recruiting; procurement of services, supplies, and
equipment; and communications, $282,337,000.
Operation and Maintenance, Air Force Reserve
For expenses, not otherwise provided for, necessary for the
operation and maintenance, including training, organization, and
administration, of the Air Force Reserve; repair of facilities and
equipment; hire of passenger motor vehicles; travel and transportation;
care of the dead; recruiting; procurement of services, supplies, and
equipment; and communications, $3,233,745,000.
Operation and Maintenance, Army National Guard
For expenses of training, organizing, and administering the Army
National Guard, including medical and hospital treatment and related
expenses in non-Federal hospitals; maintenance, operation, and repairs
to structures and facilities; hire of passenger motor vehicles;
personnel services in the National Guard Bureau; travel expenses (other
than mileage), as authorized by law for Army personnel on active duty,
for Army National Guard division, regimental, and battalion commanders
while inspecting units in compliance with National Guard Bureau
regulations when specifically authorized by the Chief, National Guard
Bureau; supplying and equipping the Army National Guard as authorized
by law; and expenses of repair, modification, maintenance, and issue of
supplies and equipment (including aircraft), $7,275,820,000.
Operation and Maintenance, Air National Guard
For expenses of training, organizing, and administering the Air
National Guard, including medical and hospital treatment and related
expenses in non-Federal hospitals; maintenance, operation, and repairs
to structures and facilities; transportation of things, hire of
passenger motor vehicles; supplying and equipping the Air National
Guard, as authorized by law; expenses for repair, modification,
maintenance, and issue of supplies and equipment, including those
furnished from stocks under the control of agencies of the Department
of Defense; travel expenses (other than mileage) on the same basis as
authorized by law for Air National Guard personnel on active Federal
duty, for Air National Guard commanders while inspecting units in
compliance with National Guard Bureau regulations when specifically
authorized by the Chief, National Guard Bureau, $6,735,930,000.
United States Court of Appeals for the Armed Forces
For salaries and expenses necessary for the United States Court of
Appeals for the Armed Forces, $14,538,000, of which not to exceed
$5,000 may be used for official representation purposes.
Environmental Restoration, Army
(including transfer of funds)
For the Department of the Army, $215,809,000, to remain available
until transferred: Provided, That the Secretary of the Army shall,
upon determining that such funds are required for environmental
restoration, reduction and recycling of hazardous waste, removal of
unsafe buildings and debris of the Department of the Army, or for
similar purposes, transfer the funds made available by this
appropriation to other appropriations made available to the Department
of the Army, to be merged with and to be available for the same
purposes and for the same time period as the appropriations to which
transferred: Provided further, That upon a determination that all or
part of the funds transferred from this appropriation are not necessary
for the purposes provided herein, such amounts may be transferred back
to this appropriation: Provided further, That the transfer authority
provided under this heading is in addition to any other transfer
authority provided elsewhere in this Act.
Environmental Restoration, Navy
(including transfer of funds)
For the Department of the Navy, $288,915,000 (increased by
$34,734,000) (increased by $30,000,000), to remain available until
transferred: Provided, That the Secretary of the Navy shall, upon
determining that such funds are required for environmental restoration,
reduction and recycling of hazardous waste, removal of unsafe buildings
and debris of the Department of the Navy, or for similar purposes,
transfer the funds made available by this appropriation to other
appropriations made available to the Department of the Navy, to be
merged with and to be available for the same purposes and for the same
time period as the appropriations to which transferred: Provided
further, That upon a determination that all or part of the funds
transferred from this appropriation are not necessary for the purposes
provided herein, such amounts may be transferred back to this
appropriation: Provided further, That the transfer authority provided
under this heading is in addition to any other transfer authority
provided elsewhere in this Act.
Environmental Restoration, Air Force
(including transfer of funds)
For the Department of the Air Force, $308,749,000 (increased by
$30,000,000), to remain available until transferred: Provided, That
the Secretary of the Air Force shall, upon determining that such funds
are required for environmental restoration, reduction and recycling of
hazardous waste, removal of unsafe buildings and debris of the
Department of the Air Force, or for similar purposes, transfer the
funds made available by this appropriation to other appropriations made
available to the Department of the Air Force, to be merged with and to
be available for the same purposes and for the same time period as the
appropriations to which transferred: Provided further, That upon a
determination that all or part of the funds transferred from this
appropriation are not necessary for the purposes provided herein, such
amounts may be transferred back to this appropriation: Provided
further, That the transfer authority provided under this heading is in
addition to any other transfer authority provided elsewhere in this
Act.
Environmental Restoration, Defense-Wide
(including transfer of funds)
For the Department of Defense, $9,002,000 (increased by
$10,000,000), to remain available until transferred: Provided, That
the Secretary of Defense shall, upon determining that such funds are
required for environmental restoration, reduction and recycling of
hazardous waste, removal of unsafe buildings and debris of the
Department of Defense, or for similar purposes, transfer the funds made
available by this appropriation to other appropriations made available
to the Department of Defense, to be merged with and to be available for
the same purposes and for the same time period as the appropriations to
which transferred: Provided further, That upon a determination that
all or part of the funds transferred from this appropriation are not
necessary for the purposes provided herein, such amounts may be
transferred back to this appropriation: Provided further, That the
transfer authority provided under this heading is in addition to any
other transfer authority provided elsewhere in this Act.
Environmental Restoration, Formerly Used Defense Sites
(including transfer of funds)
For the Department of the Army, $233,673,000, to remain available
until transferred: Provided, That the Secretary of the Army shall,
upon determining that such funds are required for environmental
restoration, reduction and recycling of hazardous waste, removal of
unsafe buildings and debris at sites formerly used by the Department of
Defense, transfer the funds made available by this appropriation to
other appropriations made available to the Department of the Army, to
be merged with and to be available for the same purposes and for the
same time period as the appropriations to which transferred: Provided
further, That upon a determination that all or part of the funds
transferred from this appropriation are not necessary for the purposes
provided herein, such amounts may be transferred back to this
appropriation: Provided further, That the transfer authority provided
under this heading is in addition to any other transfer authority
provided elsewhere in this Act.
Overseas Humanitarian, Disaster, and Civic Aid
For expenses relating to the Overseas Humanitarian, Disaster, and
Civic Aid programs of the Department of Defense (consisting of the
programs provided under sections 401, 402, 404, 407, 2557, and 2561 of
title 10, United States Code), $107,900,000, to remain available until
September 30, 2018.
Cooperative Threat Reduction Account
For assistance, including assistance provided by contract or by
grants, under programs and activities of the Department of Defense
Cooperative Threat Reduction Program authorized under the Department of
Defense Cooperative Threat Reduction Act, $324,600,000, to remain
available until September 30, 2019.
Operation and Maintenance, National Defense Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $5,000,000,000, for the ``Operation and Maintenance,
National Defense Restoration Fund'': Provided, That such funds provided
under this heading shall only be available for programs, projects and
activities necessary to implement the 2018 National Defense Strategy:
Provided further, That such funds shall not be available for transfer
until 30 days after the Secretary has submitted, and the congressional
defense committees have approved, the proposed allocation plan for the
use of such funds to implement such strategy: Provided further, That
such allocation plan shall include a detailed justification for the use
of such funds and a description of how such investments are necessary
to implement the strategy: Provided further, That the Secretary of
Defense may transfer these funds only to operation and maintenance
accounts: Provided further, That the funds transferred shall be merged
with and shall be available for the same purposes and for the same time
period, as the appropriation to which transferred: Provided further,
That none of the funds made available under this heading may be
transferred to any program, project, or activity specifically limited
or denied by this Act: Provided further, That the transfer authority
provided under this heading is in addition to any other transfer
authority available to the Department of Defense.
TITLE III
PROCUREMENT
Aircraft Procurement, Army
For construction, procurement, production, modification, and
modernization of aircraft, equipment, including ordnance, ground
handling equipment, spare parts, and accessories therefor; specialized
equipment and training devices; expansion of public and private plants,
including the land necessary therefor, for the foregoing purposes, and
such lands and interests therein, may be acquired, and construction
prosecuted thereon prior to approval of title; and procurement and
installation of equipment, appliances, and machine tools in public and
private plants; reserve plant and Government and contractor-owned
equipment layaway; and other expenses necessary for the foregoing
purposes, $4,456,533,000, to remain available for obligation until
September 30, 2020.
Missile Procurement, Army
For construction, procurement, production, modification, and
modernization of missiles, equipment, including ordnance, ground
handling equipment, spare parts, and accessories therefor; specialized
equipment and training devices; expansion of public and private plants,
including the land necessary therefor, for the foregoing purposes, and
such lands and interests therein, may be acquired, and construction
prosecuted thereon prior to approval of title; and procurement and
installation of equipment, appliances, and machine tools in public and
private plants; reserve plant and Government and contractor-owned
equipment layaway; and other expenses necessary for the foregoing
purposes, $2,581,600,000, to remain available for obligation until
September 30, 2020.
Procurement of Weapons and Tracked Combat Vehicles, Army
For construction, procurement, production, and modification of
weapons and tracked combat vehicles, equipment, including ordnance,
spare parts, and accessories therefor; specialized equipment and
training devices; expansion of public and private plants, including the
land necessary therefor, for the foregoing purposes, and such lands and
interests therein, may be acquired, and construction prosecuted thereon
prior to approval of title; and procurement and installation of
equipment, appliances, and machine tools in public and private plants;
reserve plant and Government and contractor-owned equipment layaway;
and other expenses necessary for the foregoing purposes,
$3,556,175,000, to remain available for obligation until September 30,
2020.
Procurement of Ammunition, Army
For construction, procurement, production, and modification of
ammunition, and accessories therefor; specialized equipment and
training devices; expansion of public and private plants, including
ammunition facilities, authorized by section 2854 of title 10, United
States Code, and the land necessary therefor, for the foregoing
purposes, and such lands and interests therein, may be acquired, and
construction prosecuted thereon prior to approval of title; and
procurement and installation of equipment, appliances, and machine
tools in public and private plants; reserve plant and Government and
contractor-owned equipment layaway; and other expenses necessary for
the foregoing purposes, $1,811,808,000, to remain available for
obligation until September 30, 2020.
Other Procurement, Army
For construction, procurement, production, and modification of
vehicles, including tactical, support, and non-tracked combat vehicles;
the purchase of passenger motor vehicles for replacement only;
communications and electronic equipment; other support equipment; spare
parts, ordnance, and accessories therefor; specialized equipment and
training devices; expansion of public and private plants, including the
land necessary therefor, for the foregoing purposes, and such lands and
interests therein, may be acquired, and construction prosecuted thereon
prior to approval of title; and procurement and installation of
equipment, appliances, and machine tools in public and private plants;
reserve plant and Government and contractor-owned equipment layaway;
and other expenses necessary for the foregoing purposes, $6,356,044,000
(increased by $30,000,000), to remain available for obligation until
September 30, 2020.
Aircraft Procurement, Navy
For construction, procurement, production, modification, and
modernization of aircraft, equipment, including ordnance, spare parts,
and accessories therefor; specialized equipment; expansion of public
and private plants, including the land necessary therefor, and such
lands and interests therein, may be acquired, and construction
prosecuted thereon prior to approval of title; and procurement and
installation of equipment, appliances, and machine tools in public and
private plants; reserve plant and Government and contractor-owned
equipment layaway, $17,908,270,000, to remain available for obligation
until September 30, 2020.
Weapons Procurement, Navy
For construction, procurement, production, modification, and
modernization of missiles, torpedoes, other weapons, and related
support equipment including spare parts, and accessories therefor;
expansion of public and private plants, including the land necessary
therefor, and such lands and interests therein, may be acquired, and
construction prosecuted thereon prior to approval of title; and
procurement and installation of equipment, appliances, and machine
tools in public and private plants; reserve plant and Government and
contractor-owned equipment layaway, $3,387,826,000 (increased by
$26,200,000), to remain available for obligation until September 30,
2020.
Procurement of Ammunition, Navy and Marine Corps
For construction, procurement, production, and modification of
ammunition, and accessories therefor; specialized equipment and
training devices; expansion of public and private plants, including
ammunition facilities, authorized by section 2854 of title 10, United
States Code, and the land necessary therefor, for the foregoing
purposes, and such lands and interests therein, may be acquired, and
construction prosecuted thereon prior to approval of title; and
procurement and installation of equipment, appliances, and machine
tools in public and private plants; reserve plant and Government and
contractor-owned equipment layaway; and other expenses necessary for
the foregoing purposes, $735,651,000, to remain available for
obligation until September 30, 2020.
Shipbuilding and Conversion, Navy
For expenses necessary for the construction, acquisition, or
conversion of vessels as authorized by law, including armor and
armament thereof, plant equipment, appliances, and machine tools and
installation thereof in public and private plants; reserve plant and
Government and contractor-owned equipment layaway; procurement of
critical, long lead time components and designs for vessels to be
constructed or converted in the future; and expansion of public and
private plants, including land necessary therefor, and such lands and
interests therein, may be acquired, and construction prosecuted thereon
prior to approval of title, as follows:
Ohio Replacement Submarine (AP), $842,853,000;
Carrier Replacement Program, $1,869,646,000;
Carrier Replacement Program (AP), $2,561,058,000;
Virginia Class Submarine, $3,305,315,000;
Virginia Class Submarine (AP), $1,920,596,000;
CVN Refueling Overhauls, $1,569,669,000;
CVN Refueling Overhauls (AP), $75,897,000;
DDG-1000 Program, $164,976,000;
DDG-51 Destroyer, $3,499,079,000;
DDG-51 Destroyer (AP), $90,336,000;
Littoral Combat Ship, $1,566,971,000;
Expeditionary Sea Base, $635,000,000;
LHA Replacement, $1,695,077,000;
TAO Fleet Oiler, $449,415,000;
TAO Fleet Oiler (AP), $75,068,000;
Ship to Shore Connector, $390,554,000;
Service Craft, $23,994,000;
Towing, Salvage, and Rescue Ship, $76,204,000;
LCU 1700, $31,850,000;
For outfitting, post delivery, conversions, and first
destination transportation, $542,626,000; and
Completion of Prior Year Shipbuilding Programs,
$117,542,000.
In all: $21,503,726,000, to remain available for obligation until
September 30, 2022: Provided, That additional obligations may be
incurred after September 30, 2022, for engineering services, tests,
evaluations, and other such budgeted work that must be performed in the
final stage of ship construction: Provided further, That none of the
funds provided under this heading for the construction or conversion of
any naval vessel to be constructed in shipyards in the United States
shall be expended in foreign facilities for the construction of major
components of such vessel: Provided further, That none of the funds
provided under this heading shall be used for the construction of any
naval vessel in foreign shipyards: Provided further, That funds
appropriated or otherwise made available by this Act for production of
the common missile compartment of nuclear-powered vessels may be
available for multiyear procurement of critical components to support
continuous production of such compartments only in accordance with the
provisions of subsection (i) of section 2218a of title 10, United
States Code (as added by section 1023 of the National Defense
Authorization Act for Fiscal Year 2017 (Public Law 114-328)).
Other Procurement, Navy
For procurement, production, and modernization of support equipment
and materials not otherwise provided for, Navy ordnance (except
ordnance for new aircraft, new ships, and ships authorized for
conversion); the purchase of passenger motor vehicles for replacement
only; expansion of public and private plants, including the land
necessary therefor, and such lands and interests therein, may be
acquired, and construction prosecuted thereon prior to approval of
title; and procurement and installation of equipment, appliances, and
machine tools in public and private plants; reserve plant and
Government and contractor-owned equipment layaway, $7,852,952,000, to
remain available for obligation until September 30, 2020.
Procurement, Marine Corps
For expenses necessary for the procurement, manufacture, and
modification of missiles, armament, military equipment, spare parts,
and accessories therefor; plant equipment, appliances, and machine
tools, and installation thereof in public and private plants; reserve
plant and Government and contractor-owned equipment layaway; vehicles
for the Marine Corps, including the purchase of passenger motor
vehicles for replacement only; and expansion of public and private
plants, including land necessary therefor, and such lands and interests
therein, may be acquired, and construction prosecuted thereon prior to
approval of title, $1,818,846,000 (increased by $20,000,000), to remain
available for obligation until September 30, 2020.
Aircraft Procurement, Air Force
For construction, procurement, and modification of aircraft and
equipment, including armor and armament, specialized ground handling
equipment, and training devices, spare parts, and accessories therefor;
specialized equipment; expansion of public and private plants,
Government-owned equipment and installation thereof in such plants,
erection of structures, and acquisition of land, for the foregoing
purposes, and such lands and interests therein, may be acquired, and
construction prosecuted thereon prior to approval of title; reserve
plant and Government and contractor-owned equipment layaway; and other
expenses necessary for the foregoing purposes including rents and
transportation of things, $16,553,196,000 (increased by $16,000,000),
to remain available for obligation until September 30, 2020.
Missile Procurement, Air Force
For construction, procurement, and modification of missiles,
rockets, and related equipment, including spare parts and accessories
therefor; ground handling equipment, and training devices; expansion of
public and private plants, Government-owned equipment and installation
thereof in such plants, erection of structures, and acquisition of
land, for the foregoing purposes, and such lands and interests therein,
may be acquired, and construction prosecuted thereon prior to approval
of title; reserve plant and Government and contractor-owned equipment
layaway; and other expenses necessary for the foregoing purposes
including rents and transportation of things, $2,203,101,000, to remain
available for obligation until September 30, 2020.
Space Procurement, Air Force
For construction, procurement, and modification of spacecraft,
rockets, and related equipment, including spare parts and accessories
therefor; ground handling equipment, and training devices; expansion of
public and private plants, Government-owned equipment and installation
thereof in such plants, erection of structures, and acquisition of
land, for the foregoing purposes, and such lands and interests therein,
may be acquired, and construction prosecuted thereon prior to approval
of title; reserve plant and Government and contractor-owned equipment
layaway; and other expenses necessary for the foregoing purposes
including rents and transportation of things, $3,210,355,000, to remain
available for obligation until September 30, 2020.
Procurement of Ammunition, Air Force
For construction, procurement, production, and modification of
ammunition, and accessories therefor; specialized equipment and
training devices; expansion of public and private plants, including
ammunition facilities, authorized by section 2854 of title 10, United
States Code, and the land necessary therefor, for the foregoing
purposes, and such lands and interests therein, may be acquired, and
construction prosecuted thereon prior to approval of title; and
procurement and installation of equipment, appliances, and machine
tools in public and private plants; reserve plant and Government and
contractor-owned equipment layaway; and other expenses necessary for
the foregoing purposes, $1,316,977,000, to remain available for
obligation until September 30, 2020.
Other Procurement, Air Force
For procurement and modification of equipment (including ground
guidance and electronic control equipment, and ground electronic and
communication equipment), and supplies, materials, and spare parts
therefor, not otherwise provided for; the purchase of passenger motor
vehicles for replacement only; lease of passenger motor vehicles; and
expansion of public and private plants, Government-owned equipment and
installation thereof in such plants, erection of structures, and
acquisition of land, for the foregoing purposes, and such lands and
interests therein, may be acquired, and construction prosecuted
thereon, prior to approval of title; reserve plant and Government and
contractor-owned equipment layaway, $19,318,814,000, to remain
available for obligation until September 30, 2020.
Procurement, Defense-Wide
For expenses of activities and agencies of the Department of
Defense (other than the military departments) necessary for
procurement, production, and modification of equipment, supplies,
materials, and spare parts therefor, not otherwise provided for; the
purchase of passenger motor vehicles for replacement only; expansion of
public and private plants, equipment, and installation thereof in such
plants, erection of structures, and acquisition of land for the
foregoing purposes, and such lands and interests therein, may be
acquired, and construction prosecuted thereon prior to approval of
title; reserve plant and Government and contractor-owned equipment
layaway, $5,239,239,000 (reduced by $10,000,000), to remain available
for obligation until September 30, 2020.
Defense Production Act Purchases
For activities by the Department of Defense pursuant to sections
108, 301, 302, and 303 of the Defense Production Act of 1950 (50 U.S.C.
4518, 4531, 4532, and 4533), $67,401,000, to remain available until
expended.
Procurement, National Defense Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $12,622,931,000, for the ``Procurement, National Defense
Restoration Fund'': Provided, That such funds provided under this
heading shall only be available for programs, projects and activities
necessary to implement the 2018 National Defense Strategy: Provided
further, That such funds shall not be available for transfer until 30
days after the Secretary has submitted, and the congressional defense
committees have approved, the proposed allocation plan for the use of
such funds to implement such strategy: Provided further, That such
allocation plan shall include a detailed justification for the use of
such funds and a description of how such investments are necessary to
implement the strategy: Provided further, That the Secretary of Defense
may transfer these funds only to procurement accounts: Provided
further, That the funds transferred shall be merged with and shall be
available for the same purposes and for the same time period, as the
appropriation to which transferred: Provided further, That none of the
funds made available under this heading may be transferred to any
program, project, or activity specifically limited or denied by this
Act, except for missile defense requirements resulting from urgent or
emergent operational needs: Provided further, That the transfer
authority provided under this heading is in addition to any other
transfer authority available to the Department of Defense.
TITLE IV
RESEARCH, DEVELOPMENT, TEST AND EVALUATION
Research, Development, Test and Evaluation, Army
For expenses necessary for basic and applied scientific research,
development, test and evaluation, including maintenance,
rehabilitation, lease, and operation of facilities and equipment,
$9,674,222,000 (increased by $6,000,000) (increased by $4,000,000)
(increased by $12,000,000) (increased by $5,000,000), to remain
available for obligation until September 30, 2019.
Research, Development, Test and Evaluation, Navy
For expenses necessary for basic and applied scientific research,
development, test and evaluation, including maintenance,
rehabilitation, lease, and operation of facilities and equipment,
$17,196,521,000 (increased by $598,000) (increased by $20,000,000)
(reduced by $2,500,000) (increased by $24,000,000), to remain available
for obligation until September 30, 2019: Provided, That funds
appropriated in this paragraph which are available for the V-22 may be
used to meet unique operational requirements of the Special Operations
Forces.
Research, Development, Test and Evaluation, Air Force
For expenses necessary for basic and applied scientific research,
development, test and evaluation, including maintenance,
rehabilitation, lease, and operation of facilities and equipment,
$33,874,980,000 (increased by $5,000,000) (increased by $6,000,000)
(increased by $10,000,000) (reduced by $30,000,000) (increased by
$30,000,000), to remain available for obligation until September 30,
2019.
Research, Development, Test and Evaluation, Defense-Wide
(including transfer of funds)
For expenses of activities and agencies of the Department of
Defense (other than the military departments), necessary for basic and
applied scientific research, development, test and evaluation; advanced
research projects as may be designated and determined by the Secretary
of Defense, pursuant to law; maintenance, rehabilitation, lease, and
operation of facilities and equipment, $20,698,353,000 (reduced by
$16,000,000) (reduced by $12,000,000) (reduced by $2,500,000) (reduced
by $12,500,000) (increased by $20,000,000) (reduced by $20,000,000)
(reduced by $4,135,000) (increased by $4,135,000) (reduced by
$27,500,000) (increased by $10,000,000), to remain available for
obligation until September 30, 2019: Provided, That, of the funds made
available in this paragraph, $250,000,000 for the Defense Rapid
Innovation Program shall only be available for expenses, not otherwise
provided for, to include program management and oversight, to conduct
research, development, test and evaluation to include proof of concept
demonstration; engineering, testing, and validation; and transition to
full-scale production: Provided further, That the Secretary of Defense
may transfer funds provided herein for the Defense Rapid Innovation
Program to appropriations for research, development, test and
evaluation to accomplish the purpose provided herein: Provided
further, That this transfer authority is in addition to any other
transfer authority available to the Department of Defense: Provided
further, That the Secretary of Defense shall, not fewer than 30 days
prior to making transfers from this appropriation, notify the
congressional defense committees in writing of the details of any such
transfer.
Operational Test and Evaluation, Defense
For expenses, not otherwise provided for, necessary for the
independent activities of the Director, Operational Test and
Evaluation, in the direction and supervision of operational test and
evaluation, including initial operational test and evaluation which is
conducted prior to, and in support of, production decisions; joint
operational testing and evaluation; and administrative expenses in
connection therewith, $210,900,000, to remain available for obligation
until September 30, 2019.
Research, Development, Test and Evaluation, National Defense
Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $1,000,000,000, for the ``Research, Development, Test and
Evaluation, National Defense Restoration Fund'': Provided, That such
funds provided under this heading shall only be available for programs,
projects and activities necessary to implement the 2018 National
Defense Strategy: Provided further, That such funds shall not be
available for transfer until 30 days after the Secretary has submitted,
and the congressional defense committees have approved, the proposed
allocation plan for the use of such funds to implement such strategy:
Provided further, That such allocation plan shall include a detailed
justification for the use of such funds and a description of how such
investments are necessary to implement the strategy: Provided further,
That the Secretary of Defense may transfer these funds only to
research, development, test and evaluation accounts: Provided further,
That the funds transferred shall be merged with and shall be available
for the same purposes and for the same time period, as the
appropriation to which transferred: Provided further, That none of the
funds made available under this heading may be transferred to any
program, project, or activity specifically limited or denied by this
Act, except for missile defense requirements resulting from urgent or
emergent operational needs: Provided further, That the transfer
authority provided under this heading is in addition to any other
transfer authority available to the Department of Defense.
TITLE V
REVOLVING AND MANAGEMENT FUNDS
Defense Working Capital Funds
For the Defense Working Capital Funds, $1,586,596,000.
TITLE VI
OTHER DEPARTMENT OF DEFENSE PROGRAMS
Defense Health Program
For expenses, not otherwise provided for, for medical and health
care programs of the Department of Defense as authorized by law,
$33,931,566,000 (increased by $7,000,000) (increased by $1,000,000)
(increased by $10,000,000) (increased by $2,000,000) (increased by
$2,000,000) (increased by $10,000,000) (increased by $5,000,000)
(increased by $10,000,000); of which $31,735,923,000 (increased by
$2,000,000) (increased by $5,000,000) shall be for operation and
maintenance, of which not to exceed one percent shall remain available
for obligation until September 30, 2019, and of which up to
$15,349,700,000 may be available for contracts entered into under the
TRICARE program; of which $895,328,000, to remain available for
obligation until September 30, 2020, shall be for procurement; and of
which $1,300,315,000 (increased by $7,000,000) (increased by
$1,000,000) (increased by $10,000,000) (increased by $2,000,000)
(increased by $10,000,000) (increased by $10,000,000), to remain
available for obligation until September 30, 2019, shall be for
research, development, test and evaluation: Provided, That,
notwithstanding any other provision of law, of the amount made
available under this heading for research, development, test and
evaluation, not less than $8,000,000 shall be available for HIV
prevention educational activities undertaken in connection with United
States military training, exercises, and humanitarian assistance
activities conducted primarily in African nations: Provided further,
That of the funds provided under this heading for research,
development, test and evaluation, not less than $627,100,000 shall be
made available to the United States Army Medical Research and Materiel
Command to carry out the congressionally directed medical research
programs.
Chemical Agents and Munitions Destruction, Defense
For expenses, not otherwise provided for, necessary for the
destruction of the United States stockpile of lethal chemical agents
and munitions in accordance with the provisions of section 1412 of the
Department of Defense Authorization Act, 1986 (50 U.S.C. 1521), and for
the destruction of other chemical warfare materials that are not in the
chemical weapon stockpile, $961,732,000, of which $104,237,000 shall be
for operation and maintenance, of which no less than $49,401,000 shall
be for the Chemical Stockpile Emergency Preparedness Program,
consisting of $21,045,000 for activities on military installations and
$28,356,000, to remain available until September 30, 2019, to assist
State and local governments; $18,081,000 shall be for procurement, to
remain available until September 30, 2020, of which $18,081,000 shall
be for the Chemical Stockpile Emergency Preparedness Program to assist
State and local governments; and $839,414,000, to remain available
until September 30, 2019, shall be for research, development, test and
evaluation, of which $750,700,000 shall only be for the Assembled
Chemical Weapons Alternatives program.
Drug Interdiction and Counter-Drug Activities, Defense
(including transfer of funds)
For drug interdiction and counter-drug activities of the Department
of Defense, for transfer to appropriations available to the Department
of Defense for military personnel of the reserve components serving
under the provisions of title 10 and title 32, United States Code; for
operation and maintenance; for procurement; and for research,
development, test and evaluation, $854,814,000, of which $532,648,000
shall be for counter-narcotics support; $120,813,000 shall be for the
drug demand reduction program; and $201,353,000 shall be for the
National Guard counter-drug program: Provided, That the funds
appropriated under this heading shall be available for obligation for
the same time period and for the same purpose as the appropriation to
which transferred: Provided further, That upon a determination that
all or part of the funds transferred from this appropriation are not
necessary for the purposes provided herein, such amounts may be
transferred back to this appropriation: Provided further, That the
transfer authority provided under this heading is in addition to any
other transfer authority contained elsewhere in this Act.
Office of the Inspector General
For expenses and activities of the Office of the Inspector General
in carrying out the provisions of the Inspector General Act of 1978, as
amended, $336,887,000, of which $334,087,000 shall be for operation and
maintenance, of which not to exceed $700,000 is available for
emergencies and extraordinary expenses to be expended on the approval
or authority of the Inspector General, and payments may be made on the
Inspector General's certificate of necessity for confidential military
purposes; and of which $2,800,000, to remain available until September
30, 2019, shall be for research, development, test and evaluation.
TITLE VII
RELATED AGENCIES
Central Intelligence Agency Retirement and Disability System Fund
For payment to the Central Intelligence Agency Retirement and
Disability System Fund, to maintain the proper funding level for
continuing the operation of the Central Intelligence Agency Retirement
and Disability System, $514,000,000.
Intelligence Community Management Account
For necessary expenses of the Intelligence Community Management
Account, $522,100,000.
TITLE VIII
GENERAL PROVISIONS
Sec. 1101. No part of any appropriation contained in this Act
shall be used for publicity or propaganda purposes not authorized by
the Congress.
Sec. 1102. During the current fiscal year, provisions of law
prohibiting the payment of compensation to, or employment of, any
person not a citizen of the United States shall not apply to personnel
of the Department of Defense: Provided, That salary increases granted
to direct and indirect hire foreign national employees of the
Department of Defense funded by this Act shall not be at a rate in
excess of the percentage increase authorized by law for civilian
employees of the Department of Defense whose pay is computed under the
provisions of section 5332 of title 5, United States Code, or at a rate
in excess of the percentage increase provided by the appropriate host
nation to its own employees, whichever is higher: Provided further,
That this section shall not apply to Department of Defense foreign
service national employees serving at United States diplomatic missions
whose pay is set by the Department of State under the Foreign Service
Act of 1980: Provided further, That the limitations of this provision
shall not apply to foreign national employees of the Department of
Defense in the Republic of Turkey.
Sec. 1103. No part of any appropriation contained in this Act
shall remain available for obligation beyond the current fiscal year,
unless expressly so provided herein.
Sec. 1104. No more than 20 percent of the appropriations in this
Act which are limited for obligation during the current fiscal year
shall be obligated during the last 2 months of the fiscal year:
Provided, That this section shall not apply to obligations for support
of active duty training of reserve components or summer camp training
of the Reserve Officers' Training Corps.
(transfer of funds)
Sec. 1105. Upon determination by the Secretary of Defense that
such action is necessary in the national interest, he may, with the
approval of the Office of Management and Budget, transfer not to exceed
$4,500,000,000 of working capital funds of the Department of Defense or
funds made available in this Act to the Department of Defense for
military functions (except military construction) between such
appropriations or funds or any subdivision thereof, to be merged with
and to be available for the same purposes, and for the same time
period, as the appropriation or fund to which transferred: Provided,
That such authority to transfer may not be used unless for higher
priority items, based on unforeseen military requirements, than those
for which originally appropriated and in no case where the item for
which funds are requested has been denied by the Congress: Provided
further, That the Secretary of Defense shall notify the Congress
promptly of all transfers made pursuant to this authority or any other
authority in this Act: Provided further, That no part of the funds in
this Act shall be available to prepare or present a request to the
Committees on Appropriations for reprogramming of funds, unless for
higher priority items, based on unforeseen military requirements, than
those for which originally appropriated and in no case where the item
for which reprogramming is requested has been denied by the Congress:
Provided further, That a request for multiple reprogrammings of funds
using authority provided in this section shall be made prior to June
30, 2017: Provided further, That transfers among military personnel
appropriations shall not be taken into account for purposes of the
limitation on the amount of funds that may be transferred under this
section.
Sec. 1106. (a) With regard to the list of specific programs,
projects, and activities (and the dollar amounts and adjustments to
budget activities corresponding to such programs, projects, and
activities) contained in the tables titled Explanation of Project Level
Adjustments in the explanatory statement regarding this Act, the
obligation and expenditure of amounts appropriated or otherwise made
available in this Act for those programs, projects, and activities for
which the amounts appropriated exceed the amounts requested are hereby
required by law to be carried out in the manner provided by such tables
to the same extent as if the tables were included in the text of this
Act.
(b) Amounts specified in the referenced tables described in
subsection (a) shall not be treated as subdivisions of appropriations
for purposes of section 8005 of this Act: Provided, That section 8005
shall apply when transfers of the amounts described in subsection (a)
occur between appropriation accounts.
Sec. 1107. (a) Not later than 60 days after enactment of this Act,
the Department of Defense shall submit a report to the congressional
defense committees to establish the baseline for application of
reprogramming and transfer authorities for fiscal year 2018: Provided,
That the report shall include--
(1) a table for each appropriation with a separate column
to display the President's budget request, adjustments made by
Congress, adjustments due to enacted rescissions, if
appropriate, and the fiscal year enacted level;
(2) a delineation in the table for each appropriation both
by budget activity and program, project, and activity as
detailed in the Budget Appendix; and
(3) an identification of items of special congressional
interest.
(b) Notwithstanding section 8005 of this Act, none of the funds
provided in this Act shall be available for reprogramming or transfer
until the report identified in subsection (a) is submitted to the
congressional defense committees, unless the Secretary of Defense
certifies in writing to the congressional defense committees that such
reprogramming or transfer is necessary as an emergency requirement:
Provided, That this subsection shall not apply to transfers from the
following appropriations accounts:
(1) ``Environmental Restoration, Army'';
(2) ``Environmental Restoration, Navy'' ;
(3) ``Environmental Restoration, Air Force'';
(4) ``Environmental Restoration, Defense-Wide''
(5) ``Environmental Restoration, Formerly Used Defense
Sites''; and
(6) ``Drug Interdiction and Counter-drug Activities,
Defense''.
(transfer of funds)
Sec. 1108. During the current fiscal year, cash balances in
working capital funds of the Department of Defense established pursuant
to section 2208 of title 10, United States Code, may be maintained in
only such amounts as are necessary at any time for cash disbursements
to be made from such funds: Provided, That transfers may be made
between such funds: Provided further, That transfers may be made
between working capital funds and the ``Foreign Currency Fluctuations,
Defense'' appropriation and the ``Operation and Maintenance''
appropriation accounts in such amounts as may be determined by the
Secretary of Defense, with the approval of the Office of Management and
Budget, except that such transfers may not be made unless the Secretary
of Defense has notified the Congress of the proposed transfer:
Provided further, That except in amounts equal to the amounts
appropriated to working capital funds in this Act, no obligations may
be made against a working capital fund to procure or increase the value
of war reserve material inventory, unless the Secretary of Defense has
notified the Congress prior to any such obligation.
Sec. 1109. Funds appropriated by this Act may not be used to
initiate a special access program without prior notification 30
calendar days in advance to the congressional defense committees.
Sec. 1110. None of the funds provided in this Act shall be
available to initiate: (1) a multiyear contract that employs economic
order quantity procurement in excess of $20,000,000 in any one year of
the contract or that includes an unfunded contingent liability in
excess of $20,000,000; or (2) a contract for advance procurement
leading to a multiyear contract that employs economic order quantity
procurement in excess of $20,000,000 in any one year, unless the
congressional defense committees have been notified at least 30 days in
advance of the proposed contract award: Provided, That no part of any
appropriation contained in this Act shall be available to initiate a
multiyear contract for which the economic order quantity advance
procurement is not funded at least to the limits of the Government's
liability: Provided further, That no part of any appropriation
contained in this Act shall be available to initiate multiyear
procurement contracts for any systems or component thereof if the value
of the multiyear contract would exceed $500,000,000 unless specifically
provided in this Act: Provided further, That no multiyear procurement
contract can be terminated without 30-day prior notification to the
congressional defense committees: Provided further, That the execution
of multiyear authority shall require the use of a present value
analysis to determine lowest cost compared to an annual procurement:
Provided further, That none of the funds provided in this Act may be
used for a multiyear contract executed after the date of the enactment
of this Act unless in the case of any such contract--
(1) the Secretary of Defense has submitted to Congress a
budget request for full funding of units to be procured through
the contract and, in the case of a contract for procurement of
aircraft, that includes, for any aircraft unit to be procured
through the contract for which procurement funds are requested
in that budget request for production beyond advance
procurement activities in the fiscal year covered by the
budget, full funding of procurement of such unit in that fiscal
year;
(2) cancellation provisions in the contract do not include
consideration of recurring manufacturing costs of the
contractor associated with the production of unfunded units to
be delivered under the contract;
(3) the contract provides that payments to the contractor
under the contract shall not be made in advance of incurred
costs on funded units; and
(4) the contract does not provide for a price adjustment
based on a failure to award a follow-on contract.
Funds appropriated in title III of this Act may be used, subject to
section 2306b of title 10 , United States Code, for multiyear
procurement contracts as follows: V-22 Osprey aircraft variants; up to
13 SSN Virginia Class Submarines and Government-furnished equipment;
and DDG-51 Arleigh Burke class Flight III guided missile destroyers,
the MK 41 Vertical Launching Systems, and associated Government-
furnished systems and subsystems.
Sec. 1111. Within the funds appropriated for the operation and
maintenance of the Armed Forces, funds are hereby appropriated pursuant
to section 401 of title 10, United States Code, for humanitarian and
civic assistance costs under chapter 20 of title 10, United States
Code. Such funds may also be obligated for humanitarian and civic
assistance costs incidental to authorized operations and pursuant to
authority granted in section 401 of chapter 20 of title 10, United
States Code, and these obligations shall be reported as required by
section 401(d) of title 10, United States Code: Provided, That funds
available for operation and maintenance shall be available for
providing humanitarian and similar assistance by using Civic Action
Teams in the Trust Territories of the Pacific Islands and freely
associated states of Micronesia, pursuant to the Compact of Free
Association as authorized by Public Law 99-239: Provided further, That
upon a determination by the Secretary of the Army that such action is
beneficial for graduate medical education programs conducted at Army
medical facilities located in Hawaii, the Secretary of the Army may
authorize the provision of medical services at such facilities and
transportation to such facilities, on a nonreimbursable basis, for
civilian patients from American Samoa, the Commonwealth of the Northern
Mariana Islands, the Marshall Islands, the Federated States of
Micronesia, Palau, and Guam.
Sec. 1112. (a) During the current fiscal year, the civilian
personnel of the Department of Defense may not be managed on the basis
of any end-strength, and the management of such personnel during that
fiscal year shall not be subject to any constraint or limitation (known
as an end-strength) on the number of such personnel who may be employed
on the last day of such fiscal year.
(b) The fiscal year 2019 budget request for the Department of
Defense as well as all justification material and other documentation
supporting the fiscal year 2019 Department of Defense budget request
shall be prepared and submitted to the Congress as if subsections (a)
and (b) of this provision were effective with regard to fiscal year
2019.
(c) As required by section 1107 of the National Defense
Authorization Act for Fiscal Year 2014 (Public Law 113-66; 10 U.S.C.
2358 note) civilian personnel at the Department of Army Science and
Technology Reinvention Laboratories may not be managed on the basis of
the Table of Distribution and Allowances, and the management of the
workforce strength shall be done in a manner consistent with the budget
available with respect to such Laboratories.
(d) Nothing in this section shall be construed to apply to military
(civilian) technicians.
Sec. 1113. None of the funds made available by this Act shall be
used in any way, directly or indirectly, to influence congressional
action on any legislation or appropriation matters pending before the
Congress.
Sec. 1114. None of the funds appropriated by this Act shall be
available for the basic pay and allowances of any member of the Army
participating as a full-time student and receiving benefits paid by the
Secretary of Veterans Affairs from the Department of Defense Education
Benefits Fund when time spent as a full-time student is credited toward
completion of a service commitment: Provided, That this section shall
not apply to those members who have reenlisted with this option prior
to October 1, 1987: Provided further, That this section applies only
to active components of the Army.
(transfer of funds)
Sec. 1115. Funds appropriated in title III of this Act for the
Department of Defense Pilot Mentor-Protege Program may be transferred
to any other appropriation contained in this Act solely for the purpose
of implementing a Mentor-Protege Program developmental assistance
agreement pursuant to section 831 of the National Defense Authorization
Act for Fiscal Year 1991 (Public Law 101-510; 10 U.S.C. 2302 note), as
amended, under the authority of this provision or any other transfer
authority contained in this Act.
Sec. 1116. None of the funds in this Act may be available for the
purchase by the Department of Defense (and its departments and
agencies) of welded shipboard anchor and mooring chain 4 inches in
diameter and under unless the anchor and mooring chain are manufactured
in the United States from components which are substantially
manufactured in the United States: Provided, That for the purpose of
this section, the term ``manufactured'' shall include cutting, heat
treating, quality control, testing of chain and welding (including the
forging and shot blasting process): Provided further, That for the
purpose of this section substantially all of the components of anchor
and mooring chain shall be considered to be produced or manufactured in
the United States if the aggregate cost of the components produced or
manufactured in the United States exceeds the aggregate cost of the
components produced or manufactured outside the United States:
Provided further, That when adequate domestic supplies are not
available to meet Department of Defense requirements on a timely basis,
the Secretary of the service responsible for the procurement may waive
this restriction on a case-by-case basis by certifying in writing to
the Committees on Appropriations that such an acquisition must be made
in order to acquire capability for national security purposes.
Sec. 1117. None of the funds available to the Department of
Defense may be used to demilitarize or dispose of M-1 Carbines, M-1
Garand rifles, M-14 rifles, .22 caliber rifles, .30 caliber rifles, or
M-1911 pistols, or to demilitarize or destroy small arms ammunition or
ammunition components that are not otherwise prohibited from commercial
sale under Federal law, unless the small arms ammunition or ammunition
components are certified by the Secretary of the Army or designee as
unserviceable or unsafe for further use.
Sec. 1118. No more than $500,000 of the funds appropriated or made
available in this Act shall be used during a single fiscal year for any
single relocation of an organization, unit, activity or function of the
Department of Defense into or within the National Capital Region:
Provided, That the Secretary of Defense may waive this restriction on a
case-by-case basis by certifying in writing to the congressional
defense committees that such a relocation is required in the best
interest of the Government.
Sec. 1119. Of the funds made available in this Act, $20,000,000
shall be available for incentive payments authorized by section 504 of
the Indian Financing Act of 1974 (25 U.S.C. 1544): Provided, That a
prime contractor or a subcontractor at any tier that makes a
subcontract award to any subcontractor or supplier as defined in
section 1544 of title 25, United States Code, or a small business owned
and controlled by an individual or individuals defined under section
4221(9) of title 25, United States Code, shall be considered a
contractor for the purposes of being allowed additional compensation
under section 504 of the Indian Financing Act of 1974 (25 U.S.C. 1544)
whenever the prime contract or subcontract amount is over $500,000 and
involves the expenditure of funds appropriated by an Act making
appropriations for the Department of Defense with respect to any fiscal
year: Provided further, That notwithstanding section 1906 of title 41,
United States Code, this section shall be applicable to any Department
of Defense acquisition of supplies or services, including any contract
and any subcontract at any tier for acquisition of commercial items
produced or manufactured, in whole or in part, by any subcontractor or
supplier defined in section 1544 of title 25, United States Code, or a
small business owned and controlled by an individual or individuals
defined under section 4221(9) of title 25, United States Code.
Sec. 1120. Funds appropriated by this Act for the Defense Media
Activity shall not be used for any national or international political
or psychological activities.
Sec. 1121. During the current fiscal year, the Department of
Defense is authorized to incur obligations of not to exceed
$350,000,000 for purposes specified in section 2350j(c) of title 10,
United States Code, in anticipation of receipt of contributions, only
from the Government of Kuwait, under that section: Provided, That,
upon receipt, such contributions from the Government of Kuwait shall be
credited to the appropriations or fund which incurred such obligations.
Sec. 1122. (a) Of the funds made available in this Act, not less
than $43,100,000 shall be available for the Civil Air Patrol
Corporation, of which--
(1) $30,800,000 shall be available from ``Operation and
Maintenance, Air Force'' to support Civil Air Patrol
Corporation operation and maintenance, readiness, counter-drug
activities, and drug demand reduction activities involving
youth programs;
(2) $10,600,000 shall be available from ``Aircraft
Procurement, Air Force''; and
(3) $1,700,000 shall be available from ``Other Procurement,
Air Force'' for vehicle procurement.
(b) The Secretary of the Air Force should waive reimbursement for
any funds used by the Civil Air Patrol for counter-drug activities in
support of Federal, State, and local government agencies.
Sec. 1123. (a) None of the funds appropriated in this Act are
available to establish a new Department of Defense (department)
federally funded research and development center (FFRDC), either as a
new entity, or as a separate entity administrated by an organization
managing another FFRDC, or as a nonprofit membership corporation
consisting of a consortium of other FFRDCs and other nonprofit
entities.
(b) No member of a Board of Directors, Trustees, Overseers,
Advisory Group, Special Issues Panel, Visiting Committee, or any
similar entity of a defense FFRDC, and no paid consultant to any
defense FFRDC, except when acting in a technical advisory capacity, may
be compensated for his or her services as a member of such entity, or
as a paid consultant by more than one FFRDC in a fiscal year:
Provided, That a member of any such entity referred to previously in
this subsection shall be allowed travel expenses and per diem as
authorized under the Federal Joint Travel Regulations, when engaged in
the performance of membership duties.
(c) Notwithstanding any other provision of law, none of the funds
available to the department from any source during the current fiscal
year may be used by a defense FFRDC, through a fee or other payment
mechanism, for construction of new buildings not located on a military
installation, for payment of cost sharing for projects funded by
Government grants, for absorption of contract overruns, or for certain
charitable contributions, not to include employee participation in
community service and/or development.
(d) Notwithstanding any other provision of law, of the funds
available to the department during fiscal year 2018, not more than
6,000 staff years of technical effort (staff years) may be funded for
defense FFRDCs: Provided, That, of the specific amount referred to
previously in this subsection, not more than 1,180 staff years may be
funded for the defense studies and analysis FFRDCs: Provided further,
That this subsection shall not apply to staff years funded in the
National Intelligence Program (NIP) and the Military Intelligence
Program (MIP).
(e) The Secretary of Defense shall, with the submission of the
department's fiscal year 2019 budget request, submit a report
presenting the specific amounts of staff years of technical effort to
be allocated for each defense FFRDC during that fiscal year and the
associated budget estimates.
(f) Notwithstanding any other provision of this Act, the total
amount appropriated in this Act for FFRDCs is hereby reduced by
$210,000,000.
Sec. 1124. None of the funds appropriated or made available in
this Act shall be used to procure carbon, alloy, or armor steel plate
for use in any Government-owned facility or property under the control
of the Department of Defense which were not melted and rolled in the
United States or Canada: Provided, That these procurement restrictions
shall apply to any and all Federal Supply Class 9515, American Society
of Testing and Materials (ASTM) or American Iron and Steel Institute
(AISI) specifications of carbon, alloy or armor steel plate: Provided
further, That the Secretary of the military department responsible for
the procurement may waive this restriction on a case-by-case basis by
certifying in writing to the Committees on Appropriations of the House
of Representatives and the Senate that adequate domestic supplies are
not available to meet Department of Defense requirements on a timely
basis and that such an acquisition must be made in order to acquire
capability for national security purposes: Provided further, That
these restrictions shall not apply to contracts which are in being as
of the date of the enactment of this Act.
Sec. 1125. For the purposes of this Act, the term ``congressional
defense committees'' means the Armed Services Committee of the House of
Representatives, the Armed Services Committee of the Senate, the
Subcommittee on Defense of the Committee on Appropriations of the
Senate, and the Subcommittee on Defense of the Committee on
Appropriations of the House of Representatives.
Sec. 1126. During the current fiscal year, the Department of
Defense may acquire the modification, depot maintenance and repair of
aircraft, vehicles and vessels as well as the production of components
and other Defense-related articles, through competition between
Department of Defense depot maintenance activities and private firms:
Provided, That the Senior Acquisition Executive of the military
department or Defense Agency concerned, with power of delegation, shall
certify that successful bids include comparable estimates of all direct
and indirect costs for both public and private bids: Provided further,
That Office of Management and Budget Circular A-76 shall not apply to
competitions conducted under this section.
Sec. 1127. (a)(1) If the Secretary of Defense, after consultation
with the United States Trade Representative, determines that a foreign
country which is party to an agreement described in paragraph (2) has
violated the terms of the agreement by discriminating against certain
types of products produced in the United States that are covered by the
agreement, the Secretary of Defense shall rescind the Secretary's
blanket waiver of the Buy American Act with respect to such types of
products produced in that foreign country.
(2) An agreement referred to in paragraph (1) is any reciprocal
defense procurement memorandum of understanding, between the United
States and a foreign country pursuant to which the Secretary of Defense
has prospectively waived the Buy American Act for certain products in
that country.
(b) The Secretary of Defense shall submit to the Congress a report
on the amount of Department of Defense purchases from foreign entities
in fiscal year 2018. Such report shall separately indicate the dollar
value of items for which the Buy American Act was waived pursuant to
any agreement described in subsection (a)(2), the Trade Agreement Act
of 1979 (19 U.S.C. 2501 et seq.), or any international agreement to
which the United States is a party.
(c) For purposes of this section, the term Buy American Act means
chapter 83 of title 41, United States Code.
Sec. 1128. During the current fiscal year, amounts contained in
the Department of Defense Overseas Military Facility Investment
Recovery Account established by section 2921(c)(1) of the National
Defense Authorization Act of 1991 (Public Law 101-510; 10 U.S.C. 2687
note) shall be available until expended for the payments specified by
section 2921(c)(2) of that Act.
Sec. 1129. (a) Notwithstanding any other provision of law, the
Secretary of the Air Force may convey at no cost to the Air Force,
without consideration, to Indian tribes located in the States of
Nevada, Idaho, North Dakota, South Dakota, Montana, Oregon, Minnesota,
and Washington relocatable military housing units located at Grand
Forks Air Force Base, Malmstrom Air Force Base, Mountain Home Air Force
Base, Ellsworth Air Force Base, and Minot Air Force Base that are
excess to the needs of the Air Force.
(b) The Secretary of the Air Force shall convey, at no cost to the
Air Force, military housing units under subsection (a) in accordance
with the request for such units that are submitted to the Secretary by
the Operation Walking Shield Program on behalf of Indian tribes located
in the States of Nevada, Idaho, North Dakota, South Dakota, Montana,
Oregon, Minnesota, and Washington. Any such conveyance shall be subject
to the condition that the housing units shall be removed within a
reasonable period of time, as determined by the Secretary.
(c) The Operation Walking Shield Program shall resolve any
conflicts among requests of Indian tribes for housing units under
subsection (a) before submitting requests to the Secretary of the Air
Force under subsection (b).
(d) In this section, the term Indian tribe means any recognized
Indian tribe included on the current list published by the Secretary of
the Interior under section 104 of the Federally Recognized Indian Tribe
Act of 1994 (Public Law 103-454; 108 Stat. 4792; 25 U.S.C. 479a-1).
Sec. 1130. During the current fiscal year, appropriations which
are available to the Department of Defense for operation and
maintenance may be used to purchase items having an investment item
unit cost of not more than $250,000.
Sec. 1131. None of the funds made available by this Act may be
used to--
(1) disestablish, or prepare to disestablish, a Senior
Reserve Officers' Training Corps program in accordance with
Department of Defense Instruction Number 1215.08, dated June
26, 2006; or
(2) close, downgrade from host to extension center, or
place on probation a Senior Reserve Officers' Training Corps
program in accordance with the information paper of the
Department of the Army titled ``Army Senior Reserve Officers'
Training Corps (SROTC) Program Review and Criteria'', dated
January 27, 2014.
Sec. 1132. The Secretary of Defense shall issue regulations to
prohibit the sale of any tobacco or tobacco-related products in
military resale outlets in the United States, its territories and
possessions at a price below the most competitive price in the local
community: Provided, That such regulations shall direct that the
prices of tobacco or tobacco-related products in overseas military
retail outlets shall be within the range of prices established for
military retail system stores located in the United States.
Sec. 1133. (a) During the current fiscal year, none of the
appropriations or funds available to the Department of Defense Working
Capital Funds shall be used for the purchase of an investment item for
the purpose of acquiring a new inventory item for sale or anticipated
sale during the current fiscal year or a subsequent fiscal year to
customers of the Department of Defense Working Capital Funds if such an
item would not have been chargeable to the Department of Defense
Business Operations Fund during fiscal year 1994 and if the purchase of
such an investment item would be chargeable during the current fiscal
year to appropriations made to the Department of Defense for
procurement.
(b) The fiscal year 2019 budget request for the Department of
Defense as well as all justification material and other documentation
supporting the fiscal year 2019 Department of Defense budget shall be
prepared and submitted to the Congress on the basis that any equipment
which was classified as an end item and funded in a procurement
appropriation contained in this Act shall be budgeted for in a proposed
fiscal year 2019 procurement appropriation and not in the supply
management business area or any other area or category of the
Department of Defense Working Capital Funds.
Sec. 1134. None of the funds appropriated by this Act for programs
of the Central Intelligence Agency shall remain available for
obligation beyond the current fiscal year, except for funds
appropriated for the Reserve for Contingencies, which shall remain
available until September 30, 2019: Provided, That funds appropriated,
transferred, or otherwise credited to the Central Intelligence Agency
Central Services Working Capital Fund during this or any prior or
subsequent fiscal year shall remain available until expended: Provided
further, That any funds appropriated or transferred to the Central
Intelligence Agency for advanced research and development acquisition,
for agent operations, and for covert action programs authorized by the
President under section 503 of the National Security Act of 1947 (50
U.S.C. 3093) shall remain available until September 30, 2019.
Sec. 1135. Notwithstanding any other provision of law, funds made
available in this Act and hereafter for the Defense Intelligence Agency
may be used for the design, development, and deployment of General
Defense Intelligence Program intelligence communications and
intelligence information systems for the Services, the Unified and
Specified Commands, and the component commands.
Sec. 1136. Of the funds appropriated to the Department of Defense
under the heading ``Operation and Maintenance, Defense-Wide'', not less
than $12,000,000 shall be made available only for the mitigation of
environmental impacts, including training and technical assistance to
tribes, related administrative support, the gathering of information,
documenting of environmental damage, and developing a system for
prioritization of mitigation and cost to complete estimates for
mitigation, on Indian lands resulting from Department of Defense
activities.
Sec. 1137. (a) None of the funds appropriated in this Act may be
expended by an entity of the Department of Defense unless the entity,
in expending the funds, complies with the Buy American Act. For
purposes of this subsection, the term Buy American Act means chapter 83
of title 41, United States Code.
(b) If the Secretary of Defense determines that a person has been
convicted of intentionally affixing a label bearing a ``Made in
America'' inscription to any product sold in or shipped to the United
States that is not made in America, the Secretary shall determine, in
accordance with section 2410f of title 10, United States Code, whether
the person should be debarred from contracting with the Department of
Defense.
(c) In the case of any equipment or products purchased with
appropriations provided under this Act, it is the sense of the Congress
that any entity of the Department of Defense, in expending the
appropriation, purchase only American-made equipment and products,
provided that American-made equipment and products are cost-
competitive, quality competitive, and available in a timely fashion.
Sec. 1138. (a) Except as provided in subsections (b) and (c), none
of the funds made available by this Act may be used--
(1) to establish a field operating agency; or
(2) to pay the basic pay of a member of the Armed Forces or
civilian employee of the department who is transferred or
reassigned from a headquarters activity if the member or
employee's place of duty remains at the location of that
headquarters.
(b) The Secretary of Defense or Secretary of a military department
may waive the limitations in subsection (a), on a case-by-case basis,
if the Secretary determines, and certifies to the Committees on
Appropriations of the House of Representatives and the Senate that the
granting of the waiver will reduce the personnel requirements or the
financial requirements of the department.
(c) This section does not apply to--
(1) field operating agencies funded within the National
Intelligence Program;
(2) an Army field operating agency established to
eliminate, mitigate, or counter the effects of improvised
explosive devices, and, as determined by the Secretary of the
Army, other similar threats;
(3) an Army field operating agency established to improve
the effectiveness and efficiencies of biometric activities and
to integrate common biometric technologies throughout the
Department of Defense; or
(4) an Air Force field operating agency established to
administer the Air Force Mortuary Affairs Program and Mortuary
Operations for the Department of Defense and authorized Federal
entities.
Sec. 1139. (a) None of the funds appropriated by this Act shall be
available to convert to contractor performance an activity or function
of the Department of Defense that, on or after the date of the
enactment of this Act, is performed by Department of Defense civilian
employees unless--
(1) the conversion is based on the result of a public-
private competition that includes a most efficient and cost
effective organization plan developed by such activity or
function;
(2) the Competitive Sourcing Official determines that, over
all performance periods stated in the solicitation of offers
for performance of the activity or function, the cost of
performance of the activity or function by a contractor would
be less costly to the Department of Defense by an amount that
equals or exceeds the lesser of--
(A) 10 percent of the most efficient organization's
personnel-related costs for performance of that
activity or function by Federal employees; or
(B) $10,000,000; and
(3) the contractor does not receive an advantage for a
proposal that would reduce costs for the Department of Defense
by--
(A) not making an employer-sponsored health
insurance plan available to the workers who are to be
employed in the performance of that activity or
function under the contract; or
(B) offering to such workers an employer-sponsored
health benefits plan that requires the employer to
contribute less towards the premium or subscription
share than the amount that is paid by the Department of
Defense for health benefits for civilian employees
under chapter 89 of title 5, United States Code.
(b)(1) The Department of Defense, without regard to subsection (a)
of this section or subsection (a), (b), or (c) of section 2461 of title
10, United States Code, and notwithstanding any administrative
regulation, requirement, or policy to the contrary shall have full
authority to enter into a contract for the performance of any
commercial or industrial type function of the Department of Defense
that--
(A) is included on the procurement list established
pursuant to section 2 of the Javits-Wagner-O'Day Act (section
8503 of title 41, United States Code);
(B) is planned to be converted to performance by a
qualified nonprofit agency for the blind or by a qualified
nonprofit agency for other severely handicapped individuals in
accordance with that Act; or
(C) is planned to be converted to performance by a
qualified firm under at least 51 percent ownership by an Indian
tribe, as defined in section 4(e) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450b(e)),
or a Native Hawaiian Organization, as defined in section
8(a)(15) of the Small Business Act (15 U.S.C. 637(a)(15)).
(2) This section shall not apply to depot contracts or contracts
for depot maintenance as provided in sections 2469 and 2474 of title
10, United States Code.
(c) The conversion of any activity or function of the Department of
Defense under the authority provided by this section shall be credited
toward any competitive or outsourcing goal, target, or measurement that
may be established by statute, regulation, or policy and is deemed to
be awarded under the authority of, and in compliance with, subsection
(h) of section 2304 of title 10, United States Code, for the
competition or outsourcing of commercial activities.
(rescissions)
Sec. 1140. Of the funds appropriated in Department of Defense
Appropriations Acts, the following funds are hereby rescinded from the
following accounts and programs in the specified amounts: Provided,
That no amounts may be rescinded from amounts that were designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism or as an emergency requirement pursuant to the Concurrent
Resolution on the Budget or the Balanced Budget and Emergency Deficit
Control Act of 1985, as amended:
``Aircraft Procurement, Navy'', 2016/2018, $274,000,000;
``Aircraft Procurement, Air Force'', 2016/2018,
$82,700,000;
``Missile Procurement, Army'', 2017/2019, $19,319,000;
``Procurement of Weapons and Tracked Combat Vehicles,
Army'', 2017/2019, $9,764,000;
``Other Procurement, Army'', 2017/2019, $10,000,000;
``Aircraft Procurement, Navy'', 2017/2019, $105,600,000;
``Weapons Procurement, Navy'', 2017/2019, $54,122,000;
``Shipbuilding and Conversion, Navy'', 2017/2021,
$45,116,000;
``Aircraft Procurement, Air Force'', 2017/2019,
$63,293,000;
``Missile Procurement, Air Force'', 2017/2019, $31,639,000;
``Space Procurement, Air Force'', 2017/2019, $15,000,000;
``Other Procurement, Air Force'', 2017/2019, $105,000,000;
``Research, Development, Test and Evaluation, Navy'', 2017/
2018, $34,128,000;
``Research, Development, Test and Evaluation, Air Force'',
2017/2018, $41,700,000.
Sec. 1141. None of the funds available in this Act may be used to
reduce the authorized positions for military technicians (dual status)
of the Army National Guard, Air National Guard, Army Reserve and Air
Force Reserve for the purpose of applying any administratively imposed
civilian personnel ceiling, freeze, or reduction on military
technicians (dual status), unless such reductions are a direct result
of a reduction in military force structure.
Sec. 1142. None of the funds appropriated or otherwise made
available in this Act may be obligated or expended for assistance to
the Democratic People's Republic of Korea unless specifically
appropriated for that purpose.
Sec. 1143. Funds appropriated in this Act for operation and
maintenance of the Military Departments, Combatant Commands and Defense
Agencies shall be available for reimbursement of pay, allowances and
other expenses which would otherwise be incurred against appropriations
for the National Guard and Reserve when members of the National Guard
and Reserve provide intelligence or counterintelligence support to
Combatant Commands, Defense Agencies and Joint Intelligence Activities,
including the activities and programs included within the National
Intelligence Program and the Military Intelligence Program: Provided,
That nothing in this section authorizes deviation from established
Reserve and National Guard personnel and training procedures.
Sec. 1144. (a) None of the funds available to the Department of
Defense for any fiscal year for drug interdiction or counter-drug
activities may be transferred to any other department or agency of the
United States except as specifically provided in an appropriations law.
(b) None of the funds available to the Central Intelligence Agency
for any fiscal year for drug interdiction or counter-drug activities
may be transferred to any other department or agency of the United
States except as specifically provided in an appropriations law.
Sec. 1145. None of the funds appropriated by this Act may be used
for the procurement of ball and roller bearings other than those
produced by a domestic source and of domestic origin: Provided, That
the Secretary of the military department responsible for such
procurement may waive this restriction on a case-by-case basis by
certifying in writing to the Committees on Appropriations of the House
of Representatives and the Senate, that adequate domestic supplies are
not available to meet Department of Defense requirements on a timely
basis and that such an acquisition must be made in order to acquire
capability for national security purposes: Provided further, That this
restriction shall not apply to the purchase of ``commercial items'', as
defined by section 103 of title 41, United States Code, except that the
restriction shall apply to ball or roller bearings purchased as end
items.
Sec. 1146. None of the funds made available by this Act for
Evolved Expendable Launch Vehicle service competitive procurements may
be used unless the competitive procurements are open for award to all
certified providers of Evolved Expendable Launch Vehicle-class systems:
Provided, That the award shall be made to the provider that offers the
best value to the government.
Sec. 1147. In addition to the amounts appropriated or otherwise
made available elsewhere in this Act, $44,000,000 is hereby
appropriated to the Department of Defense: Provided, That upon the
determination of the Secretary of Defense that it shall serve the
national interest, the Secretary shall make grants in the amounts
specified as follows: $20,000,000 to the United Service Organizations
and $24,000,000 to the Red Cross.
Sec. 1148. None of the funds in this Act may be used to purchase
any supercomputer which is not manufactured in the United States,
unless the Secretary of Defense certifies to the congressional defense
committees that such an acquisition must be made in order to acquire
capability for national security purposes that is not available from
United States manufacturers.
Sec. 1149. Notwithstanding any other provision in this Act, the
Small Business Innovation Research program and the Small Business
Technology Transfer program set-asides shall be taken proportionally
from all programs, projects, or activities to the extent they
contribute to the extramural budget.
Sec. 1150. None of the funds available to the Department of
Defense under this Act shall be obligated or expended to pay a
contractor under a contract with the Department of Defense for costs of
any amount paid by the contractor to an employee when--
(1) such costs are for a bonus or otherwise in excess of
the normal salary paid by the contractor to the employee; and
(2) such bonus is part of restructuring costs associated
with a business combination.
(including transfer of funds)
Sec. 1151. During the current fiscal year, no more than
$30,000,000 of appropriations made in this Act under the heading
``Operation and Maintenance, Defense-Wide'' may be transferred to
appropriations available for the pay of military personnel, to be
merged with, and to be available for the same time period as the
appropriations to which transferred, to be used in support of such
personnel in connection with support and services for eligible
organizations and activities outside the Department of Defense pursuant
to section 2012 of title 10, United States Code.
Sec. 1152. During the current fiscal year, in the case of an
appropriation account of the Department of Defense for which the period
of availability for obligation has expired or which has closed under
the provisions of section 1552 of title 31, United States Code, and
which has a negative unliquidated or unexpended balance, an obligation
or an adjustment of an obligation may be charged to any current
appropriation account for the same purpose as the expired or closed
account if--
(1) the obligation would have been properly chargeable
(except as to amount) to the expired or closed account before
the end of the period of availability or closing of that
account;
(2) the obligation is not otherwise properly chargeable to
any current appropriation account of the Department of Defense;
and
(3) in the case of an expired account, the obligation is
not chargeable to a current appropriation of the Department of
Defense under the provisions of section 1405(b)(8) of the
National Defense Authorization Act for Fiscal Year 1991, Public
Law 101-510, as amended (31 U.S.C. 1551 note): Provided, That
in the case of an expired account, if subsequent review or
investigation discloses that there was not in fact a negative
unliquidated or unexpended balance in the account, any charge
to a current account under the authority of this section shall
be reversed and recorded against the expired account: Provided
further, That the total amount charged to a current
appropriation under this section may not exceed an amount equal
to 1 percent of the total appropriation for that account.
Sec. 1153. (a) Notwithstanding any other provision of law, the
Chief of the National Guard Bureau may permit the use of equipment of
the National Guard Distance Learning Project by any person or entity on
a space-available, reimbursable basis. The Chief of the National Guard
Bureau shall establish the amount of reimbursement for such use on a
case-by-case basis.
(b) Amounts collected under subsection (a) shall be credited to
funds available for the National Guard Distance Learning Project and be
available to defray the costs associated with the use of equipment of
the project under that subsection. Such funds shall be available for
such purposes without fiscal year limitation.
Sec. 1154. None of the funds available to the Department of
Defense may be obligated to modify command and control relationships to
give Fleet Forces Command operational and administrative control of
United States Navy forces assigned to the Pacific fleet: Provided,
That the command and control relationships which existed on October 1,
2004, shall remain in force until a written modification has been
proposed to the House and Senate Appropriations Committees: Provided
further, That the proposed modification may be implemented 30 days
after the notification unless an objection is received from either the
House or Senate Appropriations Committees: Provided further, That any
proposed modification shall not preclude the ability of the commander
of United States Pacific Command to meet operational requirements.
(including transfer of funds)
Sec. 1155. Of the funds appropriated in this Act under the heading
``Operation and Maintenance, Defense-Wide'', $25,000,000 (increased by
$10,000,000) shall be for continued implementation and expansion of the
Sexual Assault Special Victims' Counsel Program: Provided, That the
funds are made available for transfer to the Department of the Army,
the Department of the Navy, and the Department of the Air Force:
Provided further, That funds transferred shall be merged with and
available for the same purposes and for the same time period as the
appropriations to which the funds are transferred: Provided further,
That this transfer authority is in addition to any other transfer
authority provided in this Act.
Sec. 1156. None of the funds appropriated in title IV of this Act
may be used to procure end-items for delivery to military forces for
operational training, operational use or inventory requirements:
Provided, That this restriction does not apply to end-items used in
development, prototyping, and test activities preceding and leading to
acceptance for operational use: Provided further, That this
restriction does not apply to programs funded within the National
Intelligence Program: Provided further, That the Secretary of Defense
may waive this restriction on a case-by-case basis by certifying in
writing to the Committees on Appropriations of the House of
Representatives and the Senate that it is in the national security
interest to do so.
Sec. 1157. (a) The Secretary of Defense may, on a case-by-case
basis, waive with respect to a foreign country each limitation on the
procurement of defense items from foreign sources provided in law if
the Secretary determines that the application of the limitation with
respect to that country would invalidate cooperative programs entered
into between the Department of Defense and the foreign country, or
would invalidate reciprocal trade agreements for the procurement of
defense items entered into under section 2531 of title 10, United
States Code, and the country does not discriminate against the same or
similar defense items produced in the United States for that country.
(b) Subsection (a) applies with respect to--
(1) contracts and subcontracts entered into on or after the
date of the enactment of this Act; and
(2) options for the procurement of items that are exercised
after such date under contracts that are entered into before
such date if the option prices are adjusted for any reason
other than the application of a waiver granted under subsection
(a).
(c) Subsection (a) does not apply to a limitation regarding
construction of public vessels, ball and roller bearings, food, and
clothing or textile materials as defined by section XI (chapters 50-65)
of the Harmonized Tariff Schedule of the United States and products
classified under headings 4010, 4202, 4203, 6401 through 6406, 6505,
7019, 7218 through 7229, 7304.41 through 7304.49, 7306.40, 7502 through
7508, 8105, 8108, 8109, 8211, 8215, and 9404.
Sec. 1158. None of the funds appropriated or otherwise made
available by this or other Department of Defense Appropriations Acts
may be obligated or expended for the purpose of performing repairs or
maintenance to military family housing units of the Department of
Defense, including areas in such military family housing units that may
be used for the purpose of conducting official Department of Defense
business.
Sec. 1159. Notwithstanding any other provision of law, funds
appropriated in this Act under the heading ``Research, Development,
Test and Evaluation, Defense-Wide'' for any new start advanced concept
technology demonstration project or joint capability demonstration
project may only be obligated 45 days after a report, including a
description of the project, the planned acquisition and transition
strategy and its estimated annual and total cost, has been provided in
writing to the congressional defense committees: Provided, That the
Secretary of Defense may waive this restriction on a case-by-case basis
by certifying to the congressional defense committees that it is in the
national interest to do so.
Sec. 1160. The Secretary of Defense shall continue to provide a
classified quarterly report to the House and Senate Appropriations
Committees, Subcommittees on Defense on certain matters as directed in
the classified annex accompanying this Act.
Sec. 1161. Notwithstanding section 12310(b) of title 10, United
States Code, a Reserve who is a member of the National Guard serving on
full-time National Guard duty under section 502(f) of title 32, United
States Code, may perform duties in support of the ground-based elements
of the National Ballistic Missile Defense System.
Sec. 1162. None of the funds provided in this Act may be used to
transfer to any nongovernmental entity ammunition held by the
Department of Defense that has a center-fire cartridge and a United
States military nomenclature designation of ``armor penetrator'',
``armor piercing (AP)'', ``armor piercing incendiary (API)'', or
``armor-piercing incendiary tracer (API-T)'', except to an entity
performing demilitarization services for the Department of Defense
under a contract that requires the entity to demonstrate to the
satisfaction of the Department of Defense that armor piercing
projectiles are either:
(1) rendered incapable of reuse by the demilitarization
process; or
(2) used to manufacture ammunition pursuant to a contract
with the Department of Defense or the manufacture of ammunition
for export pursuant to a License for Permanent Export of
Unclassified Military Articles issued by the Department of
State.
Sec. 1163. Notwithstanding any other provision of law, the Chief
of the National Guard Bureau, or his designee, may waive payment of all
or part of the consideration that otherwise would be required under
section 2667 of title 10, United States Code, in the case of a lease of
personal property for a period not in excess of 1 year to any
organization specified in section 508(d) of title 32, United States
Code, or any other youth, social, or fraternal nonprofit organization
as may be approved by the Chief of the National Guard Bureau, or his
designee, on a case-by-case basis.
(including transfer of funds)
Sec. 1164. Of the amounts appropriated in this Act under the
heading ``Operation and Maintenance, Army'', $66,881,780 shall remain
available until expended: Provided, That, notwithstanding any other
provision of law, the Secretary of Defense is authorized to transfer
such funds to other activities of the Federal Government: Provided
further, That the Secretary of Defense is authorized to enter into and
carry out contracts for the acquisition of real property, construction,
personal services, and operations related to projects carrying out the
purposes of this section: Provided further, That contracts entered
into under the authority of this section may provide for such
indemnification as the Secretary determines to be necessary: Provided
further, That projects authorized by this section shall comply with
applicable Federal, State, and local law to the maximum extent
consistent with the national security, as determined by the Secretary
of Defense.
Sec. 1165. (a) None of the funds appropriated in this or any other
Act may be used to take any action to modify--
(1) the appropriations account structure for the National
Intelligence Program budget, including through the creation of
a new appropriation or new appropriation account;
(2) how the National Intelligence Program budget request is
presented in the unclassified P-1, R-1, and O-1 documents
supporting the Department of Defense budget request;
(3) the process by which the National Intelligence Program
appropriations are apportioned to the executing agencies; or
(4) the process by which the National Intelligence Program
appropriations are allotted, obligated and disbursed.
(b) Nothing in section (a) shall be construed to prohibit the
merger of programs or changes to the National Intelligence Program
budget at or below the Expenditure Center level, provided such change
is otherwise in accordance with paragraphs (a)(1)-(3).
(c) The Director of National Intelligence and the Secretary of
Defense may jointly, only for the purposes of achieving auditable
financial statements and improving fiscal reporting, study and develop
detailed proposals for alternative financial management processes. Such
study shall include a comprehensive counterintelligence risk assessment
to ensure that none of the alternative processes will adversely affect
counterintelligence.
(d) Upon development of the detailed proposals defined under
subsection (c), the Director of National Intelligence and the Secretary
of Defense shall--
(1) provide the proposed alternatives to all affected
agencies;
(2) receive certification from all affected agencies
attesting that the proposed alternatives will help achieve
auditability, improve fiscal reporting, and will not adversely
affect counterintelligence; and
(3) not later than 30 days after receiving all necessary
certifications under paragraph (2), present the proposed
alternatives and certifications to the congressional defense
and intelligence committees.
Sec. 1166. In addition to amounts provided elsewhere in this Act,
$5,000,000 (increased by $5,000,000) is hereby appropriated to the
Department of Defense, to remain available for obligation until
expended: Provided, That notwithstanding any other provision of law,
that upon the determination of the Secretary of Defense that it shall
serve the national interest, these funds shall be available only for a
grant to the Fisher House Foundation, Inc., only for the construction
and furnishing of additional Fisher Houses to meet the needs of
military family members when confronted with the illness or
hospitalization of an eligible military beneficiary.
(including transfer of funds)
Sec. 1167. Of the amounts appropriated in this Act under the
headings ``Procurement, Defense-Wide'' and ``Research, Development,
Test and Evaluation, Defense-Wide'', $705,800,000 shall be for the
Israeli Cooperative Programs: Provided, That of this amount,
$92,000,000 shall be for the Secretary of Defense to provide to the
Government of Israel for the procurement of the Iron Dome defense
system to counter short-range rocket threats, subject to the U.S.-
Israel Iron Dome Procurement Agreement, as amended; $221,500,000 shall
be for the Short Range Ballistic Missile Defense (SRBMD) program,
including cruise missile defense research and development under the
SRBMD program, of which $120,000,000 shall be for co-production
activities of SRBMD missiles in the United States and in Israel to meet
Israel's defense requirements consistent with each nation's laws,
regulations, and procedures, subject to the U.S.-Israeli co-production
agreement for SRBMD, as amended; $205,000,000 shall be for an upper-
tier component to the Israeli Missile Defense Architecture, of which
$120,000,000 shall be for co-production activities of Arrow 3 Upper
Tier missiles in the United States and in Israel to meet Israel's
defense requirements consistent with each nation's laws, regulations,
and procedures, subject to the U.S.-Israeli co-production agreement for
Arrow 3 Upper Tier, as amended; $105,000,000 shall be for testing of
the upper-tier component to the Israeli Missile Defense Architecture in
the United States; and $82,300,000 shall be for the Arrow System
Improvement Program including development of a long range, ground and
airborne, detection suite: Provided further, That the transfer
authority provided under this provision is in addition to any other
transfer authority contained in this Act.
(including transfer of funds)
Sec. 1168. Of the amounts appropriated in this Act under the
heading ``Shipbuilding and Conversion, Navy'', $117,542,000 shall be
available until September 30, 2018, to fund prior year shipbuilding
cost increases: Provided, That upon enactment of this Act, the
Secretary of the Navy shall transfer funds to the following
appropriations in the amounts specified: Provided further, That the
amounts transferred shall be merged with and be available for the same
purposes as the appropriations to which transferred to:
(1) Under the heading ``Shipbuilding and Conversion,
Navy'', 2012/2018: Carrier Replacement Program $20,000,000;
(2) Under the heading ``Shipbuilding and Conversion,
Navy'', 2008/2018: DDG-51 Destroyer $19,436,000;
(3) Under the heading ``Shipbuilding and Conversion,
Navy'', 2012/2018: Littoral Combat Ship $6,394,000;
(4) Under the heading ``Shipbuilding and Conversion,
Navy'', 2012/2018: LHA Replacement $14,200,000;
(5) Under the heading ``Shipbuilding and Conversion,
Navy'', 2013/2018: DDG-51 Destroyer $31,941,000;
(6) Under the heading ``Shipbuilding and Conversion,
Navy'', 2014/2018: Litoral Combat Ship $20,471,000; and
(7) Under the heading ``Shipbuilding and Conversion,
Navy'', 2015/2018: LCAC $5,100,000.
Sec. 1169. Funds appropriated by this Act, or made available by
the transfer of funds in this Act, for intelligence activities are
deemed to be specifically authorized by the Congress for purposes of
section 504 of the National Security Act of 1947 (50 U.S.C. 3094)
during fiscal year 2018 until the enactment of the Intelligence
Authorization Act for Fiscal Year 2018.
Sec. 1170. None of the funds provided in this Act shall be
available for obligation or expenditure through a reprogramming of
funds that creates or initiates a new program, project, or activity
unless such program, project, or activity must be undertaken
immediately in the interest of national security and only after written
prior notification to the congressional defense committees.
Sec. 1171. The budget of the President for fiscal year 2018
submitted to the Congress pursuant to section 1105 of title 31, United
States Code, shall include separate budget justification documents for
costs of United States Armed Forces' participation in contingency
operations for the Military Personnel accounts, the Operation and
Maintenance accounts, the Procurement accounts, and the Research,
Development, Test and Evaluation accounts: Provided, That these
documents shall include a description of the funding requested for each
contingency operation, for each military service, to include all Active
and Reserve components, and for each appropriations account: Provided
further, That these documents shall include estimated costs for each
element of expense or object class, a reconciliation of increases and
decreases for each contingency operation, and programmatic data
including, but not limited to, troop strength for each Active and
Reserve component, and estimates of the major weapons systems deployed
in support of each contingency: Provided further, That these documents
shall include budget exhibits OP-5 and OP-32 (as defined in the
Department of Defense Financial Management Regulation) for all
contingency operations for the budget year and the two preceding fiscal
years.
Sec. 1172. None of the funds in this Act may be used for research,
development, test, evaluation, procurement or deployment of nuclear
armed interceptors of a missile defense system.
Sec. 1173. Notwithstanding any other provision of this Act, to
reflect savings due to favorable foreign exchange rates, the total
amount appropriated in this Act is hereby reduced by $289,000,000.
Sec. 1174. None of the funds appropriated or made available in
this Act shall be used to reduce or disestablish the operation of the
53rd Weather Reconnaissance Squadron of the Air Force Reserve, if such
action would reduce the WC-130 Weather Reconnaissance mission below the
levels funded in this Act: Provided, That the Air Force shall allow
the 53rd Weather Reconnaissance Squadron to perform other missions in
support of national defense requirements during the non-hurricane
season.
Sec. 1175. None of the funds provided in this Act shall be
available for integration of foreign intelligence information unless
the information has been lawfully collected and processed during the
conduct of authorized foreign intelligence activities: Provided, That
information pertaining to United States persons shall only be handled
in accordance with protections provided in the Fourth Amendment of the
United States Constitution as implemented through Executive Order No.
12333.
Sec. 1176. (a) None of the funds appropriated by this Act may be
used to transfer research and development, acquisition, or other
program authority relating to current tactical unmanned aerial vehicles
(TUAVs) from the Army.
(b) The Army shall retain responsibility for and operational
control of the MQ-1C Gray Eagle Unmanned Aerial Vehicle (UAV) in order
to support the Secretary of Defense in matters relating to the
employment of unmanned aerial vehicles.
Sec. 1177. None of the funds appropriated by this Act for programs
of the Office of the Director of National Intelligence shall remain
available for obligation beyond the current fiscal year, except for
funds appropriated for research and technology, which shall remain
available until September 30, 2019.
Sec. 1178. For purposes of section 1553(b) of title 31, United
States Code, any subdivision of appropriations made in this Act under
the heading ``Shipbuilding and Conversion, Navy'' shall be considered
to be for the same purpose as any subdivision under the heading
``Shipbuilding and Conversion, Navy'' appropriations in any prior
fiscal year, and the 1 percent limitation shall apply to the total
amount of the appropriation.
Sec. 1179. (a) Not later than 60 days after the date of enactment
of this Act, the Director of National Intelligence shall submit a
report to the congressional intelligence committees to establish the
baseline for application of reprogramming and transfer authorities for
fiscal year 2018: Provided, That the report shall include--
(1) a table for each appropriation with a separate column
to display the President's budget request, adjustments made by
Congress, adjustments due to enacted rescissions, if
appropriate, and the fiscal year enacted level;
(2) a delineation in the table for each appropriation by
Expenditure Center and project; and
(3) an identification of items of special congressional
interest.
(b) None of the funds provided for the National Intelligence
Program in this Act shall be available for reprogramming or transfer
until the report identified in subsection (a) is submitted to the
congressional intelligence committees, unless the Director of National
Intelligence certifies in writing to the congressional intelligence
committees that such reprogramming or transfer is necessary as an
emergency requirement.
Sec. 1180. None of the funds made available by this Act may be
used to eliminate, restructure, or realign Army Contracting Command--
New Jersey or make disproportionate personnel reductions at any Army
Contracting Command--New Jersey sites without 30-day prior notification
to the congressional defense committees.
(rescission)
Sec. 1181. Of the unobligated balances available to the Department
of Defense, the following funds are permanently rescinded from the
following accounts and programs in the specified amounts to reflect
excess cash balances in the Department of Defense Acquisition Workforce
Development Fund:
From ``Department of Defense Acquisition Workforce
Development Fund, Defense'', $10,000,000.
Sec. 1182. None of the funds made available by this Act for excess
defense articles, assistance under section 333 of title 10, United
States Code, or peacekeeping operations for the countries designated
annually to be in violation of the standards of the Child Soldiers
Prevention Act of 2008 (Public Law 110-457; 22 U.S.C. 2370c-1) may be
used to support any military training or operation that includes child
soldiers, as defined by the Child Soldiers Prevention Act of 2008,
unless such assistance is otherwise permitted under section 404 of the
Child Soldiers Prevention Act of 2008.
Sec. 1183. (a) None of the funds provided for the National
Intelligence Program in this or any prior appropriations Act shall be
available for obligation or expenditure through a reprogramming or
transfer of funds in accordance with section 102A(d) of the National
Security Act of 1947 (50 U.S.C. 3024(d)) that--
(1) creates a new start effort;
(2) terminates a program with appropriated funding of
$10,000,000 or more;
(3) transfers funding into or out of the National
Intelligence Program; or
(4) transfers funding between appropriations, unless the
congressional intelligence committees are notified 30 days in
advance of such reprogramming of funds; this notification
period may be reduced for urgent national security
requirements.
(b) None of the funds provided for the National Intelligence
Program in this or any prior appropriations Act shall be available for
obligation or expenditure through a reprogramming or transfer of funds
in accordance with section 102A(d) of the National Security Act of 1947
(50 U.S.C. 3024(d)) that results in a cumulative increase or decrease
of the levels specified in the classified annex accompanying the Act
unless the congressional intelligence committees are notified 30 days
in advance of such reprogramming of funds; this notification period may
be reduced for urgent national security requirements.
Sec. 1184. The Director of National Intelligence shall submit to
Congress each year, at or about the time that the President's budget is
submitted to Congress that year under section 1105(a) of title 31,
United States Code, a future-years intelligence program (including
associated annexes) reflecting the estimated expenditures and proposed
appropriations included in that budget. Any such future-years
intelligence program shall cover the fiscal year with respect to which
the budget is submitted and at least the four succeeding fiscal years.
Sec. 1185. For the purposes of this Act, the term ``congressional
intelligence committees'' means the Permanent Select Committee on
Intelligence of the House of Representatives, the Select Committee on
Intelligence of the Senate, the Subcommittee on Defense of the
Committee on Appropriations of the House of Representatives, and the
Subcommittee on Defense of the Committee on Appropriations of the
Senate.
(including transfer of funds)
Sec. 1186. During the current fiscal year, not to exceed
$11,000,000 from each of the appropriations made in title II of this
Act for ``Operation and Maintenance, Army'', ``Operation and
Maintenance, Navy'', and ``Operation and Maintenance, Air Force'' may
be transferred by the military department concerned to its central fund
established for Fisher Houses and Suites pursuant to section 2493(d) of
title 10, United States Code.
(including transfer of funds)
Sec. 1187. Not to exceed $500,000,000 appropriated by this Act for
operation and maintenance may be available for the purpose of making
remittances and transfer to the Defense Acquisition Workforce
Development Fund in accordance with section 1705 of title 10, United
States Code.
Sec. 1188. (a) Any agency receiving funds made available in this
Act, shall, subject to subsections (b) and (c), post on the public
website of that agency any report required to be submitted by the
Congress in this or any other Act, upon the determination by the head
of the agency that it shall serve the national interest.
(b) Subsection (a) shall not apply to a report if--
(1) the public posting of the report compromises national
security; or
(2) the report contains proprietary information.
(c) The head of the agency posting such report shall do so only
after such report has been made available to the requesting Committee
or Committees of Congress for no less than 45 days.
Sec. 1189. (a) None of the funds appropriated or otherwise made
available by this Act may be expended for any Federal contract for an
amount in excess of $1,000,000, unless the contractor agrees not to--
(1) enter into any agreement with any of its employees or
independent contractors that requires, as a condition of
employment, that the employee or independent contractor agree
to resolve through arbitration any claim under title VII of the
Civil Rights Act of 1964 or any tort related to or arising out
of sexual assault or harassment, including assault and battery,
intentional infliction of emotional distress, false
imprisonment, or negligent hiring, supervision, or retention;
or
(2) take any action to enforce any provision of an existing
agreement with an employee or independent contractor that
mandates that the employee or independent contractor resolve
through arbitration any claim under title VII of the Civil
Rights Act of 1964 or any tort related to or arising out of
sexual assault or harassment, including assault and battery,
intentional infliction of emotional distress, false
imprisonment, or negligent hiring, supervision, or retention.
(b) None of the funds appropriated or otherwise made available by
this Act may be expended for any Federal contract unless the contractor
certifies that it requires each covered subcontractor to agree not to
enter into, and not to take any action to enforce any provision of, any
agreement as described in paragraphs (1) and (2) of subsection (a),
with respect to any employee or independent contractor performing work
related to such subcontract. For purposes of this subsection, a
``covered subcontractor'' is an entity that has a subcontract in excess
of $1,000,000 on a contract subject to subsection (a).
(c) The prohibitions in this section do not apply with respect to a
contractor's or subcontractor's agreements with employees or
independent contractors that may not be enforced in a court of the
United States.
(d) The Secretary of Defense may waive the application of
subsection (a) or (b) to a particular contractor or subcontractor for
the purposes of a particular contract or subcontract if the Secretary
or the Deputy Secretary personally determines that the waiver is
necessary to avoid harm to national security interests of the United
States, and that the term of the contract or subcontract is not longer
than necessary to avoid such harm. The determination shall set forth
with specificity the grounds for the waiver and for the contract or
subcontract term selected, and shall state any alternatives considered
in lieu of a waiver and the reasons each such alternative would not
avoid harm to national security interests of the United States. The
Secretary of Defense shall transmit to Congress, and simultaneously
make public, any determination under this subsection not less than 15
business days before the contract or subcontract addressed in the
determination may be awarded.
(including transfer of funds)
Sec. 1190. From within the funds appropriated for operation and
maintenance for the Defense Health Program in this Act, up to
$115,519,000, shall be available for transfer to the Joint Department
of Defense-Department of Veterans Affairs Medical Facility
Demonstration Fund in accordance with the provisions of section 1704 of
the National Defense Authorization Act for Fiscal Year 2010, Public Law
111-84: Provided, That for purposes of section 1704(b), the facility
operations funded are operations of the integrated Captain James A.
Lovell Federal Health Care Center, consisting of the North Chicago
Veterans Affairs Medical Center, the Navy Ambulatory Care Center, and
supporting facilities designated as a combined Federal medical facility
as described by section 706 of Public Law 110-417: Provided further,
That additional funds may be transferred from funds appropriated for
operation and maintenance for the Defense Health Program to the Joint
Department of Defense-Department of Veterans Affairs Medical Facility
Demonstration Fund upon written notification by the Secretary of
Defense to the Committees on Appropriations of the House of
Representatives and the Senate.
Sec. 1191. None of the funds appropriated or otherwise made
available by this Act may be used by the Department of Defense or a
component thereof in contravention of the provisions of section 130h of
title 10, United States Code.
Sec. 1192. Appropriations available to the Department of Defense
may be used for the purchase of heavy and light armored vehicles for
the physical security of personnel or for force protection purposes up
to a limit of $450,000 per vehicle, notwithstanding price or other
limitations applicable to the purchase of passenger carrying vehicles.
(including transfer of funds)
Sec. 1193. Upon a determination by the Director of National
Intelligence that such action is necessary and in the national
interest, the Director may, with the approval of the Office of
Management and Budget, transfer not to exceed $1,500,000,000 of the
funds made available in this Act for the National Intelligence Program:
Provided, That such authority to transfer may not be used unless for
higher priority items, based on unforeseen intelligence requirements,
than those for which originally appropriated and in no case where the
item for which funds are requested has been denied by the Congress:
Provided further, That a request for multiple reprogrammings of funds
using authority provided in this section shall be made prior to June
30, 2017.
Sec. 1194. None of the funds appropriated or otherwise made
available in this or any other Act may be used to transfer, release, or
assist in the transfer or release to or within the United States, its
territories, or possessions Khalid Sheikh Mohammed or any other
detainee who--
(1) is not a United States citizen or a member of the Armed
Forces of the United States; and
(2) is or was held on or after June 24, 2009, at United
States Naval Station, Guantanamo Bay, Cuba, by the Department
of Defense.
Sec. 1195. (a) None of the funds appropriated or otherwise made
available in this or any other Act may be used to construct, acquire,
or modify any facility in the United States, its territories, or
possessions to house any individual described in subsection (c) for the
purposes of detention or imprisonment in the custody or under the
effective control of the Department of Defense.
(b) The prohibition in subsection (a) shall not apply to any
modification of facilities at United States Naval Station, Guantanamo
Bay, Cuba.
(c) An individual described in this subsection is any individual
who, as of June 24, 2009, is located at United States Naval Station,
Guantanamo Bay, Cuba, and who--
(1) is not a citizen of the United States or a member of
the Armed Forces of the United States; and
(2) is--
(A) in the custody or under the effective control
of the Department of Defense; or
(B) otherwise under detention at United States
Naval Station, Guantanamo Bay, Cuba.
Sec. 1196. None of the funds appropriated or otherwise made
available in this Act may be used to transfer any individual detained
at United States Naval Station Guantanamo Bay, Cuba, to the custody or
control of the individual's country of origin, any other foreign
country, or any other foreign entity except in accordance with section
1034 of the National Defense Authorization Act for Fiscal Year 2016
(Public Law 114-92) and section 1034 of the National Defense
Authorization Act for Fiscal Year 2017 (Public Law 114-328).
Sec. 1197. None of the funds made available by this Act may be
used in contravention of the War Powers Resolution (50 U.S.C. 1541 et
seq.).
Sec. 1198. (a) None of the funds appropriated or otherwise made
available by this or any other Act may be used by the Secretary of
Defense, or any other official or officer of the Department of Defense,
to enter into a contract, memorandum of understanding, or cooperative
agreement with, or make a grant to, or provide a loan or loan guarantee
to Rosoboronexport or any subsidiary of Rosoboronexport.
(b) The Secretary of Defense may waive the limitation in subsection
(a) if the Secretary, in consultation with the Secretary of State and
the Director of National Intelligence, determines that it is in the
vital national security interest of the United States to do so, and
certifies in writing to the congressional defense committees that, to
the best of the Secretary's knowledge:
(1) Rosoboronexport has ceased the transfer of lethal
military equipment to, and the maintenance of existing lethal
military equipment for, the Government of the Syrian Arab
Republic;
(2) The armed forces of the Russian Federation have
withdrawn from Crimea, other than armed forces present on
military bases subject to agreements in force between the
Government of the Russian Federation and the Government of
Ukraine; and
(3) Agents of the Russian Federation have ceased taking
active measures to destabilize the control of the Government of
Ukraine over eastern Ukraine.
(c) The Inspector General of the Department of Defense shall
conduct a review of any action involving Rosoboronexport with respect
to a waiver issued by the Secretary of Defense pursuant to subsection
(b), and not later than 90 days after the date on which such a waiver
is issued by the Secretary of Defense, the Inspector General shall
submit to the congressional defense committees a report containing the
results of the review conducted with respect to such waiver.
Sec. 1199. None of the funds made available in this Act may be
used for the purchase or manufacture of a flag of the United States
unless such flags are treated as covered items under section 2533a(b)
of title 10, United States Code.
Sec. 1200. (a) Of the funds appropriated in this Act for the
Department of Defense, amounts may be made available, under such
regulations as the Secretary of Defense may prescribe, to local
military commanders appointed by the Secretary, or by an officer or
employee designated by the Secretary, to provide at their discretion ex
gratia payments in amounts consistent with subsection (d) of this
section for damage, personal injury, or death that is incident to
combat operations of the Armed Forces in a foreign country.
(b) An ex gratia payment under this section may be provided only
if--
(1) the prospective foreign civilian recipient is
determined by the local military commander to be friendly to
the United States;
(2) a claim for damages would not be compensable under
chapter 163 of title 10, United States Code (commonly known as
the ``Foreign Claims Act''); and
(3) the property damage, personal injury, or death was not
caused by action by an enemy.
(c) Nature of Payments.--Any payments provided under a program
under subsection (a) shall not be considered an admission or
acknowledgement of any legal obligation to compensate for any damage,
personal injury, or death.
(d) Amount of Payments.--If the Secretary of Defense determines a
program under subsection (a) to be appropriate in a particular setting,
the amounts of payments, if any, to be provided to civilians determined
to have suffered harm incident to combat operations of the Armed Forces
under the program should be determined pursuant to regulations
prescribed by the Secretary and based on an assessment, which should
include such factors as cultural appropriateness and prevailing
economic conditions.
(e) Legal Advice.--Local military commanders shall receive legal
advice before making ex gratia payments under this subsection. The
legal advisor, under regulations of the Department of Defense, shall
advise on whether an ex gratia payment is proper under this section and
applicable Department of Defense regulations.
(f) Written Record.--A written record of any ex gratia payment
offered or denied shall be kept by the local commander and on a timely
basis submitted to the appropriate office in the Department of Defense
as determined by the Secretary of Defense.
(g) Report.--The Secretary of Defense shall report to the
congressional defense committees on an annual basis the efficacy of the
ex gratia payment program including the number of types of cases
considered, amounts offered, the response from ex gratia payment
recipients, and any recommended modifications to the program.
Sec. 1201. None of the funds available in this Act to the
Department of Defense, other than appropriations made for necessary or
routine refurbishments, upgrades or maintenance activities, shall be
used to reduce or to prepare to reduce the number of deployed and non-
deployed strategic delivery vehicles and launchers below the levels set
forth in the report submitted to Congress in accordance with section
1042 of the National Defense Authorization Act for Fiscal Year 2012.
Sec. 1202. The Secretary of Defense shall post grant awards on a
public Website in a searchable format.
Sec. 1203. None of the funds made available by this Act may be
used to fund the performance of a flight demonstration team at a
location outside of the United States: Provided, That this prohibition
applies only if a performance of a flight demonstration team at a
location within the United States was canceled during the current
fiscal year due to insufficient funding.
Sec. 1204. None of the funds made available by this Act may be
used by the National Security Agency to--
(1) conduct an acquisition pursuant to section 702 of the
Foreign Intelligence Surveillance Act of 1978 for the purpose
of targeting a United States person; or
(2) acquire, monitor, or store the contents (as such term
is defined in section 2510(8) of title 18, United States Code)
of any electronic communication of a United States person from
a provider of electronic communication services to the public
pursuant to section 501 of the Foreign Intelligence
Surveillance Act of 1978.
Sec. 1205. None of the funds made available by this Act may be
obligated or expended to implement the Arms Trade Treaty until the
Senate approves a resolution of ratification for the Treaty.
Sec. 1206. None of the funds made available in this or any other
Act may be used to pay the salary of any officer or employee of any
agency funded by this Act who approves or implements the transfer of
administrative responsibilities or budgetary resources of any program,
project, or activity financed by this Act to the jurisdiction of
another Federal agency not financed by this Act unless explicity
provided for in a Defense Appropriations Act: Provided, That this
limitation shall not apply to transfers of funds expressly provided for
in Defense Appropriations Acts, or provisions of Acts providing
supplemental appropriations for the Department of Defense.
Sec. 1207. None of the funds made available in this Act may be
obligated for activities authorized under section 1208 of the Ronald W.
Reagan National Defense Authorization Act for Fiscal Year 2005 (Public
Law 112-81; 125 Stat. 1621) to initiate support for, or expand support
to, foreign forces, irregular forces, groups, or individuals unless the
congressional defense committees are notified in accordance with the
direction contained in the classified annex accompanying this Act, not
less than 15 days before initiating such support: Provided, That none
of the funds made available in this Act may be used under section 1208
for any activity that is not in support of an ongoing military
operation being conducted by United States Special Operations Forces to
combat terrorism: Provided further, That the Secretary of Defense may
waive the prohibitions in this section if the Secretary determines that
such waiver is required by extraordinary circumstances and, by not
later than 72 hours after making such waiver, notifies the
congressional defense committees of such waiver.
Sec. 1208. None of the funds made available by this Act may be
used with respect to Iraq in contravention of the War Powers Resolution
(50 U.S.C. 1541 et seq.), including for the introduction of United
States armed forces into hostilities in Iraq, into situations in Iraq
where imminent involvement in hostilities is clearly indicated by the
circumstances, or into Iraqi territory, airspace, or waters while
equipped for combat, in contravention of the congressional consultation
and reporting requirements of sections 3 and 4 of such Resolution (50
U.S.C. 1542 and 1543).
Sec. 1209. None of the funds provided in this Act for the T-AO
Fleet Oiler or the Towing, Salvage, and Rescue Ship programs shall be
used to award a new contract that provides for the acquisition of the
following components unless those components are manufactured in the
United States: Auxiliary equipment (including pumps) for shipboard
services; propulsion equipment (including engines, reduction gears, and
propellers); shipboard cranes; and spreaders for shipboard cranes.
Sec. 1210. The amount appropriated in title II of this Act for
``Operation and Maintenance, Army'' is hereby reduced by $75,000,000 to
reflect excess cash balances in Department of Defense Working Capital
Funds.
Sec. 1211. Notwithstanding any other provision of this Act, to
reflect savings due to lower than anticipated fuel costs, the total
amount appropriated in title II of this Act is hereby reduced by
$1,007,267,000.
Sec. 1212. None of the funds made available by this Act may be
used for Government Travel Charge Card expenses by military or civilian
personnel of the Department of Defense for gaming, or for entertainment
that includes topless or nude entertainers or participants, as
prohibited by Department of Defense FMR, Volume 9, Chapter 3 and
Department of Defense Instruction 1015.10 (enclosure 3, 14a and 14b).
Sec. 1213. None of the funds made available by this Act may be
used to propose, plan for, or execute a new or additional Base
Realignment and Closure (BRAC) round.
Sec. 1214. Of the amounts appropriated in this Act for ``Operation
and Maintenance, Navy'', $289,255,000, to remain available until
expended, may be used for any purposes related to the National Defense
Reserve Fleet established under section 11 of the Merchant Ship Sales
Act of 1946 (50 U.S.C. 4405): Provided, That such amounts are
available for reimbursements to the Ready Reserve Force, Maritime
Administration account of the United States Department of
Transportation for programs, projects, activities, and expenses related
to the National Defense Reserve Fleet.
Sec. 1215. None of the funds made available by this Act for the
Joint Surveillance Target Attack Radar System recapitalization program
may be obligated or expended for pre-milestone B activities after March
31, 2018, except for source selection and other activities necessary to
enter the engineering and manufacturing development phase.
Sec. 1216. None of the funds made available by this Act may be
used to carry out the closure or realignment of the United States Naval
Station, Guantanamo Bay, Cuba.
(including transfer of funds)
Sec. 1217. Additional readiness funds made available in title II
of this Act for ``Operation and Maintenance, Army'', ``Operation and
Maintenance, Navy'', ``Operation and Maintenance, Marine Corps'', and
``Operation and Maintenance, Air Force'' may be transferred to and
merged with any appropriation of the Department of Defense for
activities related to the Zika virus in order to provide health support
for the full range of military operations and sustain the health of the
members of the Armed Forces, civilian employees of the Department of
Defense, and their families, to include: research and development,
disease surveillance, vaccine development, rapid detection, vector
controls and surveillance, training, and outbreak response: Provided,
That the authority provided in this section is subject to the same
terms and conditions as the authority provided in section 8005 of this
Act.
Sec. 1218. (a) None of the funds made available in this Act may be
used to maintain or establish a computer network unless such network is
designed to block access to pornography websites.
(b) Nothing in subsection (a) shall limit the use of funds
necessary for any Federal, State, tribal, or local law enforcement
agency or any other entity carrying out criminal investigations,
prosecution, or adjudication activities, or for any activity necessary
for the national defense, including intelligence activities.
Sec. 1219. Notwithstanding any other provision of law, any
transfer of funds appropriated or otherwise made available by this Act
to the Global Engagement Center pursuant to section 1287 of the
National Defense Authorization Act for Fiscal Year 2017 (Public Law
114-328) shall be made in accordance with section 8005 or 9002 of this
Act, as applicable.
Sec. 1220. No amounts credited or otherwise made available in this
or any other Act to the Department of Defense Acquisition Workforce
Development Fund may be transferred to:
(1) the Rapid Prototyping Fund established under section
804(d) of the National Defense Authorization Act for Fiscal
Year 2016 (10 U.S.C. 2302 note); or
(2) credited to a military-department specific fund
established under section 804(d)(2) of the National Defense
Authorization Act for Fiscal Year 2016 (as amended by section
897 of the National Defense Authorization Act for Fiscal Year
2017).
(including transfer fund)
Sec. 1221. In addition to amounts provided elsewhere in this Act
for military personnel pay, including active duty, reserve and National
Guard personnel, $206,400,000 is hereby appropriated to the Department
of Defense and made available for transfer only to military personnel
accounts: Provided, That the transfer authority provided under this
heading is in addition to any other transfer authority provided
elsewhere in this Act.
Sec. 1222. In addition to amounts provided elsewhere in this Act,
there is appropriated $235,000,000, for an additional amount for
``Operation and Maintenance, Defense-Wide'', to remain available until
expended: Provided, That such funds shall only be available to the
Secretary of Defense, acting through the Office of Economic Adjustment
of the Department of Defense, or for transfer to the Secretary of
Education, notwithstanding any other provision of law, to make grants,
conclude cooperative agreements, or supplement other Federal funds to
construct, renovate, repair, or expand elementary and secondary public
schools on military installations in order to address capacity or
facility condition deficiencies at such schools: Provided further, That
in making such funds available, the Office of Economic Adjustment or
the Secretary of Education shall give priority consideration to those
military installations with schools having the most serious capacity or
facility condition deficiencies as determined by the Secretary of
Defense: Provided further, That as a condition of receiving funds under
this section a local educational agency or State shall provide a
matching share as described in the notice titled ``Department of
Defense Program for Construction, Renovation, Repair or Expansion of
Public Schools Located on Military Installations'' published by the
Department of Defense in the Federal Register on September 9, 2011 (76
Fed. Reg. 55883 et seq.): Provided further, That these provisions apply
to funds provided under this section, and to funds previously provided
by Congress to construct, renovate, repair, or expand elementary and
secondary public schools on military installations in order to address
capacity or facility condition deficiencies at such schools to the
extent such funds remain unobligated on the date of enactment of this
section.
Sec. 1223. None of the funds made available by this Act may be
used to carry out the changes to the Joint Travel Regulations of the
Department of Defense described in the memorandum of the Per Diem
Travel and Transportation Allowance Committee titled ``UTD/CTD for MAP
118-13/CAP 118-13 - Flat Rate Per Diem for Long Term TDY'' and dated
October 1, 2014.
Sec. 1224. In carrying out the program described in the memorandum
on the subject of ``Policy for Assisted Reproductive Services for the
Benefit of Seriously or Severely Ill/Injured (Category II or III)
Active Duty Service Members'' issued by the Assistant Secretary of
Defense for Health Affairs on April 3, 2012, and the guidance issued to
implement such memorandum, the Secretary of Defense shall apply such
policy and guidance, except that--
(1) the limitation on periods regarding embryo
cryopreservation and storage set forth in part III(G) and in
part IV(H) of such memorandum shall not apply; and
(2) the term ``assisted reproductive technology'' shall
include embryo cryopreservation and storage without limitation
on the duration of such cryopreservation and storage.
TITLE IX
OVERSEAS CONTINGENCY OPERATIONS/GLOBAL WAR ON TERRORISM
MILITARY PERSONNEL
Military Personnel, Army
For an additional amount for ``Military Personnel, Army'',
$2,635,317,000: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Military Personnel, Navy
For an additional amount for ``Military Personnel, Navy'',
$377,857,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Military Personnel, Marine Corps
For an additional amount for ``Military Personnel, Marine Corps'',
$103,800,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Military Personnel, Air Force
For an additional amount for ``Military Personnel, Air Force'',
$912,779,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Reserve Personnel, Army
For an additional amount for ``Reserve Personnel, Army'',
$24,942,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Reserve Personnel, Navy
For an additional amount for ``Reserve Personnel, Navy'',
$9,091,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Reserve Personnel, Marine Corps
For an additional amount for ``Reserve Personnel, Marine Corps'',
$2,328,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Reserve Personnel, Air Force
For an additional amount for ``Reserve Personnel, Air Force'',
$20,569,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
National Guard Personnel, Army
For an additional amount for ``National Guard Personnel, Army'',
$184,589,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
National Guard Personnel, Air Force
For an additional amount for ``National Guard Personnel, Air
Force'', $5,004,000: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Military Personnel, National Defense Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $1,000,000,000, for the ``Military Personnel, National
Defense Restoration Fund'': Provided, That such funds provided under
this heading shall only be available for programs, projects and
activities necessary to implement the 2018 National Defense Strategy:
Provided further, That such funds shall not be available for transfer
until 30 days after the Secretary has submitted, and the congressional
defense committees have approved, the proposed allocation plan for the
use of such funds to implement such strategy: Provided further, That
such allocation plan shall include a detailed justification for the use
of such funds and a description of how such investments are necessary
to implement the strategy: Provided further, That the Secretary of
Defense may transfer these funds only to military personnel accounts:
Provided further, That the funds transferred shall be merged with and
shall be available for the same purposes and for the same time period,
as the appropriation to which transferred: Provided further, That none
of the funds made available under this heading may be transferred to
any program, project, or activity specifically limited or denied by
this Act: Provided further, That the transfer authority provided under
this heading is in addition to any other transfer authority available
to the Department of Defense: Provided further, That such amount is
designated by the Congress for Overseas Contingency Operations/Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
OPERATION AND MAINTENANCE
Operation and Maintenance, Army
For an additional amount for ``Operation and Maintenance, Army'',
$16,126,403,000: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Operation and Maintenance, Navy
For an additional amount for ``Operation and Maintenance, Navy'',
$5,875,015,000, of which up to $161,885,000 may be transferred to the
Coast Guard ``Operating Expenses'' account: Provided, That such amount
is designated by the Congress for Overseas Contingency Operations/
Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the
Balanced Budget and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Marine Corps
For an additional amount for ``Operation and Maintenance, Marine
Corps'', $1,116,640,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Air Force
For an additional amount for ``Operation and Maintenance, Air
Force'', $10,266,295,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Defense-Wide
For an additional amount for ``Operation and Maintenance, Defense-
Wide'', $6,944,201,000: Provided, That of the funds provided under
this heading, not to exceed $900,000,000, to remain available until
September 30, 2019, shall be for payments to reimburse key cooperating
nations for logistical, military, and other support, including access,
provided to United States military and stability operations in
Afghanistan and to counter the Islamic State of Iraq and the Levant:
Provided further, That such reimbursement payments may be made in such
amounts as the Secretary of Defense, with the concurrence of the
Secretary of State, and in consultation with the Director of the Office
of Management and Budget, may determine, based on documentation
determined by the Secretary of Defense to adequately account for the
support provided, and such determination is final and conclusive upon
the accounting officers of the United States, and 15 days following
notification to the appropriate congressional committees: Provided
further, That funds provided under this heading may be used for the
purpose of providing specialized training and procuring supplies and
specialized equipment and providing such supplies and loaning such
equipment on a non-reimbursable basis to coalition forces supporting
United States military and stability operations in Afghanistan and to
counter the Islamic State of Iraq and the Levant, and 15 days following
notification to the appropriate congressional committees: Provided
further, That funds provided under this heading may be used to support
the Government of Jordan, in such amounts as the Secretary of Defense
may determine, to enhance the ability of the armed forces of Jordan to
increase or sustain security along its borders, upon 15 days prior
written notification to the congressional defense committees outlining
the amounts intended to be provided and the nature of the expenses
incurred: Provided further, That of the funds provided under this
heading, not to exceed $750,000,000, to remain available until
September 30, 2019, shall be available to provide support and
assistance to foreign security forces or other groups or individuals to
conduct, support, or facilitate counterterrorism, crisis response, or
other Department of Defense security cooperation programs: Provided
further, That such amount is designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Operation and Maintenance, Army Reserve
For an additional amount for ``Operation and Maintenance, Army
Reserve'', $24,699,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Navy Reserve
For an additional amount for ``Operation and Maintenance, Navy
Reserve'', $23,980,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Marine Corps Reserve
For an additional amount for ``Operation and Maintenance, Marine
Corps Reserve'', $3,367,000: Provided, That such amount is designated
by the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Air Force Reserve
For an additional amount for ``Operation and Maintenance, Air Force
Reserve'', $58,523,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Army National Guard
For an additional amount for ``Operation and Maintenance, Army
National Guard'', $108,111,000: Provided, That such amount is
designated by the Congress for Overseas Contingency Operations/Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Operation and Maintenance, Air National Guard
For an additional amount for ``Operation and Maintenance, Air
National Guard'', $15,400,000: Provided, That such amount is
designated by the Congress for Overseas Contingency Operations/Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Operation and Maintenance, National Defense Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $2,000,000,000, for the ``Operation and Maintenance,
National Defense Restoration Fund'': Provided, That such funds provided
under this heading shall only be available for programs, projects and
activities necessary to implement the 2018 National Defense Strategy:
Provided further, That such funds shall not be available for transfer
until 30 days after the Secretary has submitted, and the congressional
defense committees have approved, the proposed allocation plan for the
use of such funds to implement such strategy: Provided further, That
such allocation plan shall include a detailed justification for the use
of such funds and a description of how such investments are necessary
to implement the strategy: Provided further, That the Secretary of
Defense may transfer these funds only to operation and maintenance
accounts: Provided further, That the funds transferred shall be merged
with and shall be available for the same purposes and for the same time
period, as the appropriation to which transferred: Provided further,
That none of the funds made available under this heading may be
transferred to any program, project, or activity specifically limited
or denied by this Act: Provided further, That the transfer authority
provided under this heading is in addition to any other transfer
authority available to the Department of Defense: Provided further,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Afghanistan Security Forces Fund
For the ``Afghanistan Security Forces Fund'', $4,937,515,000
(reduced by $12,000,000), to remain available until September 30, 2019:
Provided, That such funds shall be available to the Secretary of
Defense, notwithstanding any other provision of law, for the purpose of
allowing the Commander, Combined Security Transition Command--
Afghanistan, or the Secretary's designee, to provide assistance, with
the concurrence of the Secretary of State, to the security forces of
Afghanistan, including the provision of equipment, supplies, services,
training, facility and infrastructure repair, renovation, construction,
and funding: Provided further, That the Secretary of Defense may
obligate and expend funds made available to the Department of Defense
in this title for additional costs associated with existing projects
previously funded with amounts provided under the heading ``Afghanistan
Infrastructure Fund'' in prior Acts: Provided further, That such costs
shall be limited to contract changes resulting from inflation, market
fluctuation, rate adjustments, and other necessary contract actions to
complete existing projects, and associated supervision and
administration costs and costs for design during construction:
Provided further, That the Secretary may not use more than $50,000,000
under the authority provided in this section: Provided further, That
the Secretary shall notify in advance such contract changes and
adjustments in annual reports to the congressional defense committees:
Provided further, That the authority to provide assistance under this
heading is in addition to any other authority to provide assistance to
foreign nations: Provided further, That contributions of funds for the
purposes provided herein from any person, foreign government, or
international organization may be credited to this Fund, to remain
available until expended, and used for such purposes: Provided
further, That the Secretary of Defense shall notify the congressional
defense committees in writing upon the receipt and upon the obligation
of any contribution, delineating the sources and amounts of the funds
received and the specific use of such contributions: Provided further,
That the Secretary of Defense shall, not fewer than 15 days prior to
obligating from this appropriation account, notify the congressional
defense committees in writing of the details of any such obligation:
Provided further, That the Secretary of Defense shall notify the
congressional defense committees of any proposed new projects or
transfer of funds between budget sub-activity groups in excess of
$20,000,000: Provided further, That the United States may accept
equipment procured using funds provided under this heading in this or
prior Acts that was transferred to the security forces of Afghanistan
and returned by such forces to the United States: Provided further,
That equipment procured using funds provided under this heading in this
or prior Acts, and not yet transferred to the security forces of
Afghanistan or transferred to the security forces of Afghanistan and
returned by such forces to the United States, may be treated as stocks
of the Department of Defense upon written notification to the
congressional defense committees: Provided further, That of the funds
provided under this heading, not less than $10,000,000 shall be for
recruitment and retention of women in the Afghanistan National Security
Forces, and the recruitment and training of female security personnel:
Provided further, That such amount is designated by the Congress for
Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Counter-ISIL Train and Equip Fund
For the ``Counter-Islamic State of Iraq and the Levant Train and
Equip Fund'', $1,769,000,000, to remain available until September 30,
2019: Provided, That such funds shall be available to the Secretary of
Defense in coordination with the Secretary of State, to provide
assistance, including training; equipment; logistics support, supplies,
and services; stipends; infrastructure repair and renovation; and
sustainment, to foreign security forces, irregular forces, groups, or
individuals participating, or preparing to participate in activities to
counter the Islamic State of Iraq and the Levant, and their affiliated
or associated groups: Provided further, That these funds may be used in
such amounts as the Secretary of Defense may determine to enhance the
border security of nations adjacent to conflict areas including Jordan,
Lebanon, Egypt, and Tunisia resulting from actions of the Islamic State
of Iraq and the Levant: Provided further, That amounts made available
under this heading shall be available to provide assistance only for
activities in a country designated by the Secretary of Defense, in
coordination with the Secretary of State, as having a security mission
to counter the Islamic State of Iraq and the Levant, and following
written notification to the congressional defense committees of such
designation: Provided further, That the Secretary of Defense shall
ensure that prior to providing assistance to elements of any forces or
individuals, such elements or individuals are appropriately vetted,
including at a minimum, assessing such elements for associations with
terrorist groups or groups associated with the Government of Iran; and
receiving commitments from such elements to promote respect for human
rights and the rule of law: Provided further, That the Secretary of
Defense shall, not fewer than 15 days prior to obligating from this
appropriation account, notify the congressional defense committees in
writing of the details of any such obligation: Provided further, That
the Secretary of Defense may accept and retain contributions, including
assistance in-kind, from foreign governments, including the Government
of Iraq and other entities, to carry out assistance authorized under
this heading: Provided further, That contributions of funds for the
purposes provided herein from any foreign government or other entity
may be credited to this Fund, to remain available until expended, and
used for such purposes: Provided further, That the Secretary of Defense
may waive a provision of law relating to the acquisition of items and
support services or sections 40 and 40A of the Arms Export Control Act
(22 U.S.C. 2780 and 2785) if the Secretary determines that such
provision of law would prohibit, restrict, delay or otherwise limit the
provision of such assistance and a notice of and justification for such
waiver is submitted to the congressional defense committees, the
Committees on Appropriations and Foreign Relations of the Senate and
the Committees on Appropriations and Foreign Affairs of the House of
Representatives: Provided further, That the United States may accept
equipment procured using funds provided under this heading, or under
the heading, ``Iraq Train and Equip Fund'' in prior Acts, that was
transferred to security forces, irregular forces, or groups
participating, or preparing to participate in activities to counter the
Islamic State of Iraq and the Levant and returned by such forces or
groups to the United States, may be treated as stocks of the Department
of Defense upon written notification to the congressional defense
committees: Provided further, That equipment procured using funds
provided under this heading, or under the heading, ``Iraq Train and
Equip Fund'' in prior Acts, and not yet transferred to security forces,
irregular forces, or groups participating, or preparing to participate
in activities to counter the Islamic State of Iraq and the Levant may
be treated as stocks of the Department of Defense when determined by
the Secretary to no longer be required for transfer to such forces or
groups and upon written notification to the congressional defense
committees: Provided further, That the Secretary of Defense shall
provide quarterly reports to the congressional defense committees on
the use of funds provided under this heading, including, but not
limited to, the number of individuals trained, the nature and scope of
support and sustainment provided to each group or individual, the area
of operations for each group, and the contributions of other countries,
groups, or individuals: Provided further, That such amount is
designated by the Congress for Overseas Contingency Operations/ Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
PROCUREMENT
Aircraft Procurement, Army
For an additional amount for ``Aircraft Procurement, Army'',
$424,686,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Missile Procurement, Army
For an additional amount for ``Missile Procurement, Army'',
$557,583,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Procurement of Weapons and Tracked Combat Vehicles, Army
For an additional amount for ``Procurement of Weapons and Tracked
Combat Vehicles, Army'', $1,191,139,000, to remain available until
September 30, 2020: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Procurement of Ammunition, Army
For an additional amount for ``Procurement of Ammunition, Army'',
$193,436,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Other Procurement, Army
For an additional amount for ``Other Procurement, Army'',
$405,575,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Aircraft Procurement, Navy
For an additional amount for ``Aircraft Procurement, Navy'',
$157,300,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Weapons Procurement, Navy
For an additional amount for ``Weapons Procurement, Navy'',
$130,994,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Procurement of Ammunition, Navy and Marine Corps
For an additional amount for ``Procurement of Ammunition, Navy and
Marine Corps'', $223,843,000, to remain available until September 30,
2020: Provided, That such amount is designated by the Congress for
Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Other Procurement, Navy
For an additional amount for ``Other Procurement, Navy'',
$207,984,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Procurement, Marine Corps
For an additional amount for ``Procurement, Marine Corps'',
$64,071,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Aircraft Procurement, Air Force
For an additional amount for ``Aircraft Procurement, Air Force'',
$510,836,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Missile Procurement, Air Force
For an additional amount for ``Missile Procurement, Air Force'',
$381,700,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Space Procurement, Air Force
For an additional amount for ``Space Procurement, Air Force'',
$2,256,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Procurement of Ammunition, Air Force
For an additional amount for ``Procurement of Ammunition, Air
Force'', $501,509,000, to remain available until September 30, 2020:
Provided, That such amount is designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Other Procurement, Air Force
For an additional amount for ``Other Procurement, Air Force'',
$3,998,887,000, to remain available until September 30, 2020:
Provided, That such amount is designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Procurement, Defense-Wide
For an additional amount for ``Procurement, Defense-Wide'',
$510,741,000, to remain available until September 30, 2020: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
National Guard and Reserve Equipment Account
For procurement of rotary-wing aircraft; combat, tactical and
support vehicles; other weapons; and other procurement items for the
reserve components of the Armed Forces, $1,000,000,000, to remain
available for obligation until September 30, 2020: Provided, That the
Chiefs of National Guard and Reserve components shall, not later than
30 days after enactment of this Act, individually submit to the
congressional defense committees the modernization priority assessment
for their respective National Guard or Reserve component: Provided
further, That none of the funds made available by this paragraph may be
used to procure manned fixed wing aircraft, or procure or modify
missiles, munitions, or ammunition: Provided further, That such amount
is designated by the Congress for Overseas Contingency Operations/
Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the
Balanced Budget and Emergency Deficit Control Act of 1985.
Procurement, National Defense Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $6,000,000,000, for the ``Procurement, National Defense
Restoration Fund'': Provided, That such funds provided under this
heading shall only be available for programs, projects and activities
necessary to implement the 2018 National Defense Strategy: Provided
further, That such funds shall not be available for transfer until 30
days after the Secretary has submitted, and the congressional defense
committees have approved, the proposed allocation plan for the use of
such funds to implement such strategy: Provided further, That such
allocation plan shall include a detailed justification for the use of
such funds and a description of how such investments are necessary to
implement the strategy: Provided further, That the Secretary of Defense
may transfer these funds only to procurement accounts: Provided
further, That the funds transferred shall be merged with and shall be
available for the same purposes and for the same time period, as the
appropriation to which transferred: Provided further, That none of the
funds made available under this heading may be transferred to any
program, project, or activity specifically limited or denied by this
Act: Provided further, That the transfer authority provided under this
heading is in addition to any other transfer authority available to the
Department of Defense: Provided further, That such amount is designated
by the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
RESEARCH, DEVELOPMENT, TEST AND EVALUATION
Research, Development, Test and Evaluation, Army
For an additional amount for ``Research, Development, Test and
Evaluation, Army'', $119,368,000 (increased by $6,000,000), to remain
available until September 30, 2019: Provided, That such amount is
designated by the Congress for Overseas Contingency Operations/Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Research, Development, Test and Evaluation, Navy
For an additional amount for ``Research, Development, Test and
Evaluation, Navy'', $124,865,000, to remain available until September
30, 2019: Provided, That such amount is designated by the Congress for
Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
Research, Development, Test and Evaluation, Air Force
For an additional amount for ``Research, Development, Test and
Evaluation, Air Force'', $144,508,000, to remain available until
September 30, 2019: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Research, Development, Test and Evaluation, Defense-Wide
For an additional amount for ``Research, Development, Test and
Evaluation, Defense-Wide'', $226,096,000, to remain available until
September 30, 2019: Provided, That such amount is designated by the
Congress for Overseas Contingency Operations/Global War on Terrorism
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and
Emergency Deficit Control Act of 1985.
Research, Development, Test and Evaluation, National Defense
Restoration Fund
(including transfer of funds)
In addition to amounts provided elsewhere in this Act, there is
appropriated $1,000,000,000, for the ``Research, Development, Test and
Evaluation, National Defense Restoration Fund'': Provided, That such
funds provided under this heading shall only be available for programs,
projects and activities necessary to implement the 2018 National
Defense Strategy: Provided further, That such funds shall not be
available for transfer until 30 days after the Secretary has submitted,
and the congressional defense committees have approved, the proposed
allocation plan for the use of such funds to implement such strategy:
Provided further, That such allocation plan shall include a detailed
justification for the use of such funds and a description of how such
investments are necessary to implement the strategy: Provided further,
That the Secretary of Defense may transfer these funds only to
research, development, test and evaluation accounts: Provided further,
That the funds transferred shall be merged with and shall be available
for the same purposes and for the same time period, as the
appropriation to which transferred: Provided further, That none of the
funds made available under this heading may be transferred to any
program, project, or activity specifically limited or denied by this
Act: Provided further, That the transfer authority provided under this
heading is in addition to any other transfer authority available to the
Department of Defense: Provided further, That such amount is designated
by the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
REVOLVING AND MANAGEMENT FUNDS
Defense Working Capital Funds
For an additional amount for ``Defense Working Capital Funds'',
$148,956,000: Provided, That such amount is designated by the Congress
for Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985.
OTHER DEPARTMENT OF DEFENSE PROGRAMS
Defense Health Program
For an additional amount for ``Defense Health Program'',
$395,805,000, which shall be for operation and maintenance: Provided,
That such amount is designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985.
Drug Interdiction and Counter-Drug Activities, Defense
For an additional amount for ``Drug Interdiction and Counter-Drug
Activities, Defense'', $196,300,000: Provided, That such amount is
designated by the Congress for Overseas Contingency Operations/Global
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced
Budget and Emergency Deficit Control Act of 1985.
Joint Improvised-Threat Defeat Fund
(including transfer of funds)
For the ``Joint Improvised-Threat Defeat Fund'', $483,058,000, to
remain available until September 30, 2020: Provided, That such funds
shall be available to the Secretary of Defense, notwithstanding any
other provision of law, for the purpose of allowing the Director of the
Joint Improvised-Threat Defeat Organization to investigate, develop and
provide equipment, supplies, services, training, facilities, personnel
and funds to assist United States forces in the defeat of improvised
explosive devices: Provided further, That the Secretary of Defense may
transfer funds provided herein to appropriations for military
personnel; operation and maintenance; procurement; research,
development, test and evaluation; and defense working capital funds to
accomplish the purpose provided herein: Provided further, That this
transfer authority is in addition to any other transfer authority
available to the Department of Defense: Provided further, That the
Secretary of Defense shall, not fewer than 5 days prior to making
transfers from this appropriation, notify the congressional defense
committees in writing of the details of any such transfer: Provided
further, That such amount is designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Office of the Inspector General
For an additional amount for the ``Office of the Inspector
General'', $24,692,000: Provided, That such amount is designated by
the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
GENERAL PROVISIONS--THIS TITLE
Sec. 1301. Notwithstanding any other provision of law, funds made
available in this title are in addition to amounts appropriated or
otherwise made available for the Department of Defense for fiscal year
2018.
(including transfer of funds)
Sec. 1302. Upon the determination of the Secretary of Defense that
such action is necessary in the national interest, the Secretary may,
with the approval of the Office of Management and Budget, transfer up
to $2,500,000,000 between the appropriations or funds made available to
the Department of Defense in this title: Provided, That the Secretary
shall notify the Congress promptly of each transfer made pursuant to
the authority in this section: Provided further, That the authority
provided in this section is in addition to any other transfer authority
available to the Department of Defense and is subject to the same terms
and conditions as the authority provided in section 8005 of this Act.
Sec. 1303. Supervision and administration costs and costs for
design during construction associated with a construction project
funded with appropriations available for operation and maintenance or
the ``Afghanistan Security Forces Fund'' provided in this Act and
executed in direct support of overseas contingency operations in
Afghanistan, may be obligated at the time a construction contract is
awarded: Provided, That, for the purpose of this section, supervision
and administration costs and costs for design during construction
include all in-house Government costs.
Sec. 1304. From funds made available in this title, the Secretary
of Defense may purchase for use by military and civilian employees of
the Department of Defense in the United States Central Command area of
responsibility:
(1) passenger motor vehicles up to a limit of $75,000 per
vehicle; and
(2) heavy and light armored vehicles for the physical
security of personnel or for force protection purposes up to a
limit of $450,000 per vehicle, notwithstanding price or other
limitations applicable to the purchase of passenger carrying
vehicles.
Sec. 1305. Not to exceed $5,000,000 of the amounts appropriated by
this title under the heading ``Operation and Maintenance, Army'' may be
used, notwithstanding any other provision of law, to fund the
Commanders' Emergency Response Program (CERP), for the purpose of
enabling military commanders in Afghanistan to respond to urgent,
small-scale, humanitarian relief and reconstruction requirements within
their areas of responsibility: Provided, That each project (including
any ancillary or related elements in connection with such project)
executed under this authority shall not exceed $2,000,000: Provided
further, That not later than 45 days after the end of each 6 months of
the fiscal year, the Secretary of Defense shall submit to the
congressional defense committees a report regarding the source of funds
and the allocation and use of funds during that 6-month period that
were made available pursuant to the authority provided in this section
or under any other provision of law for the purposes described herein:
Provided further, That, not later than 30 days after the end of each
fiscal year quarter, the Army shall submit to the congressional defense
committees quarterly commitment, obligation, and expenditure data for
the CERP in Afghanistan: Provided further, That, not less than 15 days
before making funds available pursuant to the authority provided in
this section or under any other provision of law for the purposes
described herein for a project with a total anticipated cost for
completion of $500,000 or more, the Secretary shall submit to the
congressional defense committees a written notice containing each of
the following:
(1) The location, nature and purpose of the proposed
project, including how the project is intended to advance the
military campaign plan for the country in which it is to be
carried out.
(2) The budget, implementation timeline with milestones,
and completion date for the proposed project, including any
other CERP funding that has been or is anticipated to be
contributed to the completion of the project.
(3) A plan for the sustainment of the proposed project,
including the agreement with either the host nation, a non-
Department of Defense agency of the United States Government or
a third-party contributor to finance the sustainment of the
activities and maintenance of any equipment or facilities to be
provided through the proposed project.
Sec. 1306. Funds available to the Department of Defense for
operation and maintenance may be used, notwithstanding any other
provision of law, to provide supplies, services, transportation,
including airlift and sealift, and other logistical support to allied
forces participating in a combined operation with the armed forces of
the United States and coalition forces supporting military and
stability operations in Afghanistan and to counter the Islamic State of
Iraq and the Levant: Provided, That the Secretary of Defense shall
provide quarterly reports to the congressional defense committees
regarding support provided under this section.
Sec. 1307. None of the funds appropriated or otherwise made
available by this or any other Act shall be obligated or expended by
the United States Government for a purpose as follows:
(1) To establish any military installation or base for the
purpose of providing for the permanent stationing of United
States Armed Forces in Iraq.
(2) To exercise United States control over any oil resource
of Iraq.
(3) To establish any military installation or base for the
purpose of providing for the permanent stationing of United
States Armed Forces in Afghanistan.
Sec. 1308. None of the funds made available in this Act may be
used in contravention of the following laws enacted or regulations
promulgated to implement the United Nations Convention Against Torture
and Other Cruel, Inhuman or Degrading Treatment or Punishment (done at
New York on December 10, 1984):
(1) Section 2340A of title 18, United States Code.
(2) Section 2242 of the Foreign Affairs Reform and
Restructuring Act of 1998 (division G of Public Law 105-277;
112 Stat. 2681-822; 8 U.S.C. 1231 note) and regulations
prescribed thereto, including regulations under part 208 of
title 8, Code of Federal Regulations, and part 95 of title 22,
Code of Federal Regulations.
(3) Sections 1002 and 1003 of the Department of Defense,
Emergency Supplemental Appropriations to Address Hurricanes in
the Gulf of Mexico, and Pandemic Influenza Act, 2006 (Public
Law 109-148).
Sec. 1309. None of the funds provided for the ``Afghanistan
Security Forces Fund'' (ASFF) may be obligated prior to the approval of
a financial and activity plan by the Afghanistan Resources Oversight
Council (AROC) of the Department of Defense: Provided, That the AROC
must approve the requirement and acquisition plan for any service
requirements in excess of $50,000,000 annually and any non-standard
equipment requirements in excess of $100,000,000 using ASFF: Provided
further, That the Department of Defense must certify to the
congressional defense committees that the AROC has convened and
approved a process for ensuring compliance with the requirements in the
preceding proviso and accompanying report language for the ASFF.
Sec. 1310. Funds made available in this title to the Department of
Defense for operation and maintenance may be used to purchase items
having an investment unit cost of not more than $250,000: Provided,
That, upon determination by the Secretary of Defense that such action
is necessary to meet the operational requirements of a Commander of a
Combatant Command engaged in contingency operations overseas, such
funds may be used to purchase items having an investment item unit cost
of not more than $500,000.
Sec. 1311. Up to $500,000,000 of funds appropriated by this Act
for the Defense Security Cooperation Agency in ``Operation and
Maintenance, Defense-Wide'' may be used to provide assistance to the
Government of Jordan to support the armed forces of Jordan and to
enhance security along its borders.
Sec. 1312. None of the funds made available by this Act under the
heading ``Counter-ISIL Train and Equip Fund'' may be used to procure or
transfer man-portable air defense systems.
Sec. 1313. For the ``Ukraine Security Assistance Initiative'',
$150,000,000 is hereby appropriated, to remain available until
September 30, 2018: Provided, That such funds shall be available to
the Secretary of Defense, in coordination with the Secretary of State,
to provide assistance, including training; equipment; lethal weapons of
a defensive nature; logistics support, supplies and services;
sustainment; and intelligence support to the military and national
security forces of Ukraine, and for replacement of any weapons or
defensive articles provided to the Government of Ukraine from the
inventory of the United States: Provided further, That the Secretary
of Defense shall, not less than 15 days prior to obligating funds
provided under this heading, notify the congressional defense
committees in writing of the details of any such obligation: Provided
further, That the United States may accept equipment procured using
funds provided under this heading in this or prior Acts that was
transferred to the security forces of Ukraine and returned by such
forces to the United States: Provided further, That equipment procured
using funds provided under this heading in this or prior Acts, and not
yet transferred to the military or National Security Forces of Ukraine
or returned by such forces to the United States, may be treated as
stocks of the Department of Defense upon written notification to the
congressional defense committees: Provided further, That amounts made
available by this section are designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985.
Sec. 1314. Funds appropriated in this title shall be available for
replacement of funds for items provided to the Government of Ukraine
from the inventory of the United States to the extent specifically
provided for in section 9013 of this Act.
Sec. 1315. None of the funds made available by this Act under
section 9013 for ``Assistance and Sustainment to the Military and
National Security Forces of Ukraine'' may be used to procure or
transfer man-portable air defense systems.
Sec. 1316. (a) None of the funds appropriated or otherwise made
available by this Act under the heading ``Operation and Maintenance,
Defense-Wide'' for payments under section 1233 of Public Law 110-181
for reimbursement to the Government of Pakistan may be made available
unless the Secretary of Defense, in coordination with the Secretary of
State, certifies to the congressional defense committees that the
Government of Pakistan is--
(1) cooperating with the United States in counterterrorism
efforts against the Haqqani Network, the Quetta Shura Taliban,
Lashkar e-Tayyiba, Jaish-e-Mohammed, Al Qaeda, and other
domestic and foreign terrorist organizations, including taking
steps to end support for such groups and prevent them from
basing and operating in Pakistan and carrying out cross border
attacks into neighboring countries;
(2) not supporting terrorist activities against United
States or coalition forces in Afghanistan, and Pakistan's
military and intelligence agencies are not intervening extra-
judicially into political and judicial processes in Pakistan;
(3) dismantling improvised explosive device (IED) networks
and interdicting precursor chemicals used in the manufacture of
IEDs;
(4) preventing the proliferation of nuclear-related
material and expertise;
(5) implementing policies to protect judicial independence
and due process of law;
(6) issuing visas in a timely manner for United States
visitors engaged in counterterrorism efforts and assistance
programs in Pakistan; and
(7) providing humanitarian organizations access to
detainees, internally displaced persons, and other Pakistani
civilians affected by the conflict.
(b) The Secretary of Defense, in coordination with the Secretary of
State, may waive the restriction in subsection (a) on a case-by-case
basis by certifying in writing to the congressional defense committees
that it is in the national security interest to do so: Provided, That
if the Secretary of Defense, in coordination with the Secretary of
State, exercises such waiver authority, the Secretaries shall report to
the congressional defense committees on both the justification for the
waiver and on the requirements of this section that the Government of
Pakistan was not able to meet: Provided further, That such report may
be submitted in classified form if necessary.
(including transfer of funds)
Sec. 1317. In addition to amounts otherwise made available in this
Act, $500,000,000 is hereby appropriated to the Department of Defense
and made available for transfer only to the operation and maintenance,
military personnel, and procurement accounts, to improve the
intelligence, surveillance, and reconnaissance capabilities of the
Department of Defense: Provided, That the transfer authority provided
in this section is in addition to any other transfer authority provided
elsewhere in this Act: Provided further, That not later than 30 days
prior to exercising the transfer authority provided in this section,
the Secretary of Defense shall submit a report to the congressional
defense committees on the proposed uses of these funds: Provided
further, That the funds provided in this section may not be transferred
to any program, project, or activity specifically limited or denied by
this Act: Provided further, That amounts made available by this
section are designated by the Congress for Overseas Contingency
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii)
of the Balanced Budget and Emergency Deficit Control Act of 1985:
Provided further, That the authority to provide funding under this
section shall terminate on September 30, 2018.
Sec. 1318. None of the funds made available by this Act may be
used with respect to Syria in contravention of the War Powers
Resolution (50 U.S.C. 1541 et seq.), including for the introduction of
United States armed or military forces into hostilities in Syria, into
situations in Syria where imminent involvement in hostilities is
clearly indicated by the circumstances, or into Syrian territory,
airspace, or waters while equipped for combat, in contravention of the
congressional consultation and reporting requirements of sections 3 and
4 of that law (50 U.S.C. 1542 and 1543).
(rescissions)
Sec. 1319. Of the funds appropriated in Department of Defense
Appropriations Acts, the following funds are hereby rescinded from the
following accounts and programs in the specified amounts: Provided,
That such amounts are designated by the Congress for Overseas
Contingency Operations/Global War on Terrorism pursuant to section
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control
Act of 1985:
``Other Procurement, Air Force'', 2017/2019, $25,100,000;
``Afghanistan Security Forces Fund'', 2017/2018,
$100,000,000; and
``Counter-ISIL Train and Equip Fund'', 2017/2018,
$112,513,000.
``Operation and Maintenance, Defense-Wide, DSCA Coalition
Support Fund'', 2017/2018, $350,000,000.
Sec. 1320. Each amount designated in this Act by the Congress for
Overseas Contingency Operations/Global War on Terrorism pursuant to
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit
Control Act of 1985 shall be available only if the President
subsequently so designates all such amounts and transmits such
designations to the Congress.
Sec. 1321. (a) Not later than 30 days after the date of the
enactment of this Act, the President shall submit to Congress a report
on the United States strategy to defeat Al-Qaeda, the Taliban, the
Islamic State of Iraq and Syria (ISIS), and their associated forces and
co-belligerents.
(b) The report required under subsection (a) shall include the
following:
(1) An analysis of the adequacy of the existing legal
framework to accomplish the strategy described in subsection
(a), particularly with respect to the Authorization for Use of
Military Force (Public Law 107-40; 50 U.S.C. 1541 note) and the
Authorization for Use of Military Force Against Iraq Resolution
of 2002 (Public Law 107-243; 50 U.S.C. 1541 note).
(2) An analysis of the budgetary resources necessary to
accomplish the strategy described in subsection (a).
(c) Not later than 30 days after the date on which the President
submits to the appropriate congressional committees the report required
by subsection (a), the Secretary of State and the Secretary of Defense
shall testify at any hearing held by any of the appropriate
congressional committees on the report and to which the Secretary is
invited.
(d) In this section, the term ``appropriate congressional
committees'' means--
(1) the Committee on Foreign Relations and the Committee on
Armed Services of the Senate; and
(2) the Committee on Foreign Affairs and the Committee on
Armed Services of the House of Representatives.
Sec. 1322. (a) In addition to amounts provided elsewhere in this
Act, there is hereby appropriated $1,184,112,000, for the following
accounts and programs in the specified amounts for costs associated
with Operation Freedom's Sentinel:
(1) ``Military Personnel, Army'', $48,377,000;
(2) ``Military Personnel, Marine Corps'', $179,000;
(3) ``Military Personnel, Air Force'', $1,340,000;
(4) ``Operation and Maintenance, Army'', $872,491,000;
(5) ``Operation and Maintenance, Navy'', $76,274,000;
(6) ``Operation and Maintenance, Marine Corps'',
$24,734,000;
(7) ``Operation and Maintenance, Defense-Wide'',
$81,164,000;
(8) ``Procurement of Ammunition, Navy and Marine Corps'',
$10,853,000, to remain available until September 30, 2020;
(9) ``Other Procurement, Navy'', $31,500,000, to remain
available until September 30, 2020; and
(10) ``Research, Development, Test and Evaluation, Navy'',
$37,200,000, to remain available until September 30, 2019.
(b) Amounts provided pursuant to this section are hereby designated
by the Congress for Overseas Contingency Operations/Global War on
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget
and Emergency Deficit Control Act of 1985.
TITLE X--ADDITIONAL GENERAL PROVISIONS
references to report
Sec. 1401. Any reference to a ``report accompanying this Act''
contained in this Act shall be treated as a reference to House Report
115-219. Such report shall apply for purposes of determining the
allocation of funds provided by, and the implementation of, this Act.
spending reduction account
Sec. 1402. $0.
Sec. 1403. None of the funds appropriated or otherwise made
available under the heading ``Afghanistan Security Forces Fund'' may be
used to procure uniforms for the Afghan National Army.
Sec. 1404. None of the funds made available in this Act may be
used for the closure of a biosafety level 4 laboratory.
Sec. 1405. None of the funds made available by this Act may be
used to provide arms, training, or other assistance to the Azov
Battalion.
Sec. 1406. None of the finds made available by this Act may be
used to purchase heavy water from Iran.
Sec. 1407. None of the funds appropriated by this Act may be used
to plan for, begin, continue, complete, process, or approve a public-
private competition under the Office of Management and Budget Circular
A-76.
Sec. 1408. Notwithstanding any other provision of law, with
respect to the revised security category (as that term is defined in
section 250(c)(4)(D) of the Balanced Budget and Emergency Deficit
Control Act of 1985), any sequestration order issued under such Act for
fiscal year 2018 shall have no force or effect.
This division may be cited as the ``Department of Defense
Appropriations Act, 2018''.
DIVISION D--MISCELLANEOUS
Sec. 1501. (a) Section 1240B of the Food Security Act of 1985 (16
U.S.C. 3839aa-2) is amended by striking subsection (a) and inserting
the following:
``(a) Establishment.--During each of the 2002 through 2019 fiscal
years, the Secretary shall provide payments to producers that enter
into contracts with the Secretary under the program.''.
(b) Section 1241 of the Food Security Act of 1985 (16 U.S.C. 3841)
is amended--
(1) in subsection (a)--
(A) in the matter preceding paragraph (1), by
striking ``2018'' and inserting ``2018 (and fiscal year
2019 in the case of the program specified in paragraph
(5))''; and
(B) in paragraph (5)(E), by striking ``fiscal year
2018'' and inserting ``each of fiscal years 2018
through 2019''; and
(2) in subsection (b), by striking ``2018'' and inserting
``2018 (and fiscal year 2019 in the case of the program
specified in subsection (a)(5))''.
DIVISION E--TAX MATTERS
SEC. 1601. REPEAL OF SHIFT IN TIME OF PAYMENT OF CORPORATE ESTIMATED
TAXES.
The Trade Preferences Extension Act of 2015 is amended by striking
section 803 (relating to time for payment of corporate estimated
taxes).
DIVISION F--HEALTH PROVISIONS
SEC. 2100. SHORT TITLE.
This division may be cited as the ``Strengthening and Underpinning
the Safety-net to Aid Individuals Needing Care Act of 2018'' or the
``SUSTAIN Care Act of 2018''.
TITLE I--MEDICARE EXTENDERS AND RELATED POLICIES
Subtitle A--Medicare Part A
SEC. 2101. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.
(a) In General.--Section 1886(d)(5)(G) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
(1) in clause (i), by striking ``October 1, 2017'' and
inserting ``October 1, 2019'';
(2) in clause (ii)(II), by striking ``October 1, 2017'' and
inserting ``October 1, 2019''; and
(3) in clause (iv)--
(A) by amending subclause (I) to read as follows:
``(I) that--
``(aa) is located in a
rural area; or
``(bb) for discharges
occurring on or after October
1, 2017, is located in a State
with no rural area (as defined
in paragraph (2)(D)) and
satisfies any of the criteria
in subclause (I), (II), (III),
or (IV) of paragraph
(8)(E)(ii),''; and
(B) by adding at the end, after and below subclause
(IV), the following flush sentence:
``For purposes of applying subclause (II) of paragraph (8)(E)(ii) under
subclause (I)(bb), such subclause (II) shall be applied by inserting
`as of January 1, 2018,' after `such State' each place it appears.''.
(b) Conforming Amendments.--
(1) Extension of target amount.--Section 1886(b)(3)(D) of
the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is
amended--
(A) in the matter preceding clause (i), by striking
``October 1, 2017'' and inserting ``October 1, 2019'';
and
(B) in clause (iv), by striking ``through fiscal
year 2017'' and inserting ``through fiscal year 2019''.
(2) Permitting hospitals to decline reclassification.--
Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of
1993 (42 U.S.C. 1395ww note) is amended by striking ``through
fiscal year 2017'' and inserting ``through fiscal year 2019''.
SEC. 2102. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT
FOR CERTAIN LOW-VOLUME HOSPITALS.
Section 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(12)) is amended--
(1) in subparagraph (B), in the matter preceding clause
(i), by striking ``fiscal year 2018'' and inserting ``fiscal
year 2020'';
(2) in subparagraph (C)(i), by striking ``fiscal years 2011
through 2017'' and inserting ``fiscal years 2011 through 2019''
each place it appears; and
(3) in subparagraph (D), by striking ``fiscal years 2011
through 2017'' and inserting ``fiscal years 2011 through
2019''.
SEC. 2103. STUDIES RELATING TO HOSPITAL PROGRAMS PAID OUTSIDE OF
PROSPECTIVE PAYMENT SYSTEMS.
(a) MedPAC Report.--Using data from hospital programs with respect
to which hospitals receive payment outside of the prospective payment
systems under sections 1833 and 1886 of the Social Security Act (42
U.S.C. 1395l; 42 U.S.C. 1395ww) (such programs referred to in this
subsection as ``PPS carve-out programs'') or other data, as available,
not later than June 30, 2019, the Medicare Payment Advisory Commission
shall submit to Congress a report that evaluates and recommends changes
to PPS carve-out programs, including with respect to amendments made by
sections 2101 and 2102 of this Act, sections 1814, 1820,
1886(d)(5)(D)(iii), and 1115(A) of the Social Security Act, and such
other sections of title XVIII of the Social Security Act deemed
appropriate. To the extent feasible, such report shall make
recommendations on a payment methodology under the Medicare program for
hospital payments, including with respect to PPS carve-out programs,
that differs from the payment methodology applicable to such programs
as of September 30, 2017.
(b) MedPAC Recommendations for Possible Alternative Payments.--Not
later than 2 years after the date by which the Secretary of Health and
Human Services has collected 2 years of data under sections
1886(d)(5)(G) and 1886(d)(12) of the Social Security Act (42 U.S.C.
1395ww(d)(5)(G); 42 U.S.C. 1395ww(d)(12)), as extended pursuant to
sections 2101 and 2102 of this Act, the Medicare Payment Advisory
Commission shall submit to Congress a report, including--
(1) recommendations on payments, including a technical
prototype for payments for PPS carve-out programs, if
warranted;
(2) recommendations, if any, on which Medicare fee-for-
service regulations for hospital payments under title XVIII of
the Social Security Act should be altered (such as the critical
access hospital 96-hour rule);
(3) an analysis of the impact of the recommended payments
described in paragraph (1) on Medicare beneficiary cost-
sharing, access to care, and choice of setting;
(4) a projection of any potential reduction in expenditures
under title XVIII of the Social Security Act that may be
attributable to the application of the recommended payments
described in paragraph (1);
(5) a review of the value of hospitals participating in PPS
carve-out programs collecting and reporting to the Secretary
standardized patient assessment data with respect to inpatient
hospital services;
(6) the types of rural hospital classifications and payment
methodologies under the Medicare program, including information
on each special payment structure such as eligibility criteria,
and any areas of overlap between such special payment programs;
(7) Medicare spending on each PPS carve-out program;
(8) the financial aspects of hospitals participating in
such PPS carve-out programs, such as the share of discharges
under the Medicare and Medicaid programs; and
(9) whether such payment programs are empirically justified
to support Medicare beneficiary access to care.
SEC. 2104. EXTENSION OF HOME HEALTH RURAL ADD-ON.
(a) Extension.--
(1) In general.--Section 421 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law
108-173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended by
section 5201(b) of the Deficit Reduction Act of 2005 (Public
Law 109-171; 120 Stat. 46), section 3131(c) of the Patient
Protection and Affordable Care Act (Public Law 111-148; 124
Stat. 428), and section 210 of the Medicare Access and CHIP
Reauthorization Act of 2015 (Public Law 114-10; 129 Stat. 151)
is amended--
(A) in subsection (a), by striking ``January 1,
2018'' and inserting ``January 1, 2019'' each place it
appears;
(B) by redesignating subsections (b) and (c) as
subsections (c) and (d), respectively;
(C) in each of subsections (c) and (d), as so
redesignated, by striking ``subsection (a)'' and
inserting ``subsection (a) or (b)''; and
(D) by inserting after subsection (a) the following
new subsection:
``(b) Subsequent Temporary Increase.--
``(1) In general.--The Secretary shall increase the payment
amount otherwise made under such section 1895 for home health
services furnished in a county (or equivalent area) in a rural
area (as defined in such section 1886(d)(2)(D)) that, as
determined by the Secretary--
``(A) is in the highest quartile of all counties
(or equivalent areas) based on the number of Medicare
home health episodes furnished per 100 individuals who
are entitled to, or enrolled for, benefits under part A
of title XVIII of the Social Security Act or enrolled
for benefits under part B of such title (but not
enrolled in a plan under part C of such title)--
``(i) in the case of episodes and visits
ending during 2019, by 1.5 percent; and
``(ii) in the case of episodes and visits
ending during 2020, by 0.5 percent;
``(B) has a population density of 6 individuals or
fewer per square mile of land area and is not described
in subparagraph (A)--
``(i) in the case of episodes and visits
ending during 2019, by 4 percent;
``(ii) in the case of episodes and visits
ending during 2020, by 3 percent;
``(iii) in the case of episodes and visits
ending during 2021, by 2 percent; and
``(iv) in the case of episodes and visits
ending during 2022, by 1 percent; and
``(C) is not described in either subparagraph (A)
or (B)--
``(i) in the case of episodes and visits
ending during 2019, by 3 percent;
``(ii) in the case of episodes and visits
ending during 2020, by 2 percent; and
``(iii) in the case of episodes and visits
ending during 2021, by 1 percent.
``(2) Rules for determinations.--
``(A) No switching.--For purposes of this
subsection, the determination by the Secretary as to
which subparagraph of paragraph (1) applies to a county
(or equivalent area) shall be made a single time and
shall apply for the duration of the period to which
this subsection applies.
``(B) Utilization.--In determining which counties
(or equivalent areas) are in the highest quartile under
paragraph (1)(A), the following rules shall apply:
``(i) The Secretary shall use data from
2015.
``(ii) The Secretary shall exclude data
from the territories (and the territories shall
not be described in such paragraph).
``(iii) The Secretary may exclude data from
counties (or equivalent areas) in rural areas
with a low volume of home health episodes (and
if data is so excluded with respect to a county
(or equivalent area), such county (or
equivalent area) shall not be described in such
paragraph).
``(C) Population density.--In determining
population density under paragraph (1)(B), the
Secretary shall use data from the 2010 decennial
Census.
``(3) Limitations on review.--There shall be no
administrative or judicial review under section 1869, section
1878, or otherwise of determinations under paragraph (1).''.
(2) Requirement to submit county data on claim form.--
Section 1895(c) of the Social Security Act (42 U.S.C.
1395fff(c)) is amended--
(A) in paragraph (1), by striking ``and'' at the
end;
(B) in paragraph (2), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new
paragraph:
``(3) in the case of home health services furnished on or
after January 1, 2019, the claim contains the code for the
county (or equivalent area) in which the home health service
was furnished.''.
(b) OIG Review.--The Office of the Inspector General shall submit
to Congress, not later than January 1, 2020, and annually thereafter
through January 1, 2024, a report containing--
(1) an analysis of payments made under section 1895 of the
Social Security Act (42 U.S.C. 1395fff) increased under section
421 of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283;
42 U.S.C. 1395fff note), as amended by section 5201(b) of the
Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat.
46), section 3131(c) of the Patient Protection and Affordable
Care Act (Public Law 111-148; 124 Stat. 428), section 210 of
the Medicare Access and CHIP Reauthorization Act of 2015
(Public Law 114-10; 129 Stat. 151), and subsection (a); and
(2) a recommendation on whether such payments should
continue to be made based on county data.
Subtitle B--Medicare Part B
SEC. 2111. GROUND AMBULANCE SERVICES COST REPORTING REQUIREMENT.
(a) In General.--Section 1121 of the Social Security Act (42 U.S.C.
1320a) is amended--
(1) in subsection (a)--
(A) by striking ``For the purposes of'' and
inserting ``Subject to subsection (d), for the purposes
of'';
(B) by inserting ``suppliers of ground ambulance
services,'' after ``health maintenance
organizations,''; and
(C) in the matter following paragraph (5), by
adding the following new sentence: ``Not later than
December 31, 2019, the Secretary shall modify the
uniform reporting systems for providers of services
with respect to ground ambulance services to ensure
that such systems contain information similar (as
determined by the Secretary) to information required
under the uniform reporting system for suppliers of
ground ambulance services.''; and
(2) by adding at the end the following new subsection:
``(d) In the case of a provider or supplier of ground ambulance
services, the Secretary may modify the requirements for the inclusion
of any data element specified in subsection (a) in reports made in
accordance with the uniform reporting system established under this
section with respect to such services for such provider or supplier.''.
(b) Suspension of Payment for Ground Ambulance Services; Deeming
Certain Payments Overpayments.--Section 1834(l) of the Social Security
Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following
new paragraph:
``(17) Requirement to submit cost report and authority to
suspend payments and deem certain payments overpayments for
ground ambulance services.--
``(A) In general.--With respect to ground ambulance
services furnished by a supplier of such services
during cost reporting periods (as defined in
subparagraph (I)) beginning on or after January 1,
2020, such supplier shall make reports to the Secretary
of information described in section 1121(a) in
accordance with the uniform reporting system
established under such section for such suppliers and,
as may be required by the Secretary, of any of the
information described in subparagraph (B).
``(B) Additional information.--The Secretary may,
with respect to a supplier of ground ambulance
services, require the following information (to be
reported to the extent practicable under the uniform
reporting system established under section 1121(a) for
such suppliers):
``(i) Whether the supplier is part of an
emergency services department, a governmental
organization, or another type of entity (as
described by the Secretary).
``(ii) The number of hours in a week during
which the supplier is available for furnishing
ground ambulance services.
``(iii) The average number of volunteer
hours a week used by the supplier.
``(C) Suspension of payment.--Subject to
subparagraph (E), in the case that the Secretary
determines that a supplier of ground ambulance services
has not made to the Secretary a timely report described
in subparagraph (A) with respect to a cost reporting
period beginning on or after January 1, 2020, and
before January 1, 2022, the Secretary may suspend
payments made under this subsection, in whole or in
part, to such supplier until the Secretary determines
that such supplier has made such a report.
``(D) Deeming certain payments overpayments.--
Subject to subparagraphs (E) and (F), in the case that
the Secretary determines that a supplier of ground
ambulance services has not made to the Secretary a
complete, accurate, and timely report described in
subparagraph (A) with respect to a cost reporting
period beginning on or after January 1, 2022, the
Secretary may either--
``(i) deem payments made under this
subsection to such supplier for such period to
be overpayments and recoup such overpayments;
or
``(ii) suspend payments made under this
subsection to such supplier for such period.
``(E) Hardship delay.--The Secretary shall
establish a process whereby a supplier of ground
ambulance services may request a delay in making a
report described in subparagraph (A) with respect to a
cost reporting period for reason of significant
hardship (as determined by the Secretary).
``(F) Authority to modify cost reporting elements
and enforcement.--Not earlier than January 1, 2024, the
Secretary may provide that subparagraph (D) no longer
applies to suppliers of ground ambulance services or a
category of such suppliers after--
``(i) taking into account the
recommendation of the Medicare Payment Advisory
Commission in the most recent report available
to the Secretary submitted under section
2111(g) of the SUSTAIN Care Act of 2018 whether
cost reports made by suppliers or a category of
suppliers (as specified for purposes of the
report submitted under such section) of ground
ambulance services should be required or
modified; and
``(ii) undertaking notice and comment
rulemaking.
``(G) Audit of cost reports.--The Secretary shall
audit reports described in subparagraph (A) made with
respect to cost reporting periods beginning on or after
January 1, 2021.
``(H) Appeals.--The Secretary shall establish a
process whereby a supplier of ground ambulance services
may appeal a determination described in subparagraph
(C) or (D) made with respect to a cost report required
to be made by such supplier under subparagraph (A).
``(I) Definition.--In this paragraph, the term
`cost reporting period' means, with respect to a year,
the 12-month period beginning on January 1 of such
year.''.
(c) Stakeholder Feedback.--
(1) In general.--The Secretary of Health and Human Services
shall implement the provisions of this section, including the
amendments made by this section, through notice and comment
rulemaking and seek input from stakeholders.
(2) Nonapplication of paperwork reduction act.--Chapter 35
of title 44, United States Code, shall not apply with respect
to--
(A) the development and implementation of the
uniform reporting system required under section 1121(a)
of the Social Security Act (42 U.S.C. 1320a(a)) for
suppliers of ground ambulance services and reports
required to be made under section 1834(l)(17) of such
Act (42 U.S.C. 1395m(l)(17)); and
(B) the modification of the uniform reporting
systems under such section 1121(a) of such Act for
providers of such services and reports required to be
made under section 1861(v)(1)(F) of such Act (42 U.S.C.
1395x(v)(1)(F)).
(d) Implementation Resources.--In addition to funds otherwise
available, there are appropriated to the Centers for Medicare &
Medicaid Services Program Management Account from the Federal Hospital
Insurance Trust Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) $8,000,000 and from the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t)
$137,000,000 (of which not less than $15,000,000 shall be used to
fulfill the auditing requirement under section 1834(l)(17)(G) of such
Act, as added by subsection (b) of this section) to carry out the
provisions of this section, including the amendments made by this
section, to remain available through December 31, 2022. Of the amounts
appropriated under the previous sentence, the Secretary shall use such
sums as may be necessary to hire not less than 2 full-time employees
for purposes of carrying out such provisions, including such
amendments.
(e) Extension of Rural Add-on Payments.--Section 1834(l) of the
Social Security Act (42. U.S.C. 1395m(l)) is amended--
(1) in paragraph (12)(A), by striking ``2018'' and
inserting ``2023''; and
(2) in paragraph (13)(A), by striking ``2018'' each place
it appears and inserting ``2023''.
(f) Sense of Congress.--It is the sense of Congress that--
(1) a cost report made by a supplier of ground ambulance
services with respect to a cost reporting period beginning
before January 1, 2022, may not contain complete and accurate
information on ground ambulance services furnished during such
a period by the supplier; and
(2) the Secretary should take into account only the
timeliness of such a report made with respect to such a period
when determining whether to suspend payments to a supplier
under section 1834(l) of the Social Security Act (42 U.S.C.
1395m(l)).
(g) Ground Ambulance Services Cost Reporting Study.--
(1) In general.--Not later than March 15, 2023, and as
determined necessary by the Medicare Payment Advisory
Commission thereafter, such Commission shall assess and submit
to Congress a report on cost reports of suppliers and providers
of ground ambulance services carried out in accordance with
sections 1121(a) and 1834(l) of the Social Security Act (42
U.S.C. 1320a(a), 1395m(l)), the adequacy of payments for such
services made under section 1834(l) of such Act, and geographic
variations in the cost of providing such services.
(2) Contents.--The report described in paragraph (1) shall
contain the following:
(A) An analysis of cost report data submitted in
accordance with such sections.
(B) An analysis of any burden on providers and
suppliers of such services associated with reporting
such data.
(C) A recommendation on whether or not cost reports
of ground ambulance services made by suppliers or a
category of suppliers (as specified by the Secretary)
of such services, or the ground ambulance portion of
cost reports made by providers of such services, should
be required or modified, taking into account the
analyses described in subparagraphs (A) and (B).
SEC. 2112. EXTENSION OF WORK GPCI FLOOR.
Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 1, 2018'' and inserting
``January 1, 2020''.
SEC. 2113. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES;
REPLACEMENT WITH LIMITATION TO ENSURE APPROPRIATE
THERAPY.
Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is
amended--
(1) in paragraph (1)--
(A) by striking ``Subject to paragraphs (4) and
(5)'' and inserting ``(A) Subject to paragraphs (4) and
(5)'';
(B) in the subparagraph (A), as inserted and
designated by subparagraph (A) of this paragraph, by
adding at the end the following new sentence: ``The
preceding sentence shall not apply to expenses incurred
with respect to services furnished after December 31,
2017.''; and
(C) by adding at the end the following new
subparagraph:
``(B) With respect to services furnished during 2018 or a
subsequent year, in the case of physical therapy services of the type
described in section 1861(p), speech-language pathology services of the
type described in such section through the application of section
1861(ll)(2), and physical therapy services and speech-language
pathology services of such type which are furnished by a physician or
as incident to physicians' services, with respect to expenses incurred
in any calendar year, any amount that is more than the amount specified
in paragraph (2) for the year shall not be considered as incurred
expenses for purposes of subsections (a) and (b) unless the applicable
requirements of paragraph (7) are met.'';
(2) in paragraph (3)--
(A) by striking ``Subject to paragraphs (4) and
(5)'' and inserting ``(A) Subject to paragraphs (4) and
(5)'';
(B) in the subparagraph (A), as inserted and
designated by subparagraph (A) of this paragraph, by
adding at the end the following new sentence: ``The
preceding sentence shall not apply to expenses incurred
with respect to services furnished after December 31,
2017.''; and
(C) by adding at the end the following new
subparagraph:.
``(B) With respect to services furnished during 2018 or a
subsequent year, in the case of occupational therapy services (of the
type that are described in section 1861(p) through the operation of
section 1861(g) and of such type which are furnished by a physician or
as incident to physicians' services), with respect to expenses incurred
in any calendar year, any amount that is more than the amount specified
in paragraph (2) for the year shall not be considered as incurred
expenses for purposes of subsections (a) and (b) unless the applicable
requirements of paragraph (7) are met.'';
(3) in paragraph (5)--
(A) by redesignating subparagraph (D) as paragraph
(8) and moving such paragraph to immediately follow
paragraph (7), as added by paragraph (4) of this
section; and
(B) in subparagraph (E)(iv), by inserting ``,
except as such process is applied under paragraph
(7)(B)'' before the period at the end; and
(4) by adding at the end the following new paragraph:
``(7) For purposes of paragraphs (1)(B) and (3)(B), with respect to
services described in such paragraphs, the requirements described in
this paragraph are as follows:
``(A) Inclusion of appropriate modifier.--The claim for
such services contains an appropriate modifier (such as the KX
modifier described in paragraph (5)(B)) indicating that such
services are medically necessary as justified by appropriate
documentation in the medical record involved.
``(B) Targeted medical review for certain services above
threshold.--
``(i) In general.--In the case where expenses that
would be incurred for such services would exceed the
threshold described in clause (ii) for the year, such
services shall be subject to the process for medical
review implemented under paragraph (5)(E).
``(ii) Threshold.--The threshold under this clause
for--
``(I) a year before 2028, is $3,000;
``(II) 2028, is the amount specified in
subclause (I) increased by the percentage
increase in the MEI (as defined in section
1842(i)(3)) for 2028; and
``(III) a subsequent year, is the amount
specified in this clause for the preceding year
increased by the percentage increase in the MEI
(as defined in section 1842(i)(3)) for such
subsequent year;
except that if an increase under subclause (II) or
(III) for a year is not a multiple of $10, it shall be
rounded to the nearest multiple of $10.
``(iii) Application.--The threshold under clause
(ii) shall be applied separately--
``(I) for physical therapy services and
speech-language pathology services; and
``(II) for occupational therapy services.
``(iv) Funding.--For purposes of carrying out this
subparagraph, the Secretary shall provide for the
transfer, from the Federal Supplementary Medical
Insurance Trust Fund under section 1841 to the Centers
for Medicare & Medicaid Services Program Management
Account, of $5,000,000 for each fiscal year beginning
with fiscal year 2018, to remain available until
expended. Such funds may not be used by a contractor
under section 1893(h) for medical reviews under this
subparagraph.''.
Subtitle C--Miscellaneous
SEC. 2121. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE SPECIAL
NEEDS PLANS FOR VULNERABLE POPULATIONS.
(a) Extension.--Section 1859(f)(1) of the Social Security Act (42
U.S.C. 1395w-28(f)(1)) is amended by striking ``and for periods before
January 1, 2019''.
(b) Increased Integration of Dual SNPs.--
(1) In general.--Section 1859(f) of the Social Security Act
(42 U.S.C. 1395w-28(f)) is amended--
(A) in paragraph (3), by adding at the end the
following new subparagraph:
``(F) The plan meets the requirements applicable
under paragraph (8).''; and
(B) by adding at the end the following new
paragraph:
``(8) Increased integration of dual snps.--
``(A) Designated contact.--The Secretary, acting
through the Federal Coordinated Health Care Office
established under section 2602 of Public Law 111-148,
shall serve as a dedicated point of contact for States
to address misalignments that arise with the
integration of specialized MA plans for special needs
individuals described in subsection (b)(6)(B)(ii) under
this paragraph and, consistent with such role, shall
establish--
``(i) a uniform process for disseminating
to State Medicaid agencies information under
this title impacting contracts between such
agencies and such plans under this subsection;
and
``(ii) basic resources for States
interested in exploring such plans as a
platform for integration, such as a model
contract or other tools to achieve those goals.
``(B) Unified grievances and appeals process.--
``(i) In general.--Not later than April 1,
2020, the Secretary shall establish procedures,
to the extent feasible as determined by the
Secretary, unifying grievances and appeals
procedures under sections 1852(f), 1852(g),
1902(a)(3), 1902(a)(5), and 1932(b)(4) for
items and services provided by specialized MA
plans for special needs individuals described
in subsection (b)(6)(B)(ii) under this title
and title XIX. With respect to items and
services described in the preceding sentence,
procedures established under this clause shall
apply in place of otherwise applicable
grievances and appeals procedures. The
Secretary shall solicit comment in developing
such procedures from States, plans,
beneficiaries and their representatives, and
other relevant stakeholders.
``(ii) Procedures.--The procedures
established under clause (i) shall be included
in the plan contract under paragraph (3)(D) and
shall--
``(I) adopt the provisions for the
enrollee that are most protective for
the enrollee and, to the extent
feasible as determined by the
Secretary, are compatible with unified
timeframes and consolidated access to
external review under an integrated
process;
``(II) take into account
differences in State plans under title
XIX to the extent necessary;
``(III) be easily navigable by an
enrollee; and
``(IV) include the elements
described in clause (iii), as
applicable.
``(iii) Elements described.--Both unified
appeals and unified grievance procedures shall
include, as applicable, the following elements
described in this clause:
``(I) Single written notification
of all applicable grievances and appeal
rights under this title and title XIX.
For purposes of this subparagraph, the
Secretary may waive the requirements
under section 1852(g)(1)(B) when the
specialized MA plan covers items or
services under this part or under title
XIX.
``(II) Single pathways for
resolution of any grievance or appeal
related to a particular item or service
provided by specialized MA plans for
special needs individuals described in
subsection (b)(6)(B)(ii) under this
title and title XIX.
``(III) Notices written in plain
language and available in a language
and format that is accessible to the
enrollee, including in non-English
languages that are prevalent in the
service area of the specialized MA
plan.
``(IV) Unified timeframes for
grievances and appeals processes, such
as an individual's filing of a
grievance or appeal, a plan's
acknowledgment and resolution of a
grievance or appeal, and notification
of decisions with respect to a
grievance or appeal.
``(V) Requirements for how the plan
must process, track, and resolve
grievances and appeals, to ensure
beneficiaries are notified on a timely
basis of decisions that are made
throughout the grievance or appeals
process and are able to easily
determine the status of a grievance or
appeal.
``(iv) Continuation of benefits pending
appeal.--The unified procedures under clause
(i) shall, with respect to all benefits under
parts A and B and title XIX subject to appeal
under such procedures, incorporate provisions
under current law and implementing regulations
that provide continuation of benefits pending
appeal under this title and title XIX.
``(C) Requirement for unified grievances and
appeals.--For 2021 and subsequent years, the contract
of a specialized MA plan for special needs individuals
described in subsection (b)(6)(B)(ii) with a State
Medicaid agency under paragraph (3)(D) shall require
the use of unified grievances and appeals procedures as
described in subparagraph (B).
``(D) Requirements for integration.--
``(i) In general.--For 2021 and subsequent
years, a specialized MA plan for special needs
individuals described in subsection
(b)(6)(B)(ii) shall meet one or more of the
following requirements, to the extent permitted
under State law, for integration of benefits
under this title and title XIX:
``(I) The specialized MA plan must
meet the requirements of contracting
with the State Medicaid agency
described in paragraph (3)(D) in
addition to coordinating long-term
services and supports or behavioral
health services, or both, by meeting an
additional minimum set of requirements
determined by the Secretary through the
Federal Coordinated Health Care Office
established under section 2602 of the
Patient Protection and Affordable Care
Act based on input from stakeholders,
such as notifying the State in a timely
manner of hospitalizations, emergency
room visits, and hospital or nursing
home discharges of enrollees, assigning
one primary care provider for each
enrollee, or sharing data that would
benefit the coordination of items and
services under this title and the State
plan under title XIX. Such minimum set
of requirements must be included in the
contract of the specialized MA plan
with the State Medicaid agency under
such paragraph.
``(II) The specialized MA plan must
meet the requirements of a fully
integrated plan described in section
1853(a)(1)(B)(iv)(II) (other than the
requirement that the plan have similar
average levels of frailty, as
determined by the Secretary, as the
PACE program), or enter into a
capitated contract with the State
Medicaid agency to provide long-term
services and supports or behavioral
health services, or both.
``(III) In the case of a
specialized MA plan that is offered by
a parent organization that is also the
parent organization of a Medicaid
managed care organization providing
long term services and supports or
behavioral services under a contract
under section 1903(m), the parent
organization must assume clinical and
financial responsibility for benefits
provided under this title and title XIX
with respect to any individual who is
enrolled in both the specialized MA
plan and the Medicaid managed care
organization.
``(ii) Suspension of enrollment for failure
to meet requirements during initial period.--
During the period of plan years 2021 through
2025, if the Secretary determines that a
specialized MA plan for special needs
individuals described in subsection
(b)(6)(B)(ii) has failed to comply with clause
(i), the Secretary may provide for the
application against the Medicare Advantage
organization offering the plan of the remedy
described in section 1857(g)(2)(B) in the same
manner as the Secretary may apply such remedy,
and in accordance with the same procedures as
would apply, in the case of an MA organization
determined by the Secretary to have engaged in
conduct described in section 1857(g)(1). If the
Secretary applies such remedy to a Medicare
Advantage organization under the preceding
sentence, the organization shall submit to the
Secretary (at a time, and in a form and manner,
specified by the Secretary) information
describing how the plan will come into
compliance with clause (i).
``(E) Study and report to congress.--
``(i) In general.--Not later than January
1, 2022, and, subject to clause (iii),
biennially thereafter through 2032, the
Medicare Payment Advisory Commission
established under section 1805, in consultation
with the Medicaid and CHIP Payment and Access
Commission established under section 1900,
shall conduct (and submit to the Secretary and
the Committees on Ways and Means and Energy and
Commerce of the House of Representatives and
the Committee on Finance of the Senate a report
on) a study to determine how specialized MA
plans for special needs individuals described
in subsection (b)(6)(B)(ii) perform among each
other based on data from Healthcare
Effectiveness Data and Information Set (HEDIS)
quality measures, reported on the plan level,
as required under section 1852(e)(3) (or such
other measures or data sources that are
available and appropriate, such as encounter
data and Consumer Assessment of Healthcare
Providers and Systems data, as specified by
such Commissions as enabling an accurate
evaluation under this subparagraph). Such study
shall include, as feasible, the following
comparison groups of specialized MA plans for
special needs individuals described in
subsection (b)(6)(B)(ii):
``(I) A comparison group of such
plans that are described in
subparagraph (D)(i)(I).
``(II) A comparison group of such
plans that are described in
subparagraph (D)(i)(II).
``(III) A comparison group of such
plans operating within the Financial
Alignment Initiative demonstration for
the period for which such plan is so
operating and the demonstration is in
effect, and, in the case that an
integration option that is not with
respect to specialized MA plans for
special needs individuals is
established after the conclusion of the
demonstration involved.
``(IV) A comparison group of such
plans that are described in
subparagraph (D)(i)(III).
``(V) A comparison group of MA
plans, as feasible, not described in a
previous subclause of this clause, with
respect to the performance of such
plans for enrollees who are special
needs individuals described in
subsection (b)(6)(B)(ii).
``(ii) Discretionary additional reports.--
Beginning with 2033 and every five years
thereafter, the Medicare Payment Advisory
Commission, in consultation with the Medicaid
and CHIP Payment and Access Commission shall,
at the discretion of the Secretary, conduct a
study described in clause (i).''.
(2) Conforming amendment to responsibilities of federal
coordinated health care office.--Section 2602(d) of Public Law
111-148 (42 U.S.C. 1315b(d)) is amended by adding at the end
the following new paragraphs:
``(6) To act as a designated contact for States under
subsection (f)(8)(A) of section 1859 of the Social Security Act
(42 U.S.C. 1395w-28) with respect to the integration of
specialized MA plans for special needs individuals described in
subsection (b)(6)(B)(ii) of such section.
``(7) To be responsible, subject to the final approval of
the Secretary, for developing regulations and guidance related
to the implementation of a unified grievance and appeals
process as described in subparagraphs (B) and (C) of section
1859(f)(8) of the Social Security Act (42 U.S.C. 1395w-
28(f)(8)).
``(8) To be responsible, subject to the final approval of
the Secretary, for developing regulations and guidance related
to the integration or alignment of policy and oversight under
the Medicare program under title XVIII of such Act and the
Medicaid program under title XIX of such Act regarding
specialized MA plans for special needs individuals described in
subsection (b)(6)(B)(ii) of such section 1859.''.
(c) Improvements to Severe or Disabling Chronic Condition SNPs.--
(1) Care management requirements.--Section 1859(f)(5) of
the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is amended--
(A) by striking ``all snps.--The requirements'' and
inserting ``all snps.--
``(A) In general.--Subject to subparagraph (B), the
requirements'';
(B) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively, and indenting
appropriately; and
(C) in clause (ii), as redesignated by subparagraph
(B), by redesignating clauses (i) through (iii) as
subclauses (I) through (III), respectively, and
indenting appropriately; and
(D) by adding at the end the following new
subparagraph:
``(B) Improvements to care management requirements
for severe or disabling chronic condition snps.--For
2020 and subsequent years, in the case of a specialized
MA plan for special needs individuals described in
subsection (b)(6)(B)(iii), the requirements described
in this paragraph include the following:
``(i) The interdisciplinary team under
subparagraph (A)(ii)(III) includes a team of
providers with demonstrated expertise,
including training in an applicable specialty,
in treating individuals similar to the targeted
population of the plan.
``(ii) Requirements developed by the
Secretary to provide face-to-face encounters
with individuals enrolled in the plan not less
frequently than on an annual basis.
``(iii) As part of the model of care under
clause (i) of subparagraph (A), the results of
the initial assessment and annual reassessment
under clause (ii)(I) of such subparagraph of
each individual enrolled in the plan are
addressed in the individual's individualized
care plan under clause (ii)(II) of such
subparagraph.
``(iv) As part of the annual evaluation and
approval of such model of care, the Secretary
shall take into account whether the plan
fulfilled the previous year's goals (as
required under the model of care).
``(v) The Secretary shall establish a
minimum benchmark for each element of the model
of care of a plan. The Secretary shall only
approve a plan's model of care under this
paragraph if each element of the model of care
meets the minimum benchmark applicable under
the preceding sentence.''.
(2) Revisions to the definition of a severe or disabling
chronic conditions specialized needs individual.--
(A) In general.--Section 1859(b)(6)(B)(iii) of the
Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii))
is amended--
(i) by striking ``who have'' and inserting
``who--
``(I) before January 1, 2022,
have'';
(ii) in subclause (I), as added by clause
(i), by striking the period at the end and
inserting ``; and''; and
(iii) by adding at the end the following
new subclause:
``(II) on or after January 1, 2022,
have one or more comorbid and medically
complex chronic conditions that is life
threatening or significantly limits
overall health or function, have a high
risk of hospitalization or other
adverse health outcomes, and require
intensive care coordination and that is
listed under subsection (f)(9)(A).''.
(B) Panel of clinical advisors.--Section 1859(f) of
the Social Security Act (42 U.S.C. 1395w-28(f)), as
amended by subsection (b), is amended by adding at the
end the following new paragraph:
``(9) List of conditions for clarification of the
definition of a severe or disabling chronic conditions
specialized needs individual.--
``(A) In general.--Not later than December 31,
2020, and every 5 years thereafter, subject to
subparagraphs (B) and (C), the Secretary shall convene
a panel of clinical advisors to establish and update a
list of conditions that meet each of the following
criteria:
``(i) Conditions that meet the definition
of a severe or disabling chronic condition
under subsection (b)(6)(B)(iii) on or after
January 1, 2022.
``(ii) Conditions that require prescription
drugs, providers, and models of care that are
unique to the specific population of enrollees
in a specialized MA plan for special needs
individuals described in such subsection on or
after such date and--
``(I) as a result of access to, and
enrollment in, such a specialized MA
plan for special needs individuals,
individuals with such condition would
have a reasonable expectation of
slowing or halting the progression of
the disease, improving health outcomes
and decreasing overall costs for
individuals diagnosed with such
condition compared to available options
of care other than through such a
specialized MA plan for special needs
individuals; or
``(II) have a low prevalence in the
general population of beneficiaries
under this title or a disproportionally
high per-beneficiary cost under this
title.
``(B) Inclusion of certain conditions.--The
conditions listed under subparagraph (A) shall include
HIV/AIDS, end stage renal disease, and chronic and
disabling mental illness.
``(C) Requirement.--In establishing and updating
the list under subparagraph (A), the panel shall take
into account the availability of varied benefits, cost-
sharing, and supplemental benefits under the model
described in paragraph (2) of section 1859(h),
including the expansion under paragraph (1) of such
section.''.
(d) Quality Measurement at the Plan Level for SNPs and
Determination of Feasability of Quality Measurement at the Plan Level
for All MA Plans.--Section 1853(o) of the Social Security Act (42
U.S.C. 1395w-23(o)) is amended by adding at the end the following new
paragraphs:
``(6) Quality measurement at the plan level for snps.--
``(A) In general.--Subject to subparagraph (B), the
Secretary may require reporting of data under section
1852(e) for, and apply under this subsection, quality
measures at the plan level for specialized MA plans for
special needs individuals instead of at the contract
level.
``(B) Considerations.--Prior to applying quality
measurement at the plan level under this paragraph, the
Secretary shall--
``(i) take into consideration the minimum
number of enrollees in a specialized MA plan
for special needs individuals in order to
determine if a statistically significant or
valid measurement of quality at the plan level
is possible under this paragraph;
``(ii) take into consideration the impact
of such application on plans that serve a
disproportionate number of individuals dually
eligible for benefits under this title and
under title XIX;
``(iii) if quality measures are reported at
the plan level, ensure that MA plans are not
required to provide duplicative information;
and
``(iv) ensure that such reporting does not
interfere with the collection of encounter data
submitted by MA organizations or the
administration of any changes to the program
under this part as a result of the collection
of such data.
``(C) Application.--If the Secretary applies
quality measurement at the plan level under this
paragraph--
``(i) such quality measurement may include
Medicare Health Outcomes Survey (HOS),
Healthcare Effectiveness Data and Information
Set (HEDIS), Consumer Assessment of Healthcare
Providers and Systems (CAHPS) measures and
quality measures under part D; and
``(ii) the Secretary shall consider
applying administrative actions, such as
remedies described in section 1857(g)(2), at
the plan level.
``(7) Determination of feasibility of quality measurement
at the plan level for all ma plans.--
``(A) Determination of feasibility.--The Secretary
shall determine the feasibility of requiring reporting
of data under section 1852(e) for, and applying under
this subsection, quality measures at the plan level for
all MA plans under this part.
``(B) Consideration of change.--After making a
determination under subparagraph (A), the Secretary
shall consider requiring such reporting and applying
such quality measures at the plan level as described in
such subparagraph''.
(e) GAO Study and Report on State-Level Integration Between Dual
SNPs and Medicaid.--
(1) Study.--The Comptroller General of the United States
(in this subsection referred to as the ``Comptroller General'')
shall conduct a study on State-level integration between
specialized MA plans for special needs individuals described in
subsection (b)(6) (B)(ii) of section 1859 of the Social
Security Act (42 U.S.C. 1395w-28) and the Medicaid program
under title XIX of such Act (42 U.S.C. 1396 et seq.). Such
study shall include an analysis of the following:
(A) The characteristics of States in which the
State agency responsible for administering the State
plan under such title XIX has a contract with such a
specialized MA plan and that delivers long-term
services and supports under the State plan under such
title XIX through a managed care program, including the
requirements under such State plan with respect to
long-term services and supports.
(B) The types of such specialized MA plans, which
may include the following:
(i) A plan described in section
1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C.
1395w-23(a)(1)(B)(iv)(II)).
(ii) A plan that meets the requirements
described in subsection (f)(3)(D) of such
section 1859.
(iii) A plan described in clause (ii) that
also meets additional requirements established
by the State.
(C) The characteristics of individuals enrolled in
such specialized MA plans.
(D) As practicable, the following with respect to
State programs for the delivery of long-term services
and supports under such title XIX through a managed
care program:
(i) Which populations of individuals are
eligible to receive such services and supports.
(ii) Whether all such services and supports
are provided on a capitated basis or if any of
such services and supports are carved out and
provided through fee-forservice.
(E) As practicable, how the availability and
variation of integration arrangements of such
specialized MA plans offered in States affects
spending, service delivery options, access to
community-based care, and utilization of care.
(F) The efforts of State Medicaid programs to
transition dually-eligible beneficiaries receiving
long-term services and supports (LTSS) from
institutional settings to home and community-based
settings and related financial impacts of such
transitions.
(G) Barriers and opportunities for making further
progress on dual integration, as well as
recommendations for legislation or administrative
action to expedite or refine pathways toward fully
integrated care.
(2) Report.--Not later than 2 years after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
SEC. 2122. EXTENSION OF CERTAIN MIPPA FUNDING PROVISIONS; STATE HEALTH
INSURANCE ASSISTANCE PROGRAM REPORTING REQUIREMENTS.
(a) Funding Extensions.--Section 119 of the Medicare Improvements
for Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note) is
amended--
(1) in subsection (a)(1)(B)--
(A) in clause (vi), by striking ``and'' at the end;
(B) in clause (vii), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after clause (vii) the following
new clause:
``(viii) for each of fiscal years 2018 and
2019, of $13,000,000.'';
(2) in subsection (b)(1)(B)--
(A) in clause (vi), by striking ``and'' at the end;
(B) in clause (vii), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after clause (vii) the following
new clause:
``(viii) for each of fiscal years 2018 and
2019, of $7,500,000.'';
(3) in subsection (c)(1)(B)--
(A) in clause (vi), by striking ``and'' at the end;
(B) in clause (vii), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after clause (vii) the following
new clause:
``(viii) for each of fiscal years 2018 and
2019, of $5,000,000.''; and
(4) in subsection (d)(2)--
(A) in clause (vi), by striking ``and'' at the end;
(B) in clause (vii), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after clause (vii) the following
new clause:
``(viii) for each of fiscal years 2018 and
2019, of $12,000,000.''.
(b) State Health Insurance Assistance Program Reporting
Requirements.--Beginning not later than April 1, 2019, and biennially
thereafter, the Agency for Community Living shall electronically post
on its website the following information, with respect to grants to
States for State health insurance assistance programs, (such
information to be presented by State and by entity receiving funds from
the State to carry out such a program funded by such grant):
(1) The amount of Federal funding provided to each such
State for such program for the period involved and the amount
of Federal funding provided by each such State for such program
to each such entity for the period involved.
(2) Information as the Secretary may specify, with respect
to such programs carried out through such grants, consistent
with the terms and conditions for receipt of such grants.
SEC. 2123. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT,
AND SELECTION; REPORTING REQUIREMENTS.
(a) In General.--Section 1890(d) of the Social Security Act (42
U.S.C. 1395aaa(d)) is amended--
(1) in paragraph (2), by adding at the end the following
new sentence: ``Any of such amounts remaining available as of
the date of the enactment of the SUSTAIN Care Act of 2018 shall
be used only for purposes under this section that are purposes
other than funding a contract entered into under subsection
(a).''; and
(2) by adding at the end the following new paragraph:
``(3) For purposes of carrying out this section, the
Secretary shall provide for the transfer, from the Federal
Hospital Insurance Trust Fund under section 1817 and the
Federal Supplemental Medical Insurance Trust Fund under 1841,
in such proportion as Secretary deems appropriate, to the
Centers for Medicare & Medicaid Services Program Management
Account of $7,500,000 for each of fiscal years 2018 and 2019.
Of the amount transferred under the previous sentence for a
fiscal year, there shall be used for the purpose of funding a
contract entered into under subsection (a) with respect to
carrying out section 1890A (other than subsections (e) and (f))
for such fiscal year an amount that is not less than the amount
used for such purpose for fiscal year 2017.''.
(b) Annual Report by Secretary to Congress.--Section 1890 of the
Social Security Act (42 U.S.C. 1395aaa) is amended by adding at the end
the following new subsection:
``(e) Annual Report by Secretary to Congress.--By not later than
March 1 of each year (beginning with 2018), the Secretary shall submit
to Congress a report containing the following:
``(1) A comprehensive plan that identifies the quality
measurement needs of programs and initiatives of the Secretary
and provides a strategy for using the work performed by the
entity with a contract under subsection (a) and the work of any
other entity the Secretary has contracted with to perform work
associated with this section or section 1890A to help meet
those needs, specifically with respect to the programs under
this title and title XIX.
``(2) The amount of mandatory funding provided under
subsection (d) for purposes of carrying out this section and
section 1890A that has been obligated by the Secretary, the
amount of funding provided that has been expended, and the
amount of funding provided that remains unobligated.
``(3) A description of how the funds provided that are
obligated have been allocated, including how much of that
funding has been allocated for work performed by the Secretary,
the entity with a contract under subsection (a), and any other
entity the Secretary has contracted with to perform work
related to this section or section 1890A, respectively.
``(4) A description of the activities for which the
obligated funds have been or will be used, including any
activities performed by the Secretary, task orders, specific
projects, and activities assigned to the entity with a contract
under subsection (a), and task orders, specific projects, and
activities assigned to any other entity the Secretary has
contracted with to perform work related to carrying out this
section or section 1890A.
``(5) The amount of funding allocated to each of the
activities described in paragraph (4).
``(6) Estimates for, and descriptions of, obligations and
expenditures that the Secretary anticipates will be needed in
the succeeding two year period to carry out each of the quality
measurement activities required under this section and section
1890A, including any obligations that will require funds to be
expended in a future year.''.
(c) Revisions to Annual Report From Consensus-based Entity to
Congress and the Secretary.--
(1) In general.--Section 1890(b)(5)(A) of the Social
Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended--
(A) by redesignating clauses (i) through (vi) as
subclauses (I) through (VI), respectively, and moving
the margins accordingly;
(B) in the matter preceding subclause (I), as
redesignated by clause (i), by striking ``containing a
description of--'' and inserting ``containing the
following:
``(i) A description of--''; and
(C) by adding at the end the following new clauses:
``(ii) An itemization of financial
information for the fiscal year ending
September 30 of the preceding year, including--
``(I) annual revenues of the entity
(including any government funding,
private sector contributions, grants,
membership revenues, and investment
revenue);
``(II) annual expenses of the
entity (including grants paid, benefits
paid, salaries or other compensation,
fundraising expenses, and overhead
costs); and
``(III) a breakdown of the amount
awarded per contracted task order and
the specific projects funded in each
task order assigned to the entity.
``(iii) Any updates or modifications of
internal policies and procedures of the entity
as they relate to the duties of the entity
under this section, including--
``(I) specifically identifying any
modifications to the disclosure of
interests and conflicts of interests
for committees, work groups, task
forces, and advisory panels of the
entity; and
``(II) information on external
stakeholder participation in the duties
of the entity under this section
(including complete rosters for all
committees, work groups, task forces,
and advisory panels funded through
government contracts, descriptions of
relevant interests and any conflicts of
interest for members of all committees,
work groups, task forces, and advisory
panels, and the total percentage by
health care sector of all convened
committees, work groups, task forces,
and advisory panels.''.
(2) Effective date.--The amendments made by this subsection
shall apply to reports submitted for years beginning with 2018.
(d) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
shall conduct a study on health care quality measurement
efforts funded under sections 1890 and 1890A of the Social
Security Act (42 U.S.C. 1395aaa; 1395aaa-1). Such study shall
include an examination of the following:
(A) The extent to which the Secretary of Health and
Human Services (in this subsection referred to as the
``Secretary'') has set and prioritized objectives to be
achieved for each of the quality measurement activities
required under such sections 1890 and 1890A.
(B) The efforts that the Secretary has undertaken
to meet quality measurement objectives associated with
such sections 1890 and 1890A, including division of
responsibilities for those efforts within the
Department of Health and Human Services and through
contracts with a consensus-based entity under
subsection (a) of such section 1890 (in this subsection
referred to as the ``consensus-based entity'') and
other entities, and the extent of any overlap among the
work performed by the Secretary, the consensus-based
entity, the Measure Application Partnership (MAP)
convened by such entity to provide input to the
Secretary on the selection of quality and efficiency
measures, and any other entities the Secretary has
contracted with to perform work related to carrying out
such sections 1890 and 1890A.
(C) The total amount of mandatory funding provided
to the Secretary for purposes of carrying out such
sections 1890 and 1890A, the amount of such funding
that has been obligated by the Secretary, and the
amount of such funding that remains unobligated.
(D) How the obligated funds have been allocated,
including how much of the obligated funding has been
allocated for work performed by the Secretary, the
consensus-based entity, and any other entity the
Secretary has contracted with to perform work related
to carrying out such sections 1890 and 1890A,
respectively, and descriptions of such work.
(E) The extent to which the Secretary has developed
a comprehensive and long-term plan to ensure that it
can achieve quality measurement objectives related to
carrying out such sections 1890 and 1890A in a timely
manner and with efficient use of available resources,
including the roles of the consensus-based entity, the
Measure Application Partnership (MAP), and any other
entity the Secretary has contracted with to perform
work related to such sections 1890 and 1890A in helping
the Secretary achieve those objectives.
(2) Report.--Not later than 18 months after the date of
enactment of this Act, the Comptroller General of the United
States shall submit to Congress a report containing the results
of the study conducted under paragraph (1), together with
recommendations for such legislation and administrative action
as the Comptroller General determines appropriate.
TITLE II--ADDITIONAL MEDICARE POLICIES RELATING TO EXTENDERS
SEC. 2201. HOME HEALTH PAYMENT REFORM.
(a) Budget Neutral Transition to a 30-day Unit of Payment for Home
Health Services.--Section 1895(b) of the Social Security Act (42 U.S.C.
1395fff(b)) is amended--
(1) in paragraph (2)--
(A) by striking ``payment.--In defining'' and
inserting ``payment.--
``(A) In general.--In defining''; and
(B) by adding at the end the following new
subparagraph:
``(B) 30-day unit of service.--For purposes of
implementing the prospective payment system with
respect to home health units of service furnished
during a year beginning with 2020, the Secretary shall
apply a 30-day unit of service as the unit of service
applied under this paragraph.'';
(2) in paragraph (3)--
(A) in subparagraph (A), by adding at the end the
following new clause:
``(iv) Budget neutrality for 2020.--With
respect to payments for home health units of
service furnished that end during the 12-month
period beginning January 1, 2020, the Secretary
shall calculate a standard prospective payment
amount (or amounts) for 30-day units of service
(as described in paragraph (2)(B)) for the
prospective payment system under this
subsection. Such standard prospective payment
amount (or amounts) shall be calculated in a
manner such that the estimated aggregate amount
of expenditures under the system during such
period with application of paragraph (2)(B) is
equal to the estimated aggregate amount of
expenditures that otherwise would have been
made under the system during such period if
paragraph (2)(B) had not been enacted. The
previous sentence shall be applied before (and
not affect the application of) paragraph
(3)(B). In calculating such amount (or
amounts), the Secretary shall make assumptions
about behavior changes that could occur as a
result of the implementation of paragraph
(2)(B) and the case-mix adjustment factors
established under paragraph (4)(B) and shall
provide a description of such assumptions in
the notice and comment rulemaking used to
implement this clause.''; and
(B) by adding at the end the following new
subparagraph:
``(D) Behavior assumptions and adjustments.--
``(i) In general.--The Secretary shall
annually determine the impact of differences
between assumed behavior changes (as described
in paragraph (3)(A)(iv)) and actual behavior
changes on estimated aggregate expenditures
under this subsection with respect to years
beginning with 2020 and ending with 2026.
``(ii) Permanent adjustments.--The
Secretary shall, at a time and in a manner
determined appropriate, through notice and
comment rulemaking, provide for one or more
permanent increases or decreases to the
standard prospective payment amount (or
amounts) for applicable years, on a prospective
basis, to offset for such increases or
decreases in estimated aggregate expenditures
(as determined under clause (i)).
``(iii) Temporary adjustments for
retrospective behavior.--The Secretary shall,
at a time and in a manner determined
appropriate, through notice and comment
rulemaking, provide for one or more temporary
increases or decreases to the payment amount
for a unit of home health services (as
determined under paragraph (4)) for applicable
years, on a prospective basis, to offset for
such increases or decreases in estimated
aggregate expenditures (as determined under
clause (i)). Such a temporary increase or
decrease shall apply only with respect to the
year for which such temporary increase or
decrease is made, and the Secretary shall not
take into account such a temporary increase or
decrease in computing such amount under this
subsection for a subsequent year.''; and
(3) in paragraph (4)(B)--
(A) by striking ``Factors.--The Secretary'' and
inserting ``Factors.--
``(i) In general.--The Secretary''; and
(B) by adding at the end the following new clause:
``(ii) Treatment of therapy thresholds.--
For 2020 and subsequent years, the Secretary
shall eliminate the use of therapy thresholds
(established by the Secretary) in case mix
adjustment factors established under clause (i)
for calculating payments under the prospective
payment system under this subsection.''.
(b) Technical Expert Panel.--
(1) In general.--During the period beginning on January 1,
2018, and ending on December 31, 2018, the Secretary of Health
and Human Services shall hold at least one session of a
technical expert panel, the participants of which shall include
home health providers, patient representatives, and other
relevant stakeholders. The technical expert panel shall
identify and prioritize recommendations with respect to the
prospective payment system for home health services under
section 1895(b) of the Social Security Act (42 U.S.C.
1395fff(b)), on the following:
(A) The Home Health Groupings Model, as described
in the proposed rule ``Medicare and Medicaid Programs;
CY 2018 Home Health Prospective Payment System Rate
Update and Proposed CY 2019 Case-Mix Adjustment
Methodology Refinements; Home Health Value-Based
Purchasing Model; and Home Health Quality Reporting
Requirements'' (82 Fed. Reg. 35294 through 35332 (July
28, 2017)).
(B) Alternative case-mix models to the Home Health
Groupings Model that were submitted during 2017 as
comments in response to proposed rule making, including
patient-focused factors that consider the risks of
hospitalization and readmission to a hospital,
improvement or maintenance of functionality of
individuals to increase the capacity for self-care,
quality of care, and resource utilization.
(2) Inapplicability of faca.--The provisions of the Federal
Advisory Committee Act (5 U.S.C. App.) shall not apply to the
technical expert panel under paragraph (1).
(3) Report.--Not later than April 1, 2019, the Secretary of
Health and Human Services shall submit to the Committee on Ways
and Means and the Committee on Energy and Commerce of the House
of Representatives and the Committee on Finance of the Senate a
report on the recommendations of such panel described in such
paragraph.
(4) Notice and comment rulemaking.--Not later than December
31, 2019, the Secretary of Health and Human Services shall
pursue notice and comment rulemaking on a case-mix system with
respect to the prospective payment system for home health
services under section 1895(b) of the Social Security Act (42
U.S.C. 1395fff(b)).
(c) Reports.--
(1) Interim report.--Not later than March 15, 2022, the
Medicare Payment Advisory Commission shall submit to Congress
an interim report on the application of a 30-day unit of
service as the unit of service applied under section 1895(b)(2)
of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as
amended by subsection (a), including an analysis of the level
of payments provided to home health agencies as compared to the
cost of delivering home health services, and any unintended
consequences, including with respect to behavioral changes and
quality.
(2) Final report.--Not later than March 15, 2026, such
Commission shall submit to Congress a final report on such
application and any such consequences.
SEC. 2202. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY
FOR HOME HEALTH SERVICES.
(a) Part A.--Section 1814(a) of the Social Security Act (42 U.S.C.
1395f(a)) is amended by inserting before ``For purposes of paragraph
(2)(C),'' the following new sentence: ``For purposes of documentation
for physician certification and recertification made under paragraph
(2) on or after January 1, 2019, and made with respect to home health
services furnished by a home health agency, in addition to using
documentation in the medical record of the physician who so certifies
or the medical record of the acute or post-acute care facility (in the
case that home health services were furnished to an individual who was
directly admitted to the home health agency from such a facility), the
Secretary may use documentation in the medical record of the home
health agency as supporting material, as appropriate to the case
involved.''.
(b) Part B.--Section 1835(a) of the Social Security Act (42 U.S.C.
1395n(a)) is amended by inserting before ``For purposes of paragraph
(2)(A),'' the following new sentence: ``For purposes of documentation
for physician certification and recertification made under paragraph
(2) on or after January 1, 2019, and made with respect to home health
services furnished by a home health agency, in addition to using
documentation in the medical record of the physician who so certifies
or the medical record of the acute or post-acute care facility (in the
case that home health services were furnished to an individual who was
directly admitted to the home health agency from such a facility), the
Secretary may use documentation in the medical record of the home
health agency as supporting material, as appropriate to the case
involved.''.
SEC. 2203. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.
(a) Settlement Process for Home Health Claims.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall establish a settlement process under which a
home health agency entitled to an eligible administrative
appeal has the option to enter into a settlement with the
Secretary that is reached in a manner consistent with the
succeeding paragraphs of this subsection.
(2) Process and consideration of home health claims.--A
settlement under paragraph (1) with a home health agency that
is with respect to an eligible administrative appeal may only
be reached in accordance with the following process:
(A) A settlement under such paragraph with the home
health agency shall be with respect to all claims by
such agency, subject to paragraph (4), that, as of the
date of such settlement, are under an eligible
administrative appeal.
(B) For the duration of the settlement process with
such agency, an eligible administrative appeal that is
with respect to any such claim by such agency shall be
suspended.
(C) Under the settlement process, the Secretary
shall determine an aggregate amount to be paid to the
home health agency with respect to all claims by such
agency that are under an eligible administrative appeal
in the following manner:
(i) The Secretary shall, for purposes of
applying clause (ii) with respect to all
settlements under paragraph (1), select a
percentage. In selecting such percentage, the
Secretary shall consider the percentage used
under the Centers for Medicare & Medicaid
Services hospital appeals settlement that began
on August 29, 2014.
(ii) The Secretary shall, with respect to
each denied claim for such agency that is under
an eligible administrative appeal, calculate an
amount (referred to in this subparagraph as an
``individual claim amount'') by multiplying the
net payable amount for such claim by the
percentage selected under clause (i).
(iii) Such aggregate amount with respect to
such agency shall be determined by calculating
the total sum of all the individual claim
amounts calculated under clause (ii) with
respect to such agency.
(3) Effect of process.--
(A) Effect of settlement.--
(i) Further appeal.--As part of any
settlement under paragraph (1) between a home
health agency and the Secretary, such home
health agency shall be required to forego the
right to an administrative appeal under section
1869 of the Social Security Act (42 U.S.C.
1395ff) or section 1878 of such Act (42 U.S.C.
1395oo) (including any redetermination,
reconsideration, hearing, or review) with
respect to any claims for home health services
that are subject to the settlement.
(ii) Judicial review.--There shall be no
administrative or judicial review under such
section 1869 or otherwise of a settlement under
paragraph (1) and the claims covered by the
settlement.
(B) Effect of no settlement.--In the event that the
process described in paragraph (2) does not, with
respect to a home health agency, result in a settlement
under paragraph (1) with such agency, any appeal under
such section 1869 that is with respect to a claim by
such agency that was suspended pursuant to paragraph
(2)(B) shall resume under such section.
(4) Coordination with law enforcement.--The Secretary of
Health and Human Services shall establish a process to
coordinate with appropriate law enforcement agencies in order
to avoid the inadvertent settlement of cases that involve fraud
or other criminal activity.
(b) No Entitlement to Settlement Process.--Nothing in this section
shall be construed as creating an entitlement to enter into a
settlement process established pursuant to subsection (a).
(c) Eligible Administrative Appeal Defined.--For purposes of this
section, the term ``eligible administrative appeal'' means an appeal
under section 1869 of the Social Security Act (42 U.S.C. 1395ff)
(including any redetermination, reconsideration, hearing, or review)--
(1) that is with respect to one or more claims that--
(A) are for home health services that were
furnished on or after January 1, 2011, and before
January 1, 2015; and
(B) were timely filed consistent with section
1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) or
sections 1835(a)(1) and 1842(b)(3) of such Act (42
U.S.C. 1395n(a)(1), 1395u(b)(3)); and
(2) either--
(A) was timely filed consistent with section 1869
of such Act (42 U.S.C. 1395ff) and is pending; or
(B) for which the applicable time frame to file an
appeal has not expired.
(d) Conforming Amendment.--Section 1869 of the Social Security Act
(42 U.S.C. 1395ff) is amended by adding at the end the following new
subsection:
``(j) Application With Respect to Certain Home Health Claims.--For
the application of the provisions of this section with respect to
certain claims for home health services that were furnished on or after
January 1, 2011, and before January 1, 2015, see section 106 of the
Healthcare Extension, Reauthorization, and Opportunities Act of
2017.''.
SEC. 2204. EXTENSION OF ENFORCEMENT INSTRUCTION ON MEDICARE SUPERVISION
REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN
CRITICAL ACCESS AND SMALL RURAL HOSPITALS.
Section 1834 of the Social Security Act (42 U.S.C. 1395m) is
amended by adding at the end the following new subsection:
``(v) Extension of Enforcement Instruction on Supervision
Requirements for Outpatient Therapeutic Services in Critical Access and
Small Rural Hospitals.--For calendar year 2017, the Secretary shall
continue to apply the enforcement instruction described in the notice
of the Centers for Medicare & Medicaid Services entitled `Enforcement
Instruction on Supervision Requirements for Outpatient Therapeutic
Services in Critical Access and Small Rural Hospitals for CY 2013',
dated November 1, 2012 (providing for an exception to the restatement
and clarification under the final rulemaking changes to the Medicare
hospital outpatient prospective payment system and calendar year 2009
payment rates (published in the Federal Register on November 18, 2008,
73 Fed. Reg. 68702 through 68704) with respect to requirements for
direct supervision by physicians for therapeutic hospital outpatient
services), as previously extended under section 1 of Public Law 113-
198, as amended by section 1 of Public Law 114-112 and section 16004(a)
of the 21st Century Cures Act (Public Law 114-255).''.
SEC. 2205. TECHNICAL AMENDMENTS TO PUBLIC LAW 114-10.
(a) MIPS Transition.--Section 1848 of the Social Security Act (42
U.S.C. 1395w-4) is amended--
(1) in subsection (q)--
(A) in paragraph (1)--
(i) in subparagraph (B), by striking
``items and services'' and inserting ``covered
professional services (as defined in subsection
(k)(3)(A))''; and
(ii) in subparagraph (C)(iv)--
(I) by amending subclause (I) to
read as follows:
``(I) The minimum number (as
determined by the Secretary) of--
``(aa) for performance
periods beginning before
January 1, 2018, individuals
enrolled under this part who
are treated by the eligible
professional for the
performance period involved;
and
``(bb) for performance
periods beginning on or after
January 1, 2018, individuals
enrolled under this part who
are furnished covered
professional services (as
defined in subsection
(k)(3)(A)) by the eligible
professional for the
performance period involved.'';
(II) in subclause (II), by striking
``items and services'' and inserting
``covered professional services (as
defined in subsection (k)(3)(A))''; and
(III) by amending subclause (III)
to read as follows:
``(III) The minimum amount (as
determined by the Secretary) of--
``(aa) for performance
periods beginning before
January 1, 2018, allowed
charges billed by such
professional under this part
for such performance period;
and
``(bb) for performance
periods beginning on or after
January 1, 2018, allowed
charges for covered
professional services (as
defined in subsection
(k)(3)(A)) billed by such
professional for such
performance period.'';
(B) in paragraph (5)(D)--
(i) in clause (i)(I), by inserting
``subject to clause (iii),'' after ``clauses
(i) and (ii) of paragraph (2)(A),''; and
(ii) by adding at the end the following new
clause:
``(iii) Transition years.--For each of the
second, third, fourth, and fifth years for
which the MIPS applies to payments, the
performance score for the performance category
described in paragraph (2)(A)(ii) shall not
take into account the improvement of the
professional involved.'';
(C) in paragraph (5)(E)--
(i) in clause (i)(I)(bb)--
(I) in the heading by striking
``First 2 years'' and inserting ``First
5 years''; and
(II) by striking ``the first and
second years'' and inserting ``each of
the first through fifth years'';
(ii) in clause (i)(II)(bb)--
(I) in the heading, by striking ``2
years'' and inserting ``5 years''; and
(II) by striking the second
sentence and inserting the following
new sentences: ``For each of the
second, third, fourth, and fifth years
for which the MIPS applies to payments,
not less than 10 percent and not more
than 30 percent of such score shall be
based on performance with respect to
the category described in clause (ii)
of paragraph (2)(A). Nothing in the
previous sentence shall be construed,
with respect to a performance period
for a year described in the previous
sentence, as preventing the Secretary
from basing 30 percent of such score
for such year with respect to the
category described in such clause (ii),
if the Secretary determines, based on
information posted under subsection
(r)(2)(I) that sufficient resource use
measures are ready for adoption for use
under the performance category under
paragraph (2)(A)(ii) for such
performance period.'';
(D) in paragraph (6)(D)--
(i) in clause (i), in the second sentence,
by striking ``Such performance threshold'' and
inserting ``Subject to clauses (iii) and (iv),
such performance threshold'';
(ii) in clause (ii)--
(I) in the first sentence, by
inserting ``(beginning with 2019 and
ending with 2024)'' after ``for each
year of the MIPS''; and
(II) in the second sentence, by
inserting ``subject to clause (iii),''
after ``For each such year,'';
(iii) in clause (iii)--
(I) in the heading, by striking
``2'' and inserting ``5''; and
(II) in the first sentence, by
striking ``two years'' and inserting
``five years''; and
(iv) by adding at the end the following new
clause:
``(iv) Additional special rule for third,
fourth and fifth years of mips.--For purposes
of determining MIPS adjustment factors under
subparagraph (A), in addition to the
requirements specified in clause (iii), the
Secretary shall increase the performance
threshold with respect to each of the third,
fourth, and fifth years to which the MIPS
applies to ensure a gradual and incremental
transition to the performance threshold
described in clause (i) (as estimated by the
Secretary) with respect to the sixth year to
which the MIPS applies.'';
(E) in paragraph (6)(E)--
(i) by striking ``In the case of items and
services'' and inserting ``In the case of
covered professional services (as defined in
subsection (k)(3)(A))''; and
(ii) by striking ``under this part with
respect to such items and services'' and
inserting ``under this part with respect to
such covered professional services''; and
(F) in paragraph (7), in the first sentence, by
striking ``items and services'' and inserting ``covered
professional services (as defined in subsection
(k)(3)(A))'';
(2) in subsection (r)(2), by adding at the end the
following new subparagraph:
``(I) Information.--The Secretary shall, not later
than December 31st of each year (beginning with 2018),
post on the Internet website of the Centers for
Medicare & Medicaid Services information on resource
use measures in use under subsection (q), resource use
measures under development and the time-frame for such
development, potential future resource use measure
topics, a description of stakeholder engagement, and
the percent of expenditures under part A and this part
that are covered by resource use measures.''; and
(3) in subsection (s)(5)(B), by striking ``section
1833(z)(2)(C)'' and inserting ``section 1833(z)(3)(D)''.
(b) Physician-focused Payment Model Technical Advisory Committee
Provision of Initial Proposal Feedback.--Section 1868(c)(2)(C) of the
Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as
follows:
``(C) Committee review of models submitted.--The
Committee, on a periodic basis--
``(i) shall review models submitted under
subparagraph (B);
``(ii) may provide individuals and
stakeholder entities who submitted such models
with--
``(I) initial feedback on such
models regarding the extent to which
such models meet the criteria described
in subparagraph (A); and
``(II) an explanation of the basis
for the feedback provided under
subclause (I); and
``(iii) shall prepare comments and
recommendations regarding whether such models
meet the criteria described in subparagraph (A)
and submit such comments and recommendations to
the Secretary.''.
SEC. 2206. REVISED REQUIREMENTS FOR MEDICARE INTENSIVE CARDIAC
REHABILITATION PROGRAMS.
(a) In General.--Section 1861(eee)(4)(B) of the Social Security Act
(42 U.S.C. 1395x(eee)(4)(B)) is amended--
(1) in clause (v), by striking ``or'' at the end;
(2) in clause (vi), by striking the period at the end and
inserting a semicolon; and
(3) by adding at the end the following new clauses:
``(vii) stable, chronic heart failure (defined as
patients with left ventricular ejection fraction of 35
percent or less and New York Heart Association (NYHA)
class II to IV symptoms despite being on optimal heart
failure therapy for at least 6 weeks); or
``(viii) any additional condition for which the
Secretary has determined that a cardiac rehabilitation
program shall be covered, unless the Secretary
determines, using the same process used to determine
that the condition is covered for a cardiac
rehabilitation program, that such coverage is not
supported by the clinical evidence.''.
(b) Ensuring Future Supervision Level Parity With Cardiac
Rehabilitation Programs.--Section 1861(eee)(4)(A) of the Social
Security Act (42 U.S.C. 1395x(eee)(4)(A)) is amended, in the matter
preceding clause (i), by striking ``physician-supervised program (as
described in paragraph (2))'' and inserting ``program (supervised as
described in paragraph (2))''.
TITLE III--CREATING HIGH-QUALITY RESULTS AND OUTCOMES NECESSARY TO
IMPROVE CHRONIC (CHRONIC) CARE
Subtitle A--Receiving High Quality Care in the Home
SEC. 2301. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRATION PROGRAM.
(a) In General.--Section 1866E of the Social Security Act (42
U.S.C. 1395cc-5) is amended--
(1) in subsection (e)--
(A) in paragraph (1)--
(i) by striking ``An agreement'' and
inserting ``Agreements''; and
(ii) by striking ``5-year'' and inserting
``7-year''; and
(B) in paragraph (5)--
(i) by striking ``10,000'' and inserting
``15,000''; and
(ii) by adding at the end the following new
sentence: ``An applicable beneficiary that
participates in the demonstration program by
reason of the increase from 10,000 to 15,000 in
the preceding sentence pursuant to the
amendment made by section 2301(a)(1)(B) of the
SUSTAIN Care Act of 2018 shall be considered in
the spending target estimates under paragraph
(1) of subsection (c) and the incentive payment
calculations under paragraph (2) of such
subsection for the sixth and seventh years of
such program.'';
(2) in subsection (g), in the first sentence, by inserting
``, including, to the extent practicable, with respect to the
use of electronic health information systems, as described in
subsection (b)(1)(A)(vi)'' after ``under the demonstration
program''; and
(3) in subsection (i)(1)(A), by striking ``will not receive
an incentive payment for the second of 2'' and inserting ``did
not achieve savings for the third of 3''.
(b) Effective Date.--The amendment made by subsection (a)(3) shall
take effect as if included in the enactment of Public Law 111-148.
SEC. 2302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.
(a) In General.--Section 1881(b)(3) of the Social Security Act (42
U.S.C. 1395rr(b)(3)) is amended--
(1) by redesignating subparagraphs (A) and (B) as clauses
(i) and (ii), respectively;
(2) in clause (ii), as redesignated by paragraph (1), by
striking ``on a comprehensive'' and insert ``subject to
subparagraph (B), on a comprehensive'';
(3) by striking ``With respect to'' and inserting ``(A)
With respect to''; and
(4) by adding at the end the following new subparagraph:
``(B)(i) For purposes of subparagraph (A)(ii), subject to clause
(ii), an individual determined to have end stage renal disease
receiving home dialysis may choose to receive monthly end stage renal
disease-related clinical assessments furnished on or after January 1,
2019, via telehealth.
``(ii) Clause (i) shall apply to an individual only if the
individual receives a face-to-face clinical assessment, without the use
of telehealth--
``(I) in the case of the initial 3 months of home dialysis
of such individual, at least monthly; and
``(II) after such initial 3 months, at least once every 3
consecutive months.''.
(b) Originating Site Requirements.--
(1) In general.--Section 1834(m) of the Social Security Act
(42 U.S.C. 1395m(m)) is amended--
(A) in paragraph (4)(C)(ii), by adding at the end
the following new subclauses:
``(IX) A renal dialysis facility,
but only for purposes of section
1881(b)(3)(B).
``(X) The home of an individual,
but only for purposes of section
1881(b)(3)(B).''; and
(B) by adding at the end the following new
paragraph:
``(5) Treatment of home dialysis monthly esrd-related
visit.--The geographic requirements described in paragraph
(4)(C)(i) shall not apply with respect to telehealth services
furnished on or after January 1, 2019, for purposes of section
1881(b)(3)(B), at an originating site described in subclause
(VI), (IX), or (X) of paragraph (4)(C)(ii).''.
(2) No facility fee if originating site for home dialysis
therapy is the home.--Section 1834(m)(2)(B) of the Social
Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
(A) by redesignating clauses (i) and (ii) as
subclauses (I) and (II), and indenting appropriately;
(B) in subclause (II), as redesignated by
subparagraph (A), by striking ``clause (i) or this
clause'' and inserting ``subclause (I) or this
subclause'';
(C) by striking ``site.--With respect to'' and
inserting ``site.--
``(i) In general.--Subject to clause (ii),
with respect to''; and
(D) by adding at the end the following new clause:
``(ii) No facility fee if originating site
for home dialysis therapy is the home.--No
facility fee shall be paid under this
subparagraph to an originating site described
in paragraph (4)(C)(ii)(X).''.
(c) Clarification Regarding Telehealth Provided to Beneficiaries.--
Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-
7a(i)(6)) is amended--
(1) in subparagraph (H), by striking ``or'' at the end;
(2) in subparagraph (I), by striking the period at the end
and inserting ``; or''; and
(3) by adding at the end the following new subparagraph:
``(J) the provision of telehealth technologies (as
defined by the Secretary) on or after January 1, 2019,
by a provider of services or a renal dialysis facility
(as such terms are defined for purposes of title XVIII)
to an individual with end stage renal disease who is
receiving home dialysis for which payment is being made
under part B of such title, if--
``(i) the telehealth technologies are not
offered as part of any advertisement or
solicitation;
``(ii) the telehealth technologies are
provided for the purpose of furnishing
telehealth services related to the individual's
end stage renal disease; and
``(iii) the provision of the telehealth
technologies meets any other requirements set
forth in regulations promulgated by the
Secretary.''.
(d) Conforming Amendment.--Section 1881(b)(1) of the Social
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking
``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.
Subtitle B--Expanding Innovation and Technology
SEC. 2311. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL
MEDICARE ADVANTAGE ENROLLEES.
Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is
amended by adding at the end the following new subsection:
``(h) National Testing of Medicare Advantage Value-Based Insurance
Design Model.--
``(1) In general.--In implementing the Medicare Advantage
Value-Based Insurance Design model that is being tested under
section 1115A(b), the Secretary shall revise the testing of the
model under such section to cover, effective not later than
January 1, 2020, all States.
``(2) Termination and modification provision not applicable
until january 1, 2022.--The provisions of section
1115A(b)(3)(B) shall apply to the Medicare Advantage Value-
Based Insurance Design model, including such model as revised
under paragraph (1), beginning January 1, 2022, but shall not
apply to such model, as so revised, prior to such date.
``(3) Funding.--The Secretary shall allocate funds made
available under section 1115A(f)(1) to design, implement, and
evaluate the Medicare Advantage Value-Based Insurance Design
model, as revised under paragraph (1).''.
SEC. 2312. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF
CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.
(a) In General.--Section 1852(a)(3) of the Social Security Act (42
U.S.C. 1395w-22(a)(3)) is amended--
(1) in subparagraph (A), by striking ``Each'' and inserting
``Subject to subparagraph (D), each''; and
(2) by adding at the end the following new subparagraph:
``(D) Expanding supplemental benefits to meet the
needs of chronically ill enrollees.--
``(i) In general.--For plan year 2020 and
subsequent plan years, in addition to any
supplemental health care benefits otherwise
provided under this paragraph, an MA plan,
including a specialized MA plan for special
needs individuals (as defined in section
1859(b)(6)), may provide supplemental benefits
described in clause (ii) to a chronically ill
enrollee (as defined in clause (iii)).
``(ii) Supplemental benefits described.--
``(I) In general.--Supplemental
benefits described in this clause are
supplemental benefits that, with
respect to a chronically ill enrollee,
have a reasonable expectation of
improving or maintaining the health or
overall function of the chronically ill
enrollee and may not be limited to
being primarily health related
benefits.
``(II) Authority to waive
uniformity requirements.--The Secretary
may, only with respect to supplemental
benefits provided to a chronically ill
enrollee under this subparagraph, waive
the uniformity requirements under this
part, as determined appropriate by the
Secretary.
``(iii) Chronically ill enrollee defined.--
In this subparagraph, the term `chronically ill
enrollee' means an enrollee in an MA plan that
the Secretary determines--
``(I) has one or more comorbid and
medically complex chronic conditions
that is life threatening or
significantly limits the overall health
or function of the enrollee;
``(II) has a high risk of
hospitalization or other adverse health
outcomes; and
``(III) requires intensive care
coordination.''.
(b) GAO Study and Report.--
(1) Study.--The Comptroller General of the United States
(in this subsection referred to as the ``Comptroller General'')
shall conduct a study on supplemental benefits provided to
enrollees in Medicare Advantage plans under part C of title
XVIII of the Social Security Act, including specialized MA
plans for special needs individuals (as defined in section
1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))). To the
extend data are available, such study shall include an analysis
of the following:
(A) The type of supplemental benefits provided to
such enrollees, the total number of enrollees receiving
each supplemental benefit, and whether the supplemental
benefit is covered by the standard benchmark cost of
the benefit or with an additional premium.
(B) The frequency in which supplemental benefits
are utilized by such enrollees.
(C) The impact supplemental benefits have on--
(i) indicators of the quality of care
received by such enrollees, including overall
health and function of the enrollees;
(ii) the utilization of items and services
for which benefits are available under the
original Medicare fee-for-service program
option under parts A and B of such title XVIII
by such enrollees; and
(iii) the amount of the bids submitted by
Medicare Advantage Organizations for Medicare
Advantage plans under such part C.
(2) Consultation.--In conducting the study under paragraph
(1), the Comptroller General shall, as necessary, consult with
the Centers for Medicare & Medicaid Services and Medicare
Advantage organizations offering Medicare Advantage plans.
(3) Report.--Not later than 5 years after the date of the
enactment of this Act, the Comptroller General shall submit to
Congress a report containing the results of the study conducted
under paragraph (1), together with recommendations for such
legislation and administrative action as the Comptroller
General determines appropriate.
SEC. 2313. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE ENROLLEES
THROUGH TELEHEALTH.
(a) In General.--Section 1852 of the Social Security Act (42 U.S.C.
1395w-22) is amended--
(1) in subsection (a)(1)(B)(i), by inserting ``, subject to
subsection (m),'' after ``means''; and
(2) by adding at the end the following new subsection:
``(m) Provision of Additional Telehealth Benefits.--
``(1) MA plan option.--For plan year 2020 and subsequent
plan years, subject to the requirements of paragraph (3), an MA
plan may provide additional telehealth benefits (as defined in
paragraph (2)) to individuals enrolled under this part.
``(2) Additional telehealth benefits defined.--
``(A) In general.--For purposes of this subsection
and section 1854:
``(i) Definition.--The term `additional
telehealth benefits' means services--
``(I) for which benefits are
available under part B, including
services for which payment is not made
under section 1834(m) due to the
conditions for payment under such
section; and
``(II) that are identified for the
year involved by the Secretary as
clinically appropriate to furnish using
electronic information and
telecommunications technology when a
physician (as defined in section
1861(r)) or practitioner (described in
section 1842(b)(18)(C)) providing the
service is not at the same location as
the plan enrollee.
``(ii) Exclusion of capital and
infrastructure costs and investments.--The term
`additional telehealth benefits' does not
include capital and infrastructure costs and
investments relating to such benefits.
``(B) Public comment.--Not later than November 30,
2018, the Secretary shall solicit comments on--
``(i) what types of items and services
(including those provided through supplemental
health care benefits, such as remote patient
monitoring, secure messaging, store and forward
technologies, and other non-face-to-face
communication) should be considered to be
additional telehealth benefits; and
``(ii) the requirements for the provision
or furnishing of such benefits (such as
licensure, training, and coordination
requirements).
``(3) Requirements for additional telehealth benefits.--The
Secretary shall specify requirements for the provision or
furnishing of additional telehealth benefits, including with
respect to the following:
``(A) Physician or practitioner qualifications
(other than licensure) and other requirements such as
specific training.
``(B) Factors necessary for the coordination of
such benefits with other items and services, including
those furnished in-person.
``(C) Such other areas as determined by the
Secretary.
``(4) Enrollee choice.--If an MA plan provides a service as
an additional telehealth benefit (as defined in paragraph
(2))--
``(A) the MA plan shall also provide access to such
benefit through an in-person visit (and not only as an
additional telehealth benefit); and
``(B) an individual enrollee shall have discretion
as to whether to receive such service through the in-
person visit or as an additional telehealth benefit.
``(5) Treatment under ma.--For purposes of this subsection
and section 1854, if a plan provides additional telehealth
benefits, such additional telehealth benefits shall be treated
as if they were benefits under the original Medicare fee-for-
service program option.
``(6) Construction.--Nothing in this subsection shall be
construed as affecting the requirement under subsection (a)(1)
that MA plans provide enrollees with items and services (other
than hospice care) for which benefits are available under parts
A and B, including benefits available under section 1834(m).''.
(b) Clarification Regarding Inclusion in Bid Amount.--Section
1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)(A)(ii)(I)) is amended by inserting ``, including, for plan
year 2020 and subsequent plan years, the provision of additional
telehealth benefits as described in section 1852(m)'' before the
semicolon at the end.
SEC. 2314. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE ABILITY TO
EXPAND THE USE OF TELEHEALTH.
(a) In General.--Section 1899 of the Social Security Act (42 U.S.C.
1395jjj) is amended by adding at the end the following new subsection:
``(l) Providing ACOs the Ability To Expand the Use of Telehealth
Services.--
``(1) In general.--In the case of telehealth services for
which payment would otherwise be made under this title
furnished on or after January 1, 2020, for purposes of this
subsection only, the following shall apply with respect to such
services furnished by a physician or practitioner participating
in an applicable ACO (as defined in paragraph (2)) to a
Medicare fee-for-service beneficiary assigned to the applicable
ACO:
``(A) Inclusion of home as originating site.--
Subject to paragraph (3), the home of a beneficiary
shall be treated as an originating site described in
section 1834(m)(4)(C)(ii).
``(B) No application of geographic limitation.--The
geographic limitation under section 1834(m)(4)(C)(i)
shall not apply with respect to an originating site
described in section 1834(m)(4)(C)(ii) (including the
home of a beneficiary under subparagraph (A)), subject
to State licensing requirements.
``(2) Definitions.--In this subsection:
``(A) Applicable aco.--The term `applicable ACO'
means an ACO participating in a model tested or
expanded under section 1115A or under this section--
``(i) that operates under a two-sided
model--
``(I) described in section
425.600(a) of title 42, Code of Federal
Regulations; or
``(II) tested or expanded under
section 1115A; and
``(ii) for which Medicare fee-for-service
beneficiaries are assigned to the ACO using a
prospective assignment method, as determined
appropriate by the Secretary.
``(B) Home.--The term `home' means, with respect to
a Medicare fee-for-service beneficiary, the place of
residence used as the home of the beneficiary.
``(3) Telehealth services received in the home.--In the
case of telehealth services described in paragraph (1) where
the home of a Medicare fee-for-service beneficiary is the
originating site, the following shall apply:
``(A) No facility fee.--There shall be no facility
fee paid to the originating site under section
1834(m)(2)(B).
``(B) Exclusion of certain services.--No payment
may be made for such services that are inappropriate to
furnish in the home setting such as services that are
typically furnished in inpatient settings such as a
hospital.''.
(b) Study and Report.--
(1) Study.--
(A) In general.--The Secretary of Health and Human
Services (in this subsection referred to as the
``Secretary'') shall conduct a study on the
implementation of section 1899(l) of the Social
Security Act, as added by subsection (a). Such study
shall include an analysis of the utilization of, and
expenditures for, telehealth services under such
section.
(B) Collection of data.--The Secretary may collect
such data as the Secretary determines necessary to
carry out the study under this paragraph.
(2) Report.--Not later than January 1, 2026, the Secretary
shall submit to Congress a report containing the results of the
study conducted under paragraph (1), together with
recommendations for such legislation and administrative action
as the Secretary determines appropriate.
SEC. 2315. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS WITH STROKE.
Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as
amended by section 2302(b), is amended--
(1) in paragraph (4)(C)(i), in the matter preceding
subclause (I), by striking ``The term'' and inserting ``Except
as provided in paragraph (6), the term''; and
(2) by adding at the end the following new paragraph:
``(6) Treatment of stroke telehealth services.--
``(A) Non-application of originating site
requirements.--The requirements described in paragraph
(4)(C) shall not apply with respect to telehealth
services furnished on or after January 1, 2021, for
purposes of diagnosis, evaluation, or treatment of
symptoms of an acute stroke, as determined by the
Secretary.
``(B) Inclusion of certain sites.--With respect to
telehealth services described in subparagraph (A), the
term `originating site' shall include any hospital (as
defined in section 1861(e)) or critical access hospital
(as defined in section 1861(mm)(1)), any mobile stroke
unit (as defined by the Secretary), or any other site
determined appropriate by the Secretary, at which the
eligible telehealth individual is located at the time
the service is furnished via a telecommunications
system.
``(C) No originating site facility fee for new
sites.--No facility fee shall be paid under paragraph
(2)(B) to an originating site with respect to a
telehealth service described in subparagraph (A) if the
originating site does not otherwise meet the
requirements for an originating site under paragraph
(4)(C).''.
Subtitle C--Identifying the Chronically Ill Population
SEC. 2321. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART OF AN
ACCOUNTABLE CARE ORGANIZATION.
Section 1899(c) of the Social Security Act (42 U.S.C. 1395jjj(c))
is amended--
(1) by redesignating paragraphs (1) and (2) as
subparagraphs (A) and (B), respectively, and indenting
appropriately;
(2) by striking ``ACOs.--The Secretary'' and inserting
``ACOs.--
``(1) In general.--Subject to paragraph (2), the
Secretary''; and
(3) by adding at the end the following new paragraph:
``(2) Providing flexibility.--
``(A) Choice of prospective assignment.--For each
agreement period (effective for agreements entered into
or renewed on or after January 1, 2020), in the case
where an ACO established under the program is in a
Track that provides for the retrospective assignment of
Medicare fee-for-service beneficiaries to the ACO, the
Secretary shall permit the ACO to choose to have
Medicare fee-for-service beneficiaries assigned
prospectively, rather than retrospectively, to the ACO
for an agreement period.
``(B) Assignment based on voluntary identification
by medicare fee-for-service beneficiaries.--
``(i) In general.--For performance year
2018 and each subsequent performance year, if a
system is available for electronic designation,
the Secretary shall permit a Medicare fee-for-
service beneficiary to voluntarily identify an
ACO professional as the primary care provider
of the beneficiary for purposes of assigning
such beneficiary to an ACO, as determined by
the Secretary.
``(ii) Notification process.--The Secretary
shall establish a process under which a
Medicare fee-for-service beneficiary is--
``(I) notified of their ability to
make an identification described in
clause (i); and
``(II) informed of the process by
which they may make and change such
identification.
``(iii) Superseding claims-based
assignment.--A voluntary identification by a
Medicare fee-for-service beneficiary under this
subparagraph shall supersede any claims-based
assignment otherwise determined by the
Secretary.''.
Subtitle D--Empowering Individuals and Caregivers in Care Delivery
SEC. 2331. ELIMINATING BARRIERS TO CARE COORDINATION UNDER ACCOUNTABLE
CARE ORGANIZATIONS.
(a) In General.--Section 1899 of the Social Security Act (42 U.S.C.
1395jjj), as amended by section 2314(a), is amended--
(1) in subsection (b)(2), by adding at the end the
following new subparagraph:
``(I) An ACO that seeks to operate an ACO
Beneficiary Incentive Program pursuant to subsection
(m) shall apply to the Secretary at such time, in such
manner, and with such information as the Secretary may
require.'';
(2) by adding at the end the following new subsection:
``(m) Authority To Provide Incentive Payments to Beneficiaries With
Respect to Qualifying Primary Care Services.--
``(1) Program.--
``(A) In general.--In order to encourage Medicare
fee-for-service beneficiaries to obtain medically
necessary primary care services, an ACO participating
under this section under a payment model described in
clause (i) or (ii) of paragraph (2)(B) may apply to
establish an ACO Beneficiary Incentive Program to
provide incentive payments to such beneficiaries who
are furnished qualifying services in accordance with
this subsection. The Secretary shall permit such an ACO
to establish such a program at the Secretary's
discretion and subject to such requirements, including
program integrity requirements, as the Secretary
determines necessary.
``(B) Implementation.--The Secretary shall
implement this subsection on a date determined
appropriate by the Secretary. Such date shall be no
earlier than January 1, 2019, and no later than January
1, 2020.
``(2) Conduct of program.--
``(A) Duration.--Subject to subparagraph (H), an
ACO Beneficiary Incentive Program established under
this subsection shall be conducted for such period (of
not less than 1 year) as the Secretary may approve.
``(B) Scope.--An ACO Beneficiary Incentive Program
established under this subsection shall provide
incentive payments to all of the following Medicare
fee-for-service beneficiaries who are furnished
qualifying services by the ACO:
``(i) With respect to the Track 2 and Track
3 payment models described in section
425.600(a) of title 42, Code of Federal
Regulations (or in any successor regulation),
Medicare fee-for-service beneficiaries who are
preliminarily prospectively or prospectively
assigned (or otherwise assigned, as determined
by the Secretary) to the ACO.
``(ii) With respect to any future payment
models involving two-sided risk, Medicare fee-
for-service beneficiaries who are assigned to
the ACO, as determined by the Secretary.
``(C) Qualifying service.--For purposes of this
subsection, a qualifying service is a primary care
service, as defined in section 425.20 of title 42, Code
of Federal Regulations (or in any successor
regulation), with respect to which coinsurance applies
under part B, furnished through an ACO by--
``(i) an ACO professional described in
subsection (h)(1)(A) who has a primary care
specialty designation included in the
definition of primary care physician under
section 425.20 of title 42, Code of Federal
Regulations (or any successor regulation);
``(ii) an ACO professional described in
subsection (h)(1)(B); or
``(iii) a Federally qualified health center
or rural health clinic (as such terms are
defined in section 1861(aa)).
``(D) Incentive payments.--An incentive payment
made by an ACO pursuant to an ACO Beneficiary Incentive
Program established under this subsection shall be--
``(i) in an amount up to $20, with such
maximum amount updated annually by the
percentage increase in the consumer price index
for all urban consumers (United States city
average) for the 12-month period ending with
June of the previous year;
``(ii) in the same amount for each Medicare
fee-for-service beneficiary described in clause
(i) or (ii) of subparagraph (B) without regard
to enrollment of such a beneficiary in a
medicare supplemental policy (described in
section 1882(g)(1)), in a State Medicaid plan
under title XIX or a waiver of such a plan, or
in any other health insurance policy or health
benefit plan;
``(iii) made for each qualifying service
furnished to such a beneficiary described in
clause (i) or (ii) of subparagraph (B) during a
period specified by the Secretary; and
``(iv) made no later than 30 days after a
qualifying service is furnished to such a
beneficiary described in clause (i) or (ii) of
subparagraph (B).
``(E) No separate payments from the secretary.--The
Secretary shall not make any separate payment to an ACO
for the costs, including incentive payments, of
carrying out an ACO Beneficiary Incentive Program
established under this subsection. Nothing in this
subparagraph shall be construed as prohibiting an ACO
from using shared savings received under this section
to carry out an ACO Beneficiary Incentive Program.
``(F) No application to shared savings
calculation.--Incentive payments made by an ACO under
this subsection shall be disregarded for purposes of
calculating benchmarks, estimated average per capita
Medicare expenditures, and shared savings under this
section.
``(G) Reporting requirements.--An ACO conducting an
ACO Beneficiary Incentive Program under this subsection
shall, at such times and in such format as the
Secretary may require, report to the Secretary such
information and retain such documentation as the
Secretary may require, including the amount and
frequency of incentive payments made and the number of
Medicare fee-for-service beneficiaries receiving such
payments.
``(H) Termination.--The Secretary may terminate an
ACO Beneficiary Incentive Program established under
this subsection at any time for reasons determined
appropriate by the Secretary.
``(3) Exclusion of incentive payments.--Any payment made
under an ACO Beneficiary Incentive Program established under
this subsection shall not be considered income or resources or
otherwise taken into account for purposes of--
``(A) determining eligibility for benefits or
assistance (or the amount or extent of benefits or
assistance) under any Federal program or under any
State or local program financed in whole or in part
with Federal funds; or
``(B) any Federal or State laws relating to
taxation.'';
(3) in subsection (e), by inserting ``, including an ACO
Beneficiary Incentive Program under subsections (b)(2)(I) and
(m)'' after ``the program''; and
(4) in subsection (g)(6), by inserting ``or of an ACO
Beneficiary Incentive Program under subsections (b)(2)(I) and
(m)'' after ``under subsection (d)(4)''.
(b) Amendment to Section 1128B.--Section 1128B(b)(3) of the Social
Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) by striking ``and'' at the end of subparagraph (I);
(2) by striking the period at the end of subparagraph (J)
and inserting ``; and''; and
(3) by adding at the end the following new subparagraph:
``(K) an incentive payment made to a Medicare fee-
for-service beneficiary by an ACO under an ACO
Beneficiary Incentive Program established under
subsection (m) of section 1899, if the payment is made
in accordance with the requirements of such subsection
and meets such other conditions as the Secretary may
establish.''.
(c) Evaluation and Report.--
(1) Evaluation.--The Secretary of Health and Human Services
(in this subsection referred to as the ``Secretary'') shall
conduct an evaluation of the ACO Beneficiary Incentive Program
established under subsections (b)(2)(I) and (m) of section 1899
of the Social Security Act (42 U.S.C. 1395jjj), as added by
subsection (a). The evaluation shall include an analysis of the
impact of the implementation of the Program on expenditures and
beneficiary health outcomes under title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(2) Report.--Not later than October 1, 2023, the Secretary
shall submit to Congress a report containing the results of the
evaluation under paragraph (1), together with recommendations
for such legislation and administrative action as the Secretary
determines appropriate.
SEC. 2332. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHENSIVE CARE
PLANNING SERVICES UNDER MEDICARE PART B.
(a) Study.--The Comptroller General shall conduct a study on the
establishment under part B of the Medicare program under title XVIII of
the Social Security Act of a payment code for a visit for longitudinal
comprehensive care planning services. Such study shall include an
analysis of the following to the extent such information is available:
(1) The frequency with which services similar to
longitudinal comprehensive care planning services are furnished
to Medicare beneficiaries, which providers of services and
suppliers are furnishing those services, whether Medicare
reimbursement is being received for those services, and, if so,
through which codes those services are being reimbursed.
(2) Whether, and the extent to which, longitudinal
comprehensive care planning services would overlap, and could
therefore result in duplicative payment, with services covered
under the hospice benefit as well as the chronic care
management code, evaluation and management codes, or other
codes that already exist under part B of the Medicare program.
(3) Any barriers to hospitals, skilled nursing facilities,
hospice programs, home health agencies, and other applicable
providers working with a Medicare beneficiary to engage in the
care planning process and complete the necessary documentation
to support the treatment and care plan of the beneficiary and
provide such documentation to other providers and the
beneficiary or the beneficiary's representative.
(4) Any barriers to providers, other than the provider
furnishing longitudinal comprehensive care planning services,
accessing the care plan and associated documentation for use
related to the care of the Medicare beneficiary.
(5) Potential options for ensuring that applicable
providers are notified of a patient's existing longitudinal
care plan and that applicable providers consider that plan in
making their treatment decisions, and what the challenges might
be in implementing such options.
(6) Stakeholder's views on the need for the development of
quality metrics with respect to longitudinal comprehensive care
planning services, such as measures related to--
(A) the process of eliciting input from the
Medicare beneficiary or from a legally authorized
representative and documenting in the medical record
the patient-directed care plan;
(B) the effectiveness and patient-centeredness of
the care plan in organizing delivery of services
consistent with the plan;
(C) the availability of the care plan and
associated documentation to other providers that care
for the beneficiary; and
(D) the extent to which the beneficiary received
services and support that is free from discrimination
based on advanced age, disability status, or advanced
illness.
(7) Stakeholder's views on how such quality metrics would
provide information on--
(A) the goals, values, and preferences of the
beneficiary;
(B) the documentation of the care plan;
(C) services furnished to the beneficiary; and
(D) outcomes of treatment.
(8) Stakeholder's views on--
(A) the type of training and education needed for
applicable providers, individuals, and caregivers in
order to facilitate longitudinal comprehensive care
planning services;
(B) the types of providers of services and
suppliers that should be included in the
interdisciplinary team of an applicable provider; and
(C) the characteristics of Medicare beneficiaries
that would be most appropriate to receive longitudinal
comprehensive care planning services, such as
individuals with advanced disease and individuals who
need assistance with multiple activities of daily
living.
(9) Stakeholder's views on the frequency with which
longitudinal comprehensive care planning services should be
furnished.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress
a report containing the results of the study conducted under subsection
(a), together with recommendations for such legislation and
administrative action as the Comptroller General determines
appropriate.
(c) Definitions.--In this section:
(1) Applicable provider.--The term ``applicable provider''
means a hospice program (as defined in subsection (dd)(2) of
section 1861 of the Social Security Act (42 U.S.C. 1395ww)) or
other provider of services (as defined in subsection (u) of
such section) or supplier (as defined in subsection (d) of such
section) that--
(A) furnishes longitudinal comprehensive care
planning services through an interdisciplinary team;
and
(B) meets such other requirements as the Secretary
may determine to be appropriate.
(2) Comptroller general.--The term ``Comptroller General''
means the Comptroller General of the United States.
(3) Interdisciplinary team.--The term ``interdisciplinary
team'' means a group that--
(A) includes the personnel described in subsection
(dd)(2)(B)(i) of such section 1861;
(B) may include a chaplain, minister, or other
clergy; and
(C) may include other direct care personnel.
(4) Longitudinal comprehensive care planning services.--The
term ``longitudinal comprehensive care planning services''
means a voluntary shared decisionmaking process that is
furnished by an applicable provider through an
interdisciplinary team and includes a conversation with
Medicare beneficiaries who have received a diagnosis of a
serious or life-threatening illness. The purpose of such
services is to discuss a longitudinal care plan that addresses
the progression of the disease, treatment options, the goals,
values, and preferences of the beneficiary, and the
availability of other resources and social supports that may
reduce the beneficiary's health risks and promote self-
management and shared decisionmaking.
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
Subtitle E--Other Policies to Improve Care for the Chronically Ill
SEC. 2341. GAO STUDY AND REPORT ON IMPROVING MEDICATION
SYNCHRONIZATION.
(a) Study.--The Comptroller General of the United States (in this
section referred to as the ``Comptroller General'') shall conduct a
study on the extent to which Medicare prescription drug plans (MA-PD
plans and stand alone prescription drug plans) under part D of title
XVIII of the Social Security Act and private payors use programs that
synchronize pharmacy dispensing so that individuals may receive
multiple prescriptions on the same day to facilitate comprehensive
counseling and promote medication adherence. The study shall include a
analysis of the following:
(1) The extent to which pharmacies have adopted such
programs.
(2) The common characteristics of such programs, including
how pharmacies structure counseling sessions under such
programs and the types of payment and other arrangements that
Medicare prescription drug plans and private payors employ
under such programs to support the efforts of pharmacies.
(3) How such programs compare for Medicare prescription
drug plans and private payors.
(4) What is known about how such programs affect patient
medication adherence and overall patient health outcomes,
including if adherence and outcomes vary by patient
subpopulations, such as disease state and socioeconomic status.
(5) What is known about overall patient satisfaction with
such programs and satisfaction with such programs, including
within patient subpopulations, such as disease state and
socioeconomic status.
(6) The extent to which laws and regulations of the
Medicare program support such programs.
(7) Barriers to the use of medication synchronization
programs by Medicare prescription drug plans.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress
a report containing the results of the study under subsection (a),
together with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
SEC. 2342. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS ON PATIENT
HEALTH AND SPENDING.
(a) Study.--The Comptroller General of the United States (in this
section referred to as the ``Comptroller General'') shall, to the
extent data are available, conduct a study on the use of prescription
drugs to manage the weight of obese patients and the impact of coverage
of such drugs on patient health and on health care spending. Such study
shall examine the use and impact of these obesity drugs in the non-
Medicare population and for Medicare beneficiaries who have such drugs
covered through an MA-PD plan (as defined in section 1860D-1(a)(3)(C)
of the Social Security Act (42 U.S.C. 1395w-101(a)(3)(C))) as a
supplemental health care benefit. The study shall include an analysis
of the following:
(1) The prevalence of obesity in the Medicare and non-
Medicare population.
(2) The utilization of obesity drugs.
(3) The distribution of Body Mass Index by individuals
taking obesity drugs, to the extent practicable.
(4) What is known about the use of obesity drugs in
conjunction with the receipt of other items or services, such
as behavioral counseling, and how these compare to items and
services received by obese individuals who do not take obesity
drugs.
(5) Physician considerations and attitudes related to
prescribing obesity drugs.
(6) The extent to which coverage policies cease or limit
coverage for individuals who fail to receive clinical benefit.
(7) What is known about the extent to which individuals who
take obesity drugs adhere to the prescribed regimen.
(8) What is known about the extent to which individuals who
take obesity drugs maintain weight loss over time.
(9) What is known about the subsequent impact such drugs
have on medical services that are directly related to obesity,
including with respect to subpopulations determined based on
the extent of obesity.
(10) What is known about the spending associated with the
care of individuals who take obesity drugs, compared to the
spending associated with the care of individuals who do not
take such drugs.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Comptroller General shall submit to Congress
a report containing the results of the study under subsection (a),
together with recommendations for such legislation and administrative
action as the Comptroller General determines appropriate.
SEC. 2343. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR CHRONIC
CONDITIONS AMONG MEDICARE BENEFICIARIES.
(a) Study.--The Secretary of Health and Human Services (in this
section referred to as the ``Secretary'') shall conduct a study on
long-term cost drivers to the Medicare program, including obesity,
tobacco use, mental health conditions, and other factors that may
contribute to the deterioration of health conditions among individuals
with chronic conditions in the Medicare population. The study shall
include an analysis of any barriers to collecting and analyzing such
information and how to remove any such barriers (including through
legislation and administrative actions).
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary shall submit to Congress a report
containing the results of the study under subsection (a), together with
recommendations for such legislation and administrative action as the
Secretary determines appropriate. The Secretary shall also post such
report on the Internet website of the Department of Health and Human
Services.
TITLE IV--MEDICARE PART B MISCELLANEOUS POLICIES
Subtitle A--Medicare Part B Improvement Act
SEC. 2401. HOME INFUSION THERAPY SERVICES TEMPORARY TRANSITIONAL
PAYMENT.
(a) In General.--Section 1834(u) of the Social Security Act (42
U.S.C. 1395m(u)) is amended by adding at the end the following new
paragraph:
``(7) Home infusion therapy services temporary transitional
payment.--
``(A) Temporary transitional payment.--
``(i) In general.--The Secretary shall, in
accordance with the payment methodology
described in subparagraph (B) and subject to
the provisions of this paragraph, provide a
home infusion therapy services temporary
transitional payment under this part to an
eligible home infusion supplier (as defined in
subparagraph (F)) for items and services
described in subparagraphs (A) and (B) of
section 1861(iii)(2)) furnished during the
period specified in clause (ii) by such
supplier in coordination with the furnishing of
transitional home infusion drugs (as defined in
clause (iii)).
``(ii) Period specified.--For purposes of
clause (i), the period specified in this clause
is the period beginning on January 1, 2019, and
ending on the day before the date of the
implementation of the payment system under
paragraph (1)(A).
``(iii) Transitional home infusion drug
defined.--For purposes of this paragraph, the
term `transitional home infusion drug' has the
meaning given to the term `home infusion drug'
under section 1861(iii)(3)(C)), except that
clause (ii) of such section shall not apply if
a drug described in such clause is identified
in clauses (i), (ii), (iii) or (iv) of
subparagraph (C) as of the date of the
enactment of this paragraph.
``(B) Payment methodology.--For purposes of this
paragraph, the Secretary shall establish a payment
methodology, with respect to items and services
described in subparagraph (A)(i). Under such payment
methodology the Secretary shall--
``(i) create the three payment categories
described in clauses (i), (ii), and (iii) of
subparagraph (C);
``(ii) assign drugs to such categories, in
accordance with such clauses;
``(iii) assign appropriate Healthcare
Common Procedure Coding System (HCPCS) codes to
each payment category; and
``(iv) establish a single payment amount
for each such payment category, in accordance
with subparagraph (D), for each infusion drug
administration calendar day in the individual's
home for drugs assigned to such category.
``(C) Payment categories.--
``(i) Payment category 1.--The Secretary
shall create a payment category 1 and assign to
such category drugs which are covered under the
Local Coverage Determination on External
Infusion Pumps (LCD number L33794) and billed
with the following HCPCS codes (as identified
as of January 1, 2018, and as subsequently
modified by the Secretary): J0133, J0285,
J0287, J0288, J0289, J0895, J1170, J1250,
J1265, J1325, J1455, J1457, J1570, J2175,
J2260, J2270, J2274, J2278, J3010, or J3285.
``(ii) Payment category 2.--The Secretary
shall create a payment category 2 and assign to
such category drugs which are covered under
such local coverage determination and billed
with the following HCPCS codes (as identified
as of January 1, 2018, and as subsequently
modified by the Secretary): J1555 JB, J1559 JB,
J1561 JB, J1562 JB, J1569 JB, or J1575 JB.
``(iii) Payment category 3.--The Secretary
shall create a payment category 3 and assign to
such category drugs which are covered under
such local coverage determination and billed
with the following HCPCS codes (as identified
as of January 1, 2018, and as subsequently
modified by the Secretary): J9000, J9039,
J9040, J9065, J9100, J9190, J9200, J9360, or
J9370.
``(iv) Infusion drugs not otherwise
included.--With respect to drugs that are not
included in payment category 1, 2, or 3 under
clause (i), (ii), or (iii), respectively, the
Secretary shall assign to the most appropriate
of such categories, as determined by the
Secretary, drugs which are--
``(I) covered under such local
coverage determination and billed under
HCPCS codes J7799 or J7999 (as
identified as of July 1, 2017, and as
subsequently modified by the
Secretary); or
``(II) billed under any code that
is implemented after the date of the
enactment of this paragraph and
included in such local coverage
determination or included in
subregulatory guidance as a home
infusion drug described in subparagraph
(A)(i).
``(D) Payment amounts.--
``(i) In general.--Under the payment
methodology, the Secretary shall pay eligible
home infusion suppliers, with respect to items
and services described in subparagraph (A)(i)
furnished during the period described in
subparagraph (A)(ii) by such supplier to an
individual, at amounts equal to the amounts
determined under the physician fee schedule
established under section 1848 for services
furnished during the year for codes and units
of such codes described in clauses (ii), (iii),
and (iv) with respect to drugs included in the
payment category under subparagraph (C)
specified in the respective clause, determined
without application of the geographic
adjustment under subsection (e) of such
section.
``(ii) Payment amount for category 1.--For
purposes of clause (i), the codes and units
described in this clause, with respect to drugs
included in payment category 1 described in
subparagraph (C)(i), are one unit of HCPCS code
96365 plus three units of HCPCS code 96366 (as
identified as of January 1, 2018, and as
subsequently modified by the Secretary).
``(iii) Payment amount for category 2.--For
purposes of clause (i), the codes and units
described in this clause, with respect to drugs
included in payment category 2 described in
subparagraph (C)(i), are one unit of HCPCS code
96369 plus three units of HCPCS code 96370 (as
identified as of January 1, 2018, and as
subsequently modified by the Secretary).
``(iv) Payment amount for category 3.--For
purposes of clause (i), the codes and units
described in this clause, with respect to drugs
included in payment category 3 described in
subparagraph (C)(i), are one unit of HCPCS code
96413 plus three units of HCPCS code 96415 (as
identified as of January 1, 2018, and as
subsequently modified by the Secretary).
``(E) Clarifications.--
``(i) Infusion drug administration day.--
For purposes of this subsection, with respect
to the furnishing of transitional home infusion
drugs or home infusion drugs to an individual
by an eligible home infusion supplier or a
qualified home infusion therapy supplier, a
reference to payment to such supplier for an
infusion drug administration calendar day in
the individual's home shall refer to payment
only for the date on which professional
services (as described in section
1861(iii)(2)(A)) were furnished to administer
such drugs to such individual. For purposes of
the previous sentence, an infusion drug
administration calendar day shall include all
such drugs administered to such individual on
such day.
``(ii) Treatment of multiple drugs
administered on same infusion drug
administration day.--In the case that an
eligible home infusion supplier, with respect
to an infusion drug administration calendar day
in an individual's home, furnishes to such
individual transitional home infusion drugs
which are not all assigned to the same payment
category under subparagraph (C), payment to
such supplier for such infusion drug
administration calendar day in the individual's
home shall be a single payment equal to the
amount of payment under this paragraph for the
drug, among all such drugs so furnished to such
individual during such calendar day, for which
the highest payment would be made under this
paragraph.
``(F) Eligible home infusion suppliers.--In this
paragraph, the term `eligible home infusion supplier'
means a supplier that is enrolled under this part as a
pharmacy that provides external infusion pumps and
external infusion pump supplies and that maintains all
pharmacy licensure requirements in the State in which
the applicable infusion drugs are administered.
``(G) Implementation.--Notwithstanding any other
provision of law, the Secretary may implement this
paragraph by program instruction or otherwise.''.
(b) Conforming Amendment.--
(1) Section 1842(b)(6)(I) of the Social Security Act (42
U.S.C. 1395u(b)(6)(I)) is amended by inserting ``or, in the
case of items and services described in clause (i) of section
1834(u)(7)(A) furnished to an individual during the period
described in clause (ii) of such section, payment shall be made
to the eligible home infusion therapy supplier'' after
``payment shall be made to the qualified home infusion therapy
supplier''.
(2) Section 5012(d) of the 21st Century Cures Act is
amended by inserting the following before the period at the end
the following: ``, except that the amendments made by
paragraphs (1) and (2) of subsection (c) shall apply to items
and services furnished on or after January 1, 2019''.
SEC. 2402. ORTHOTIST'S AND PROSTHETIST'S CLINICAL NOTES AS PART OF THE
PATIENT'S MEDICAL RECORD.
Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is
amended by adding at the end the following new paragraph:
``(5) Documentation created by orthotists and
prosthetists.--For purposes of determining the reasonableness
and medical necessity of orthotics and prosthetics,
documentation created by an orthotist or prosthetist shall be
considered part of the individual's medical record to support
documentation created by eligible professionals described in
section 1848(k)(3)(B).''.
SEC. 2403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES AND
ASSURANCE OF HIGH QUALITY SURVEYS.
(a) Accreditation and Surveys.--
(1) In general.--Section 1865 of the Social Security Act
(42 U.S.C. 1395bb) is amended--
(A) in subsection (a)--
(i) in paragraph (1), in the matter
preceding subparagraph (A), by striking ``or
the conditions and requirements under section
1881(b)''; and
(ii) in paragraph (4), by inserting
``(including a renal dialysis facility)'' after
``facility''; and
(B) by adding at the end the following new
subsection:
``(e) With respect to an accreditation body that has received
approval from the Secretary under subsection (a)(3)(A) for
accreditation of provider entities that are required to meet the
conditions and requirements under section 1881(b), in addition to
review and oversight authorities otherwise applicable under this title,
the Secretary shall (as the Secretary determines appropriate) conduct,
with respect to such accreditation body and provider entities, any or
all of the following as frequently as is otherwise required to be
conducted under this title with respect to other accreditation bodies
or other provider entities:
``(1) Validation surveys referred to in subsection (d).
``(2) Accreditation program reviews (as defined in section
488.8(c) of title 42 of the Code of Federal Regulations, or a
successor regulation).
``(3) Performance reviews (as defined in section 488.8(a)
of title 42 of the Code of Federal Regulations, or a successor
regulation).''.
(2) Timing for acceptance of requests from accreditation
organizations.--Not later than 90 days after the date of
enactment of this Act, the Secretary of Health and Human
Services shall begin accepting requests from national
accreditation bodies for a finding described in section
1865(a)(3)(A) of the Social Security Act (42 U.S.C.
1395bb(a)(3)(A)) for purposes of accrediting provider entities
that are required to meet the conditions and requirements under
section 1881(b) of such Act (42 U.S.C. 1395rr(b)).
(b) Requirement for Timing of Surveys of New Dialysis Facilities.--
Section 1881(b)(1) of the Social Security Act (42 U.S.C. 1395rr(b)(1))
is amended by adding at the end the following new sentence: ``Beginning
180 days after the date of the enactment of this sentence, an initial
survey of a provider of services or a renal dialysis facility to
determine if the conditions and requirements under this paragraph are
met shall be initiated not later than 90 days after such date on which
both the provider enrollment form (without regard to whether such form
is submitted prior to or after such date of enactment) has been
determined by the Secretary to be complete and the provider's
enrollment status indicates approval is pending the results of such
survey.''.
SEC. 2404. MODERNIZING THE APPLICATION OF THE STARK RULE UNDER
MEDICARE.
(a) Clarification of the Writing Requirement and Signature
Requirement for Arrangements Pursuant to the Stark Rule.--
(1) Writing requirement.--Section 1877(h)(1) of the Social
Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding at
the end the following new subparagraph:
``(D) Written requirement clarified.--In the case of any
requirement pursuant to this section for a compensation
arrangement to be in writing, such requirement shall be
satisfied by such means as determined by the Secretary,
including by a collection of documents, including
contemporaneous documents evidencing the course of conduct
between the parties involved.''.
(2) Signature requirement.--Section 1877(h)(1) of the
Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by
paragraph (1), is further amended by adding at the end the
following new subparagraph:
``(E) Special rule for signature requirements.--In
the case of any requirement pursuant to this section
for a compensation arrangement to be in writing and
signed by the parties, such signature requirement shall
be met if--
``(i) not later than 90 consecutive
calendar days immediately following the date on
which the compensation arrangement became
noncompliant, the parties obtain the required
signatures; and
``(ii) the compensation arrangement
otherwise complies with all criteria of the
applicable exception.''.
(b) Indefinite Holdover for Lease Arrangements and Personal
Services Arrangements Pursuant to the Stark Rule.--Section 1877(e) of
the Social Security Act (42 U.S.C. 1395nn(e)) is amended--
(1) in paragraph (1), by adding at the end the following
new subparagraph:
``(C) Holdover lease arrangements.--In the case of
a holdover lease arrangement for the lease of office
space or equipment, which immediately follows a lease
arrangement described in subparagraph (A) for the use
of such office space or subparagraph (B) for the use of
such equipment and that expired after a term of at
least 1 year, payments made by the lessee to the lessor
pursuant to such holdover lease arrangement, if--
``(i) the lease arrangement met the
conditions of subparagraph (A) for the lease of
office space or subparagraph (B) for the use of
equipment when the arrangement expired;
``(ii) the holdover lease arrangement is on
the same terms and conditions as the
immediately preceding arrangement; and
``(iii) the holdover arrangement continues
to satisfy the conditions of subparagraph (A)
for the lease of office space or subparagraph
(B) for the use of equipment.''; and
(2) in paragraph (3), by adding at the end the following
new subparagraph:
``(C) Holdover personal service arrangement.--In
the case of a holdover personal service arrangement,
which immediately follows an arrangement described in
subparagraph (A) that expired after a term of at least
1 year, remuneration from an entity pursuant to such
holdover personal service arrangement, if--
``(i) the personal service arrangement met
the conditions of subparagraph (A) when the
arrangement expired;
``(ii) the holdover personal service
arrangement is on the same terms and conditions
as the immediately preceding arrangement; and
``(iii) the holdover arrangement continues
to satisfy the conditions of subparagraph
(A).''.
Subtitle B--Additional Provisions
SEC. 2411. MAKING PERMANENT THE REMOVAL OF THE RENTAL CAP FOR DURABLE
MEDICAL EQUIPMENT UNDER MEDICARE WITH RESPECT TO SPEECH
GENERATING DEVICES.
Section 1834(a)(2)(A)(iv) of the Social Security Act (42 U.S.C.
1395m(a)(2)(A)(iv)) is amended by striking ``and before October 1,
2018,''.
SEC. 2412. INCREASED CIVIL AND CRIMINAL PENALTIES AND INCREASED
SENTENCES FOR FEDERAL HEALTH CARE PROGRAM FRAUD AND
ABUSE.
(a) Increased Civil Money Penalties and Criminal Fines.--
(1) Increased civil money penalties.--Section 1128A of the
Social Security Act (42 U.S.C. 1320a-7a) is amended--
(A) in subsection (a), in the matter following
paragraph (10)--
(i) by striking ``$10,000'' and inserting
``$20,000'' each place it appears;
(ii) by striking ``$15,000'' and inserting
``$30,000''; and
(iii) by striking ``$50,000'' and inserting
``$100,000'' each place it appears; and
(B) in subsection (b)--
(i) in paragraph (1), in the flush text
following subparagraph (B), by striking
``$2,000'' and inserting ``$5,000'';
(ii) in paragraph (2), by striking
``$2,000'' and inserting ``$5,000''; and
(iii) in paragraph (3)(A)(i), by striking
``$5,000'' and inserting ``$10,000''.
(2) Increased criminal fines.--Section 1128B of such Act
(42 U.S.C. 1320a-7b) is amended--
(A) in subsection (a), in the matter following
paragraph (6)--
(i) by striking ``$25,000'' and inserting
``$100,000''; and
(ii) by striking ``$10,000'' and inserting
``$20,000'';
(B) in subsection (b)--
(i) in paragraph (1), in the flush text
following subparagraph (B), by striking
``$25,000'' and inserting ``$100,000''; and
(ii) in paragraph (2), in the flush text
following subparagraph (B), by striking
``$25,000'' and inserting ``$100,000'';
(C) in subsection (c), by striking ``$25,000'' and
inserting ``$100,000'';
(D) in subsection (d), in the flush text following
paragraph (2), by striking ``$25,000'' and inserting
``$100,000''; and
(E) in subsection (e), by striking ``$2,000'' and
inserting ``$4,000''.
(b) Increased Sentences for Felonies Involving Federal Health Care
Program Fraud and Abuse.--
(1) False statements and representations.--Section 1128B(a)
of the Social Security Act (42 U.S.C. 1320a-7b(a)) is amended,
in the matter following paragraph (6), by striking ``not more
than five years or both, or (ii)'' and inserting ``not more
than 10 years or both, or (ii)''.
(2) Antikickback.--Section 1128B(b) of such Act (42 U.S.C.
1320a-7b(b)) is amended--
(A) in paragraph (1), in the flush text following
subparagraph (B), by striking ``not more than five
years'' and inserting ``not more than 10 years''; and
(B) in paragraph (2), in the flush text following
subparagraph (B), by striking ``not more than five
years'' and inserting ``not more than 10 years''.
(3) False statement or representation with respect to
conditions or operations of facilities.--Section 1128B(c) of
such Act (42 U.S.C. 1320a-7b(c)) is amended by striking ``not
more than five years'' and inserting ``not more than 10
years''.
(4) Excess charges.--Section 1128B(d) of such Act (42
U.S.C. 1320a-7b(d)) is amended, in the flush text following
paragraph (2), by striking ``not more than five years'' and
inserting ``not more than 10 years''.
(c) Effective Date.--The amendments made by this section shall
apply to acts committed after the date of the enactment of this Act.
SEC. 2413. REDUCING THE VOLUME OF FUTURE EHR-RELATED SIGNIFICANT
HARDSHIP REQUESTS.
Section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(A)) and section 1886(n)(3)(A) of such Act (42 U.S.C.
1395ww(n)(3)(A)) are each amended in the last sentence by striking ``by
requiring'' and all that follows through ``this paragraph''.
SEC. 2414. COVERAGE OF CERTAIN DNA SPECIMEN PROVENANCE ASSAY TESTS
UNDER MEDICARE.
(a) Benefit.--
(1) Coverage.--Section 1861 of the Social Security Act (42
U.S.C. 1395x) is amended--
(A) in subsection (s)(2)--
(i) in subparagraph (FF), by striking
``and'' at the end;
(ii) in subparagraph (GG), by inserting
``and'' at the end; and
(iii) by adding at the end the following
new subparagraph:
``(HH) a prostate cancer DNA Specimen Provenance Assay test
(DSPA test) (as defined in subsection (jjj)); and''; and
(B) by adding at the end the following new
subsection:
``(jjj) Prostate Cancer DNA Speciment Provenance Assay Test.--The
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test)
means a test that, after a determination of cancer in one or more
prostate biopsy specimens obtained from an individual, assesses the
identity of the DNA in such specimens by comparing such DNA with the
DNA that was separately taken from such individual at the time of the
biopsy.''.
(2) Exclusion from coverage.--Section 1862(a)(1) of the
Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
(A) in subparagraph (O), by striking ``and'' at the
end;
(B) in subparagraph (P), by striking the semicolon
at the end and inserting ``, and''; and
(C) by adding at the end the following new
subparagraph:
``(Q) in the case of a prostate cancer DNA Specimen
Provenance Assay test (DSPA test) (as defined in section
1861(jjj)), unless such test is furnished on or after January
1, 2019, and before January 1, 2024, and such test is ordered
by the physician who furnished the prostate cancer biopsy that
obtained the specimen tested;''.
(b) Payment Amount and Related Requirements.--Section 1834 of the
Social Security Act (42 U.S.C. 1395m), as amended by section 2204, is
further amended by adding at the end the following new subsection:
``(w) Prostate Cancer DNA Specimen Provenance Assay Tests.--
``(1) Payment for covered tests.--
``(A) In general.--Subject to subparagraph (B), the
payment amount for a prostate cancer DNA Specimen
Provenance Assay test (DSPA test) (as defined in
section 1861(jjj)) shall be $200. Such payment shall be
payment for all of the specimens obtained from the
biopsy furnished to an individual that are tested.
``(B) Limitation.--Payment for a DSPA test under
subparagraph (A) may only be made on an assignment-
related basis.
``(C) Prohibition on separate payment.--No separate
payment shall be made for obtaining DNA that was
separately taken from an individual at the time of a
biopsy described in subparagraph (A).
``(2) HCPCS code and modifier assignment.--
``(A) In general.--The Secretary shall assign one
or more HCPCS codes to a prostate cancer DNA Specimen
Provenance Assay test and may use a modifier to
facilitate making payment under this section for such
test.
``(B) Identification of dna match on claim.--The
Secretary shall require an indication on a claim for a
prostate cancer DNA Specimen Provenance Assay test of
whether the DNA of the prostate biopsy specimens match
the DNA of the individual diagnosed with prostate
cancer. Such indication may be made through use of a
HCPCS code, a modifier, or other means, as determined
appropriate by the Secretary.
``(3) DNA match review.--
``(A) In general.--The Secretary shall review at
least three years of claims under part B for prostate
cancer DNA Specimen Provenance Assay tests to identify
whether the DNA of the prostate biopsy specimens match
the DNA of the individuals diagnosed with prostate
cancer.
``(B) Posting on internet website.--Not later than
July 1, 2022, the Secretary shall post on the Internet
website of the Centers for Medicare & Medicaid Services
the findings of the review conducted under subparagraph
(A).''.
(c) Cost-sharing.--Section 1833(a)(1) of the Social Security Act
(42 U.S.C. 1395l(a)(1)) is amended--
(1) by striking ``and (BB)'' and inserting ``(BB)''; and
(2) by inserting before the semicolon at the end the
following: ``, and (CC) with respect to a prostate cancer DNA
Specimen Provenance Assay test (DSPA test) (as defined in
section 1861(jjj)), the amount paid shall be an amount equal to
80 percent of the lesser of the actual charge for the test or
the amount specified under section 1834(w)''.
SEC. 2415. STRENGTHENING RULES IN CASE OF COMPETITION FOR DIABETIC
TESTING STRIPS.
(a) Special Rule in Case of Competition for Diabetic Testing
Strips.--
(1) In general.--Paragraph (10) of section 1847(b) of the
Social Security Act (42 U.S.C. 1395w-3(b)) is amended--
(A) in subparagraph (A), by striking the second
sentence and inserting the following new sentence:
``With respect to bids to furnish such types of
products on or after January 1, 2019, the volume for
such types of products shall be determined by the
Secretary through the use of multiple sources of data
(from mail order and non-mail order Medicare markets),
including market-based data measuring sales of diabetic
testing strip products that are not exclusively sold by
a single retailer from such markets.''; and
(B) by adding at the end the following new
subparagraphs:
``(C) Demonstration of ability to furnish types of
diabetic testing strip products.--With respect to bids
to furnish diabetic testing strip products on or after
January 1, 2019, an entity shall attest to the
Secretary that the entity has the ability to obtain an
inventory of the types and quantities of diabetic
testing strip products that will allow the entity to
furnish such products in a manner consistent with its
bid and--
``(i) demonstrate to the Secretary, through
letters of intent with manufacturers,
wholesalers, or other suppliers, or other
evidence as the Secretary may specify, such
ability; or
``(ii) demonstrate to the Secretary that it
made a good faith attempt to obtain such a
letter of intent or such other evidence.
``(D) Use of unlisted types in calculation of
percentage.--With respect to bids to furnish diabetic
testing strip products on or after January 1, 2019, in
determining under subparagraph (A) whether a bid
submitted by an entity under such subparagraph covers
50 percent (or such higher percentage as the Secretary
may specify) of all types of diabetic testing strip
products, the Secretary may not attribute a percentage
to types of diabetic testing strip products that the
Secretary does not identify by brand, model, and market
share volume.
``(E) Adherence to demonstration.--
``(i) In general.--In the case of an entity
that is furnishing diabetic testing strip
products on or after January 1, 2019, under a
contract entered into under the competition
conducted pursuant to paragraph (1), the
Secretary shall establish a process to monitor,
on an ongoing basis, the extent to which such
entity continues to cover the product types
included in the entity's bid.
``(ii) Termination.--If the Secretary
determines that an entity described in clause
(i) fails to maintain in inventory, or
otherwise maintain ready access to (through
requirements, contracts, or otherwise) a type
of product included in the entity's bid, the
Secretary may terminate such contract unless
the Secretary finds that the failure of the
entity to maintain inventory of, or ready
access to, the product is the result of the
discontinuation of the product by the product
manufacturer, a market-wide shortage of the
product, or the introduction of a newer model
or version of the product in the market
involved.''.
(b) Codifying and Expanding Anti-switching Rule.--Section 1847(b)
of the Social Security Act (42 U.S.C. 1395w-3(b)), as amended by
subsection (a)(1), is further amended--
(1) by redesignating paragraph (11) as paragraph (12); and
(2) by inserting after paragraph (10) the following new
paragraph:
``(11) Additional special rules in case of competition for
diabetic testing strips.--
``(A) In general.--With respect to an entity that
is furnishing diabetic testing strip products to
individuals under a contract entered into under the
competitive acquisition program established under this
section, the entity shall furnish to each individual a
brand of such products that is compatible with the home
blood glucose monitor selected by the individual.
``(B) Prohibition on influencing and
incentivizing.--An entity described in subparagraph (A)
may not attempt to influence or incentivize an
individual to switch the brand of glucose monitor or
diabetic testing strip product selected by the
individual, including by--
``(i) persuading, pressuring, or advising
the individual to switch; or
``(ii) furnishing information about
alternative brands to the individual where the
individual has not requested such information.
``(C) Provision of information.--
``(i) Standardized information.--Not later
than January 1, 2019, the Secretary shall
develop and make available to entities
described in subparagraph (A) standardized
information that describes the rights of an
individual with respect to such an entity. The
information described in the preceding sentence
shall include information regarding--
``(I) the requirements established
under subparagraphs (A) and (B);
``(II) the right of the individual
to purchase diabetic testing strip
products from another mail order
supplier of such products or a retail
pharmacy if the entity is not able to
furnish the brand of such product that
is compatible with the home blood
glucose monitor selected by the
individual; and
``(III) the right of the individual
to return diabetic testing strip
products furnished to the individual by
the entity.
``(ii) Requirement.--With respect to
diabetic testing strip products furnished on or
after the date on which the Secretary develops
the standardized information under clause (i),
an entity described in subparagraph (A) may not
communicate directly to an individual until the
entity has verbally provided the individual
with such standardized information.
``(D) Order refills.--With respect to diabetic
testing strip products furnished on or after January 1,
2019, the Secretary shall require an entity furnishing
diabetic testing strip products to an individual to
contact and receive a request from the individual for
such products not more than 14 days prior to dispensing
a refill of such products to the individual.''.
(c) Implementation; Non-application of the Paperwork Reduction
Act.--
(1) Implementation.--Notwithstanding any other provision of
law, the Secretary of Health and Human Services may implement
the provisions of, and amendments made by, this section by
program instruction or otherwise.
(2) Non-application of the paperwork reduction act.--
Chapter 35 of title 44, United States Code (commonly referred
to as the ``Paperwork Reduction Act of 1995''), shall not apply
to this section or the amendments made by this section.
TITLE V--OTHER HEALTH EXTENDERS
SEC. 2501. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH
SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE
GME PROGRAMS.
(a) Community Health Centers Funding.--Section 10503(b)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)), as
amended by section 3101 of Public Law 115-96, is amended by amending
subparagraph (F) to read as follows:
``(F) $3,600,000,000 for each of fiscal years 2018
and 2019.''.
(b) Other Community Health Centers Provisions.--Section 330 of the
Public Health Service Act (42 U.S.C. 254b) is amended--
(1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and
inserting ``use disorder'';
(2) in subsection (b)(2)(A), by striking ``abuse'' and
inserting ``use disorder'';
(3) in subsection (c)--
(A) in paragraph (1), by striking subparagraphs (B)
through (D);
(B) by striking ``(1) In general'' and all that
follows through ``The Secretary'' and inserting the
following:
``(1) Centers.--The Secretary''; and
(C) in paragraph (1), as amended, by redesignating
clauses (i) through (v) as subparagraphs (A) through
(E) and moving the margin of each of such redesignated
subparagraph 2 ems to the left;
(4) by striking subsection (d) and inserting the following:
``(d) Improving Quality of Care.--
``(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under this
section to implement evidence-based models for increasing
access to high-quality primary care services, which may include
models related to--
``(A) improving the delivery of care for
individuals with multiple chronic conditions;
``(B) workforce configuration;
``(C) reducing the cost of care;
``(D) enhancing care coordination;
``(E) expanding the use of telehealth and
technology-enabled collaborative learning and capacity
building models;
``(F) care integration, including integration of
behavioral health, mental health, or substance use
disorder services; and
``(G) addressing emerging public health or
substance use disorder issues to meet the health needs
of the population served by the health center.
``(2) Sustainability.--In making supplemental awards under
this subsection, the Secretary may consider whether the health
center involved has submitted a plan for continuing the
activities funded under this subsection after supplemental
funding is expended.
``(3) Special consideration.--The Secretary may give
special consideration to applications for supplemental funding
under this subsection that seek to address significant barriers
to access to care in areas with a greater shortage of health
care providers and health services relative to the national
average.'';
(5) in subsection (e)(1)--
(A) in subparagraph (B)--
(i) by striking ``2 years'' and inserting
``1 year''; and
(ii) by adding at the end the following:
``The Secretary shall not make a grant under
this paragraph unless the applicant provides
assurances to the Secretary that within 120
days of receiving grant funding for the
operation of the health center, the applicant
will submit, for approval by the Secretary, an
implementation plan to meet the requirements of
subsection (k)(3). The Secretary may extend
such 120-day period for achieving compliance
upon a demonstration of good cause by the
health center.''; and
(B) in subparagraph (C)--
(i) in the subparagraph heading, by
striking ``and plans'';
(ii) by striking ``or plan (as described in
subparagraphs (B) and (C) of subsection
(c)(1))'';
(iii) by striking ``or plan, including the
purchase'' and inserting the following:
``including--
``(i) the purchase'';
(iv) by inserting ``, which may include
data and information systems'' after ``of
equipment'';
(v) by striking the period at the end and
inserting a semicolon; and
(vi) by adding at the end the following:
``(ii) the provision of training and
technical assistance; and
``(iii) other activities that--
``(I) reduce costs associated with
the provision of health services;
``(II) improve access to, and
availability of, health services
provided to individuals served by the
centers;
``(III) enhance the quality and
coordination of health services; or
``(IV) improve the health status of
communities.'';
(6) in subsection (e)(5)(B)--
(A) in the heading of subparagraph (B), by striking
``and plans''; and
(B) by striking ``and subparagraphs (B) and (C) of
subsection (c)(1) to a health center or to a network or
plan'' and inserting ``to a health center or to a
network'';
(7) in subsection (e), by adding at the end the following:
``(6) New access points and expanded services.--
``(A) Approval of new access points.--
``(i) In general.--The Secretary may
approve applications for grants under
subparagraph (A) or (B) of paragraph (1) to
establish new delivery sites.
``(ii) Special consideration.--In carrying
out clause (i), the Secretary may give special
consideration to applicants that have
demonstrated the new delivery site will be
located within a sparsely populated area, or an
area which has a level of unmet need that is
higher relative to other applicants.
``(iii) Consideration of applications.--In
carrying out clause (i), the Secretary shall
approve applications for grants in such a
manner that the ratio of the medically
underserved populations in rural areas which
may be expected to use the services provided by
the applicants involved to the medically
underserved populations in urban areas which
may be expected to use the services provided by
the applicants is not less than two to three or
greater than three to two.
``(iv) Service area overlap.--If in
carrying out clause (i) the applicant proposes
to serve an area that is currently served by
another health center funded under this
section, the Secretary may consider whether the
award of funding to an additional health center
in the area can be justified based on the unmet
need for additional services within the
catchment area.
``(B) Approval of expanded service applications.--
``(i) In general.--The Secretary may
approve applications for grants under
subparagraph (A) or (B) of paragraph (1) to
expand the capacity of the applicant to provide
required primary health services described in
subsection (b)(1) or additional health services
described in subsection (b)(2).
``(ii) Priority expansion projects.--In
carrying out clause (i), the Secretary may give
special consideration to expanded service
applications that seek to address emerging
public health or behavioral health, mental
health, or substance abuse issues through
increasing the availability of additional
health services described in subsection (b)(2)
in an area in which there are significant
barriers to accessing care.
``(iii) Consideration of applications.--In
carrying out clause (i), the Secretary shall
approve applications for grants in such a
manner that the ratio of the medically
underserved populations in rural areas which
may be expected to use the services provided by
the applicants involved to the medically
underserved populations in urban areas which
may be expected to use the services provided by
such applicants is not less than two to three
or greater than three to two.'';
(8) in subsection (h)--
(A) in paragraph (1), by striking ``and children
and youth at risk of homelessness'' and inserting ``,
children and youth at risk of homelessness, homeless
veterans, and veterans at risk of homelessness''; and
(B) in paragraph (5)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph (C) as
subparagraph (B); and
(iii) in subparagraph (B) (as so
redesignated)--
(I) in the subparagraph heading, by
striking ``abuse'' and inserting ``use
disorder''; and
(II) by striking ``abuse'' and
inserting ``use disorder'';
(9) in subsection (k)--
(A) in paragraph (2)--
(i) in the paragraph heading, by inserting
``unmet'' before ``need'';
(ii) in the matter preceding subparagraph
(A), by inserting ``or subsection (e)(6)''
after ``subsection (e)(1)'';
(iii) in subparagraph (A), by inserting
``unmet'' before ``need for health services'';
(iv) in subparagraph (B), by striking
``and'' at the end;
(v) in subparagraph (C), by striking the
period at the end and inserting ``; and''; and
(vi) by adding after subparagraph (C) the
following:
``(D) in the case of an application for a grant
pursuant to subsection (e)(6), a demonstration that the
applicant has consulted with appropriate State and
local government agencies, and health care providers
regarding the need for the health services to be
provided at the proposed delivery site.'';
(B) in paragraph (3)--
(i) in the matter preceding subparagraph
(A), by inserting ``or subsection (e)(6)''
after ``subsection (e)(1)(B)'';
(ii) in subparagraph (B), by striking ``in
the catchment area of the center'' and
inserting ``, including other health care
providers that provide care within the
catchment area, local hospitals, and specialty
providers in the catchment area of the center,
to provide access to services not available
through the health center and to reduce the
non-urgent use of hospital emergency
departments'';
(iii) in subparagraph (H)(ii), by inserting
``who shall be directly employed by the
center'' after ``approves the selection of a
director for the center'';
(iv) in subparagraph (L), by striking
``and'' at the end;
(v) in subparagraph (M), by striking the
period and inserting ``; and''; and
(vi) by inserting after subparagraph (M),
the following:
``(N) the center has written policies and
procedures in place to ensure the appropriate use of
Federal funds in compliance with applicable Federal
statutes, regulations, and the terms and conditions of
the Federal award.''; and
(C) by striking paragraph (4);
(10) in subsection (l), by adding at the end the following:
``Funds expended to carry out activities under this subsection
and operational support activities under subsection (m) shall
not exceed 3 percent of the amount appropriated for this
section for the fiscal year involved.'';
(11) in subsection (q)(4), by adding at the end the
following: ``A waiver provided by the Secretary under this
paragraph may not remain in effect for more than 1 year and may
not be extended after such period. An entity may not receive
more than one waiver under this paragraph in consecutive
years.'';
(12) in subsection (r)(3)--
(A) by striking ``appropriate committees of
Congress a report concerning the distribution of funds
under this section'' and inserting the following:
``Committee on Health, Education, Labor, and Pensions
of the Senate, and the Committee on Energy and Commerce
of the House of Representatives, a report including, at
a minimum--
``(A) the distribution of funds for carrying out
this section'';
(B) by striking ``populations. Such report shall
include an assessment'' and inserting the following:
``populations;
``(B) an assessment'';
(C) by striking ``and the rationale for any
substantial changes in the distribution of funds.'' and
inserting a semicolon; and
(D) by adding at the end the following:
``(C) the distribution of awards and funding for
new or expanded services in each of rural areas and
urban areas;
``(D) the distribution of awards and funding for
establishing new access points, and the number of new
access points created;
``(E) the amount of unexpended funding for loan
guarantees and loan guarantee authority under title
XVI;
``(F) the rationale for any substantial changes in
the distribution of funds;
``(G) the rate of closures for health centers and
access points;
``(H) the number and reason for any grants awarded
pursuant to subsection (e)(1)(B); and
``(I) the number and reason for any waivers
provided pursuant to subsection (q)(4).'';
(13) in subsection (r), by adding at the end the following
new paragraph:
``(5) Funding for participation of health centers in all of
us research program.--In addition to any amounts made available
pursuant to paragraph (1) of this subsection, section 402A of
this Act, or section 10503 of the Patient Protection and
Affordable Care Act, there is authorized to be appropriated,
and there is appropriated, out of any monies in the Treasury
not otherwise appropriated, to the Secretary $25,000,000 for
fiscal year 2018 to support the participation of health centers
in the All of Us Research Program under the Precision Medicine
Initiative under section 498E of this Act.''; and
(14) by striking subsection (s).
(c) National Health Service Corps.--Section 10503(b)(2) of the
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)), as
amended by section 3101 of Public Law 115-96, is amended by amending
subparagraph (F) to read as follows:
``(F) $310,000,000 for each of fiscal years 2018
and 2019.''.
(d) Teaching Health Centers That Operate Graduate Medical Education
Programs.--
(1) Payments.--Subsection (a) of section 340H of the Public
Health Service Act (42 U.S.C. 256h) is amended to read as
follows:
``(a) Payments.--
``(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for direct
expenses and indirect expenses to qualified teaching health
centers that are listed as sponsoring institutions by the
relevant accrediting body for, as appropriate--
``(A) maintenance of filled positions at existing
approved graduate medical residency training programs;
``(B) expansion of existing approved graduate
medical residency training programs; and
``(C) establishment of new approved graduate
medical residency training programs.
``(2) Per resident amount.--In making payments under
paragraph (1), the Secretary shall consider the cost of
training residents at teaching health centers and the
implications of the per resident amount on approved graduate
medical residency training programs at teaching health centers.
``(3) Priority.--In making payments under paragraph (1)(C),
the Secretary shall give priority to qualified teaching health
centers that--
``(A) serve a health professional shortage area
with a designation in effect under section 332 or a
medically underserved community (as defined in section
799B); or
``(B) are located in a rural area (as defined in
section 1886(d)(2)(D) of the Social Security Act).''.
(2) Funding.--Paragraph (1) of section 340H(g) of the
Public Health Service Act (42 U.S.C. 256h(g)), as amended by
section 3101 of Public Law 115-96, is amended by striking ``and
$30,000,000 for the period of the first and second quarters of
fiscal year 2018'' and inserting ``and $126,500,000 for each of
fiscal years 2018 and 2019''.
(3) Annual reporting.--Subsection (h)(1) of section 340H of
the Public Health Service Act (42 U.S.C. 256h) is amended--
(A) by redesignating subparagraph (D) as
subparagraph (H); and
(B) by inserting after subparagraph (C) the
following:
``(D) The number of patients treated by residents
described in paragraph (4).
``(E) The number of visits by patients treated by
residents described in paragraph (4).
``(F) Of the number of residents described in
paragraph (4) who completed their residency training at
the end of such residency academic year, the number and
percentage of such residents entering primary care
practice (meaning any of the areas of practice listed
in the definition of a primary care residency program
in section 749A).
``(G) Of the number of residents described in
paragraph (4) who completed their residency training at
the end of such residency academic year, the number and
percentage of such residents who entered practice at a
health care facility--
``(i) primarily serving a health
professional shortage area with a designation
in effect under section 332 or a medically
underserved community (as defined in section
799B); or
``(ii) located in a rural area (as defined
in section 1886(d)(2)(D) of the Social Security
Act).''.
(4) Report on training costs.--Not later than March 31,
2019, the Secretary of Health and Human Services shall submit
to the Congress a report on the direct graduate expenses of
approved graduate medical residency training programs, and the
indirect expenses associated with the additional costs of
teaching residents, of qualified teaching health centers (as
such terms are used or defined in section 340H of the Public
Health Service Act (42 U.S.C. 256h)).
(5) Definition.--Subsection (j) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended--
(A) by redesignating paragraphs (2) and (3) as
paragraphs (3) and (4), respectively; and
(B) by inserting after paragraph (1) the following:
``(2) New approved graduate medical residency training
program.--The term `new approved graduate medical residency
training program' means an approved graduate medical residency
training program for which the sponsoring qualified teaching
health center has not received a payment under this section for
a previous fiscal year (other than pursuant to subsection
(a)(1)(C)).''.
(6) Technical correction.--Subsection (f) of section 340H
(42 U.S.C. 256h) is amended by striking ``hospital'' each place
it appears and inserting ``teaching health center''.
(7) Payments for previous fiscal years.--The provisions of
section 340H of the Public Health Service Act (42 U.S.C. 256h),
as in effect on the day before the date of enactment of Public
Law 115-96, shall continue to apply with respect to payments
under such section for fiscal years before fiscal year 2018.
(e) Application.--Amounts appropriated pursuant to this section for
fiscal year 2018 or 2019 are subject to the requirements contained in
Public Law 115-31 for funds for programs authorized under sections 330
through 340 of the Public Health Service Act (42 U.S.C. 254b-256).
(f) Conforming Amendment.--Paragraph (4) of section 3014(h) of
title 18, United States Code, as amended by section 3101 of Public Law
115-96, is amended by striking ``and section 3101(d) of the CHIP and
Public Health Funding Extension Act'' and inserting ``and section
2501(e) of the SUSTAIN Care Act of 2018''.
SEC. 2502. EXTENSION FOR SPECIAL DIABETES PROGRAMS.
(a) Special Diabetes Program for Type I Diabetes.--Subparagraph (D)
of section 330B(b)(2) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)), as amended by section 3102 of Public Law 115-96, is amended
to read as follows:
``(D) $150,000,000 for each of fiscal years 2018
and 2019, to remain available until expended.''.
(b) Special Diabetes Program for Indians.--Subparagraph (D) of
section 330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
3(c)(2)), as amended by section 3102 of Public Law 115-96, is amended
to read as follows:
``(D) $150,000,000 for each of fiscal years 2018
and 2019, to remain available until expended.''.
SEC. 2503. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.
Section 501(c) of the Social Security Act (42 U.S.C. 701(c)) is
amended--
(1) in paragraph (1)(A)--
(A) in clause (v), by striking ``and'' at the end;
(B) in clause (vi), by striking the period at the
end and inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vii) $6,000,000 for each of fiscal years 2018 and
2019.'';
(2) in paragraph (3)(C), by inserting before the period the
following: ``, and with respect to fiscal years 2018 and 2019,
such centers shall also be developed in all territories and at
least one such center shall be developed for Indian Tribes'';
and
(3) by amending paragraph (5) to read as follows:
``(5) For purposes of this subsection--
``(A) the term `Indian Tribe' has the meaning given to the
term `Indian tribe' in section 4 of the Indian Health Care
Improvement Act (25 U.S.C. 1603);
``(B) the term `State' means each of the 50 States and the
District of Columbia; and
``(C) the term `territory' means Puerto Rico, Guam,
American Samoa, the United States Virgin Islands, and the
Northern Mariana Islands.''.
SEC. 2504. EXTENSION FOR SEXUAL RISK AVOIDANCE EDUCATION.
(a) In General.--Section 510 of the Social Security Act (42 U.S.C.
710) is amended to read as follows:
``SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION.
``(a) In General.--
``(1) Allotments to states.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, allot to each State which has transmitted an
application for the fiscal year under section 505(a) an amount
equal to the product of--
``(A) the amount appropriated pursuant to
subsection (e)(1) for the fiscal year, minus the amount
reserved under subsection (e)(2) for the fiscal year;
and
``(B) the proportion that the number of low-income
children in the State bears to the total of such
numbers of children for all the States.
``(2) Other allotments.--
``(A) Other entities.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal
years 2018 and 2019, for any State which has not
transmitted an application for the fiscal year under
section 505(a), allot to one or more entities in the
State the amount that would have been allotted to the
State under paragraph (1) if the State had submitted
such an application.
``(B) Process.--The Secretary shall select the
recipients of allotments under subparagraph (A) by
means of a competitive grant process under which--
``(i) not later than 30 days after the
deadline for the State involved to submit an
application for the fiscal year under section
505(a), the Secretary publishes a notice
soliciting grant applications; and
``(ii) not later than 120 days after such
deadline, all such applications must be
submitted.
``(b) Purpose.--
``(1) In general.--Except for research under paragraph (5)
and information collection and reporting under paragraph (6),
the purpose of an allotment under subsection (a) to a State (or
to another entity in the State pursuant to subsection (a)(2))
is to enable the State or other entity to implement education
exclusively on sexual risk avoidance (meaning voluntarily
refraining from sexual activity).
``(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section shall--
``(A) ensure that the unambiguous and primary
emphasis and context for each topic described in
paragraph (3) is a message to youth that normalizes the
optimal health behavior of avoiding nonmarital sexual
activity;
``(B) be medically accurate and complete;
``(C) be age-appropriate;
``(D) be based on adolescent learning and
developmental theories for the age group receiving the
education; and
``(E) be culturally appropriate, recognizing the
experiences of youth from diverse communities,
backgrounds, and experiences.
``(3) Topics.--Education on sexual risk avoidance pursuant
to an allotment under this section shall address each of the
following topics:
``(A) The holistic individual and societal benefits
associated with personal responsibility, self-
regulation, goal setting, healthy decisionmaking, and a
focus on the future.
``(B) The advantage of refraining from nonmarital
sexual activity in order to improve the future
prospects and physical and emotional health of youth.
``(C) The increased likelihood of avoiding poverty
when youth attain self-sufficiency and emotional
maturity before engaging in sexual activity.
``(D) The foundational components of healthy
relationships and their impact on the formation of
healthy marriages and safe and stable families.
``(E) How other youth risk behaviors, such as drug
and alcohol usage, increase the risk for teen sex.
``(F) How to resist and avoid, and receive help
regarding, sexual coercion and dating violence,
recognizing that even with consent teen sex remains a
youth risk behavior.
``(4) Contraception.--Education on sexual risk avoidance
pursuant to an allotment under this section shall ensure that--
``(A) any information provided on contraception is
medically accurate and complete and ensures that
students understand that contraception offers physical
risk reduction, but not risk elimination; and
``(B) the education does not include
demonstrations, simulations, or distribution of
contraceptive devices.
``(5) Research.--
``(A) In general.--A State or other entity
receiving an allotment pursuant to subsection (a) may
use up to 20 percent of such allotment to build the
evidence base for sexual risk avoidance education by
conducting or supporting research.
``(B) Requirements.--Any research conducted or
supported pursuant to subparagraph (A) shall be--
``(i) rigorous;
``(ii) evidence-based; and
``(iii) designed and conducted by
independent researchers who have experience in
conducting and publishing research in peer-
reviewed outlets.
``(6) Information collection and reporting.--A State or
other entity receiving an allotment pursuant to subsection (a)
shall, as specified by the Secretary--
``(A) collect information on the programs and
activities funded through the allotment; and
``(B) submit reports to the Secretary on the data
from such programs and activities.
``(c) National Evaluation.--
``(1) In general.--The Secretary shall--
``(A) in consultation with appropriate State and
local agencies, conduct one or more rigorous
evaluations of the education funded through this
section and associated data; and
``(B) submit a report to the Congress on the
results of such evaluations, together with a summary of
the information collected pursuant to subsection
(b)(6).
``(2) Consultation.--In conducting the evaluations required
by paragraph (1), including the establishment of rigorous
evaluation methodologies, the Secretary shall consult with
relevant stakeholders and evaluation experts.
``(d) Applicability of Certain Provisions.--
``(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as
such sections apply to allotments under section 502(c).
``(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary to be
appropriate.
``(e) Definitions.--In this section:
``(1) The term `age-appropriate' means suitable (in terms
of topics, messages, and teaching methods) to the developmental
and social maturity of the particular age or age group of
children or adolescents, based on developing cognitive,
emotional, and behavioral capacity typical for the age or age
group.
``(2) The term `medically accurate and complete' means
verified or supported by the weight of research conducted in
compliance with accepted scientific methods and--
``(A) published in peer-reviewed journals, where
applicable; or
``(B) comprising information that leading
professional organizations and agencies with relevant
expertise in the field recognize as accurate,
objective, and complete.
``(3) The term `rigorous', with respect to research or
evaluation, means using--
``(A) established scientific methods for measuring
the impact of an intervention or program model in
changing behavior (specifically sexual activity or
other sexual risk behaviors), or reducing pregnancy,
among youth; or
``(B) other evidence-based methodologies
established by the Secretary for purposes of this
section.
``(4) The term `youth' refers to one or more individuals
who have attained age 10 but not age 20.
``(f) Funding.--
``(1) In general.--To carry out this section, there is
appropriated, out of any money in the Treasury not otherwise
appropriated, $75,000,000 for each of fiscal years 2018 and
2019.
``(2) Reservation.--The Secretary shall reserve, for each
of fiscal years 2018 and 2019, not more than 20 percent of the
amount appropriated pursuant to paragraph (1) for administering
the program under this section, including the conducting of
national evaluations and the provision of technical assistance
to the recipients of allotments.''.
(b) Effective Date.--The amendment made by this section takes
effect on October 1, 2017.
SEC. 2505. EXTENSION FOR PERSONAL RESPONSIBILITY EDUCATION.
(a) In General.--Section 513 of the Social Security Act (42 U.S.C.
713) is amended--
(1) in subsection (a)(1)(A), by striking ``2017'' and
inserting ``2019''; and
(2) in subsection (a)(4)--
(A) in subparagraph (A), by striking ``2017'' each
place it appears and inserting ``2019''; and
(B) in subparagraph (B)--
(i) in the subparagraph heading, by
striking ``3-year grants'' and inserting
``Competitive prep grants''; and
(ii) in clause (i), by striking ``solicit
applications to award 3-year grants in each of
fiscal years 2012 through 2017'' and inserting
``continue through fiscal year 2019 grants
awarded for any of fiscal years 2015 through
2017'';
(3) in subsection (c)(1), by inserting after ``youth with
HIV/AIDS,'' the following: ``victims of human trafficking,'';
and
(4) in subsection (f), by striking ``2017'' and inserting
``2019''.
(b) Effective Date.--The amendments made by this section take
effect on October 1, 2017.
TITLE VI--CHILD AND FAMILY SERVICES AND SUPPORT
Subtitle A--Family First Prevention Services Act
SEC. 2601. SHORT TITLE.
This subtitle may be cited as the ``Family First Prevention
Services Act''.
CHAPTER 1--INVESTING IN PREVENTION AND FAMILY SERVICES
SEC. 2611. PURPOSE.
The purpose of this chapter is to enable States to use Federal
funds available under parts B and E of title IV of the Social Security
Act to provide enhanced support to children and families and prevent
foster care placements through the provision of mental health and
substance abuse prevention and treatment services, in-home parent
skill-based programs, and kinship navigator services.
Subchapter A--Prevention Activities Under Title IV-E
SEC. 2621. FOSTER CARE PREVENTION SERVICES AND PROGRAMS.
(a) State Option.--Section 471 of the Social Security Act (42
U.S.C. 671) is amended--
(1) in subsection (a)(1), by striking ``and'' and all that
follows through the semicolon and inserting ``, adoption
assistance in accordance with section 473, and, at the option
of the State, services or programs specified in subsection
(e)(1) of this section for children who are candidates for
foster care or who are pregnant or parenting foster youth and
the parents or kin caregivers of the children, in accordance
with the requirements of that subsection;''; and
(2) by adding at the end the following:
``(e) Prevention and Family Services and Programs.--
``(1) In general.--Subject to the succeeding provisions of
this subsection, the Secretary may make a payment to a State
for providing the following services or programs for a child
described in paragraph (2) and the parents or kin caregivers of
the child when the need of the child, such a parent, or such a
caregiver for the services or programs are directly related to
the safety, permanence, or well-being of the child or to
preventing the child from entering foster care:
``(A) Mental health and substance abuse prevention
and treatment services.--Mental health and substance
abuse prevention and treatment services provided by a
qualified clinician for not more than a 12-month period
that begins on any date described in paragraph (3) with
respect to the child.
``(B) In-home parent skill-based programs.--In-home
parent skill-based programs for not more than a 12-
month period that begins on any date described in
paragraph (3) with respect to the child and that
include parenting skills training, parent education,
and individual and family counseling.
``(2) Child described.--For purposes of paragraph (1), a
child described in this paragraph is the following:
``(A) A child who is a candidate for foster care
(as defined in section 475(13)) but can remain safely
at home or in a kinship placement with receipt of
services or programs specified in paragraph (1).
``(B) A child in foster care who is a pregnant or
parenting foster youth.
``(3) Date described.--For purposes of paragraph (1), the
dates described in this paragraph are the following:
``(A) The date on which a child is identified in a
prevention plan maintained under paragraph (4) as a
child who is a candidate for foster care (as defined in
section 475(13)).
``(B) The date on which a child is identified in a
prevention plan maintained under paragraph (4) as a
pregnant or parenting foster youth in need of services
or programs specified in paragraph (1).
``(4) Requirements related to providing services and
programs.--Services and programs specified in paragraph (1) may
be provided under this subsection only if specified in advance
in the child's prevention plan described in subparagraph (A)
and the requirements in subparagraphs (B) through (E) are met:
``(A) Prevention plan.--The State maintains a
written prevention plan for the child that meets the
following requirements (as applicable):
``(i) Candidates.--In the case of a child
who is a candidate for foster care described in
paragraph (2)(A), the prevention plan shall--
``(I) identify the foster care
prevention strategy for the child so
that the child may remain safely at
home, live temporarily with a kin
caregiver until reunification can be
safely achieved, or live permanently
with a kin caregiver;
``(II) list the services or
programs to be provided to or on behalf
of the child to ensure the success of
that prevention strategy; and
``(III) comply with such other
requirements as the Secretary shall
establish.
``(ii) Pregnant or parenting foster
youth.--In the case of a child who is a
pregnant or parenting foster youth described in
paragraph (2)(B), the prevention plan shall--
``(I) be included in the child's
case plan required under section
475(1);
``(II) list the services or
programs to be provided to or on behalf
of the youth to ensure that the youth
is prepared (in the case of a pregnant
foster youth) or able (in the case of a
parenting foster youth) to be a parent;
``(III) describe the foster care
prevention strategy for any child born
to the youth; and
``(IV) comply with such other
requirements as the Secretary shall
establish.
``(B) Trauma-informed.--The services or programs to
be provided to or on behalf of a child are provided
under an organizational structure and treatment
framework that involves understanding, recognizing, and
responding to the effects of all types of trauma and in
accordance with recognized principles of a trauma-
informed approach and trauma-specific interventions to
address trauma's consequences and facilitate healing.
``(C) Only services and programs provided in
accordance with promising, supported, or well-supported
practices permitted.--
``(i) In general.--Only State expenditures
for services or programs specified in
subparagraph (A) or (B) of paragraph (1) that
are provided in accordance with practices that
meet the requirements specified in clause (ii)
of this subparagraph and that meet the
requirements specified in clause (iii), (iv),
or (v), respectively, for being a promising,
supported, or well-supported practice, shall be
eligible for a Federal matching payment under
section 474(a)(6)(A).
``(ii) General practice requirements.--The
general practice requirements specified in this
clause are the following:
``(I) The practice has a book,
manual, or other available writings
that specify the components of the
practice protocol and describe how to
administer the practice.
``(II) There is no empirical basis
suggesting that, compared to its likely
benefits, the practice constitutes a
risk of harm to those receiving it.
``(III) If multiple outcome studies
have been conducted, the overall weight
of evidence supports the benefits of
the practice.
``(IV) Outcome measures are
reliable and valid, and are
administrated consistently and
accurately across all those receiving
the practice.
``(V) There is no case data
suggesting a risk of harm that was
probably caused by the treatment and
that was severe or frequent.
``(iii) Promising practice.--A practice
shall be considered to be a `promising
practice' if the practice is superior to an
appropriate comparison practice using
conventional standards of statistical
significance (in terms of demonstrated
meaningful improvements in validated measures
of important child and parent outcomes, such as
mental health, substance abuse, and child
safety and well-being), as established by the
results or outcomes of at least one study
that--
``(I) was rated by an independent
systematic review for the quality of
the study design and execution and
determined to be well-designed and
well-executed; and
``(II) utilized some form of
control (such as an untreated group, a
placebo group, or a wait list study).
``(iv) Supported practice.--A practice
shall be considered to be a `supported
practice' if--
``(I) the practice is superior to
an appropriate comparison practice
using conventional standards of
statistical significance (in terms of
demonstrated meaningful improvements in
validated measures of important child
and parent outcomes, such as mental
health, substance abuse, and child
safety and well-being), as established
by the results or outcomes of at least
one study that--
``(aa) was rated by an
independent systematic review
for the quality of the study
design and execution and
determined to be well-designed
and well-executed;
``(bb) was a rigorous
random-controlled trial (or, if
not available, a study using a
rigorous quasi-experimental
research design); and
``(cc) was carried out in a
usual care or practice setting;
and
``(II) the study described in
subclause (I) established that the
practice has a sustained effect (when
compared to a control group) for at
least 6 months beyond the end of the
treatment.
``(v) Well-supported practice.--A practice
shall be considered to be a `well-supported
practice' if--
``(I) the practice is superior to
an appropriate comparison practice
using conventional standards of
statistical significance (in terms of
demonstrated meaningful improvements in
validated measures of important child
and parent outcomes, such as mental
health, substance abuse, and child
safety and well-being), as established
by the results or outcomes of at least
two studies that--
``(aa) were rated by an
independent systematic review
for the quality of the study
design and execution and
determined to be well-designed
and well-executed;
``(bb) were rigorous
random-controlled trials (or,
if not available, studies using
a rigorous quasi-experimental
research design); and
``(cc) were carried out in
a usual care or practice
setting; and
``(II) at least one of the studies
described in subclause (I) established
that the practice has a sustained
effect (when compared to a control
group) for at least 1 year beyond the
end of treatment.
``(D) Guidance on practices criteria and pre-
approved services and programs.--
``(i) In general.--Not later than October
1, 2018, the Secretary shall issue guidance to
States regarding the practices criteria
required for services or programs to satisfy
the requirements of subparagraph (C). The
guidance shall include a pre-approved list of
services and programs that satisfy the
requirements.
``(ii) Updates.--The Secretary shall issue
updates to the guidance required by clause (i)
as often as the Secretary determines necessary.
``(E) Outcome assessment and reporting.--The State
shall collect and report to the Secretary the following
information with respect to each child for whom, or on
whose behalf mental health and substance abuse
prevention and treatment services or in-home parent
skill-based programs are provided during a 12-month
period beginning on the date the child is determined by
the State to be a child described in paragraph (2):
``(i) The specific services or programs
provided and the total expenditures for each of
the services or programs.
``(ii) The duration of the services or
programs provided.
``(iii) In the case of a child described in
paragraph (2)(A), the child's placement status
at the beginning, and at the end, of the 1-year
period, respectively, and whether the child
entered foster care within 2 years after being
determined a candidate for foster care.
``(5) State plan component.--
``(A) In general.--A State electing to provide
services or programs specified in paragraph (1) shall
submit as part of the State plan required by subsection
(a) a prevention services and programs plan component
that meets the requirements of subparagraph (B).
``(B) Prevention services and programs plan
component.--In order to meet the requirements of this
subparagraph, a prevention services and programs plan
component, with respect to each 5-year period for which
the plan component is in operation in the State, shall
include the following:
``(i) How providing services and programs
specified in paragraph (1) is expected to
improve specific outcomes for children and
families.
``(ii) How the State will monitor and
oversee the safety of children who receive
services and programs specified in paragraph
(1), including through periodic risk
assessments throughout the period in which the
services and programs are provided on behalf of
a child and reexamination of the prevention
plan maintained for the child under paragraph
(4) for the provision of the services or
programs if the State determines the risk of
the child entering foster care remains high
despite the provision of the services or
programs.
``(iii) With respect to the services and
programs specified in subparagraphs (A) and (B)
of paragraph (1), information on the specific
promising, supported, or well-supported
practices the State plans to use to provide the
services or programs, including a description
of--
``(I) the services or programs and
whether the practices used are
promising, supported, or well-
supported;
``(II) how the State plans to
implement the services or programs,
including how implementation of the
services or programs will be
continuously monitored to ensure
fidelity to the practice model and to
determine outcomes achieved and how
information learned from the monitoring
will be used to refine and improve
practices;
``(III) how the State selected the
services or programs;
``(IV) the target population for
the services or programs; and
``(V) how each service or program
provided will be evaluated through a
well-designed and rigorous process,
which may consist of an ongoing, cross-
site evaluation approved by the
Secretary.
``(iv) A description of the consultation
that the State agencies responsible for
administering the State plans under this part
and part B engage in with other State agencies
responsible for administering health programs,
including mental health and substance abuse
prevention and treatment services, and with
other public and private agencies with
experience in administering child and family
services, including community-based
organizations, in order to foster a continuum
of care for children described in paragraph (2)
and their parents or kin caregivers.
``(v) A description of how the State shall
assess children and their parents or kin
caregivers to determine eligibility for
services or programs specified in paragraph
(1).
``(vi) A description of how the services or
programs specified in paragraph (1) that are
provided for or on behalf of a child and the
parents or kin caregivers of the child will be
coordinated with other child and family
services provided to the child and the parents
or kin caregivers of the child under the State
plans in effect under subparts 1 and 2 of part
B.
``(vii) Descriptions of steps the State is
taking to support and enhance a competent,
skilled, and professional child welfare
workforce to deliver trauma-informed and
evidence-based services, including--
``(I) ensuring that staff is
qualified to provide services or
programs that are consistent with the
promising, supported, or well-supported
practice models selected; and
``(II) developing appropriate
prevention plans, and conducting the
risk assessments required under clause
(iii).
``(viii) A description of how the State
will provide training and support for
caseworkers in assessing what children and
their families need, connecting to the families
served, knowing how to access and deliver the
needed trauma-informed and evidence-based
services, and overseeing and evaluating the
continuing appropriateness of the services.
``(ix) A description of how caseload size
and type for prevention caseworkers will be
determined, managed, and overseen.
``(x) An assurance that the State will
report to the Secretary such information and
data as the Secretary may require with respect
to the provision of services and programs
specified in paragraph (1), including
information and data necessary to determine the
performance measures for the State under
paragraph (6) and compliance with paragraph
(7).
``(C) Reimbursement for services under the
prevention plan component.--
``(i) Limitation.--Except as provided in
subclause (ii), a State may not receive a
Federal payment under this part for a given
promising, supported, or well-supported
practice unless (in accordance with
subparagraph (B)(iii)(V)) the plan includes a
well-designed and rigorous evaluation strategy
for that practice.
``(ii) Waiver of limitation.--The Secretary
may waive the requirement for a well-designed
and rigorous evaluation of any well-supported
practice if the Secretary deems the evidence of
the effectiveness of the practice to be
compelling and the State meets the continuous
quality improvement requirements included in
subparagraph (B)(iii)(II) with regard to the
practice.
``(6) Prevention services measures.--
``(A) Establishment; annual updates.--Beginning
with fiscal year 2021, and annually thereafter, the
Secretary shall establish the following prevention
services measures based on information and data
reported by States that elect to provide services and
programs specified in paragraph (1):
``(i) Percentage of candidates for foster
care who do not enter foster care.--The
percentage of candidates for foster care for
whom, or on whose behalf, the services or
programs are provided who do not enter foster
care, including those placed with a kin
caregiver outside of foster care, during the
12-month period in which the services or
programs are provided and through the end of
the succeeding 12-month period.
``(ii) Per-child spending.--The total
amount of expenditures made for mental health
and substance abuse prevention and treatment
services or in-home parent skill-based
programs, respectively, for, or on behalf of,
each child described in paragraph (2).
``(B) Data.--The Secretary shall establish and
annually update the prevention services measures--
``(i) based on the median State values of
the information reported under each clause of
subparagraph (A) for the 3 then most recent
years; and
``(ii) taking into account State
differences in the price levels of consumption
goods and services using the most recent
regional price parities published by the Bureau
of Economic Analysis of the Department of
Commerce or such other data as the Secretary
determines appropriate.
``(C) Publication of state prevention services
measures.--The Secretary shall annually make available
to the public the prevention services measures of each
State.
``(7) Maintenance of effort for state foster care
prevention expenditures.--
``(A) In general.--If a State elects to provide
services and programs specified in paragraph (1) for a
fiscal year, the State foster care prevention
expenditures for the fiscal year shall not be less than
the amount of the expenditures for fiscal year 2014
(or, at the option of a State described in subparagraph
(E), fiscal year 2015 or fiscal year 2016 (whichever
the State elects)).
``(B) State foster care prevention expenditures.--
The term `State foster care prevention expenditures'
means the following:
``(i) TANF; iv-b; ssbg.--State expenditures
for foster care prevention services and
activities under the State program funded under
part A (including from amounts made available
by the Federal Government), under the State
plan developed under part B (including any such
amounts), or under the Social Services Block
Grant Programs under subtitle A of title XX
(including any such amounts).
``(ii) Other state programs.--State
expenditures for foster care prevention
services and activities under any State program
that is not described in clause (i) (other than
any State expenditures for foster care
prevention services and activities under the
State program under this part (including under
a waiver of the program)).
``(C) State expenditures.--The term `State
expenditures' means all State or local funds that are
expended by the State or a local agency including State
or local funds that are matched or reimbursed by the
Federal Government and State or local funds that are
not matched or reimbursed by the Federal Government.
``(D) Determination of prevention services and
activities.--The Secretary shall require each State
that elects to provide services and programs specified
in paragraph (1) to report the expenditures specified
in subparagraph (B) for fiscal year 2014 and for such
fiscal years thereafter as are necessary to determine
whether the State is complying with the maintenance of
effort requirement in subparagraph (A). The Secretary
shall specify the specific services and activities
under each program referred to in subparagraph (B) that
are `prevention services and activities' for purposes
of the reports.
``(E) State described.--For purposes of
subparagraph (A), a State is described in this
subparagraph if the population of children in the State
in 2014 was less than 200,000 (as determined by the
Bureau of the Census).
``(8) Prohibition against use of state foster care
prevention expenditures and federal iv-e prevention funds for
matching or expenditure requirement.--A State that elects to
provide services and programs specified in paragraph (1) shall
not use any State foster care prevention expenditures for a
fiscal year for the State share of expenditures under section
474(a)(6) for a fiscal year.
``(9) Administrative costs.--Expenditures described in
section 474(a)(6)(B)--
``(A) shall not be eligible for payment under
subparagraph (A), (B), or (E) of section 474(a)(3); and
``(B) shall be eligible for payment under section
474(a)(6)(B) without regard to whether the expenditures
are incurred on behalf of a child who is, or is
potentially, eligible for foster care maintenance
payments under this part.
``(10) Application.--
``(A) In general.--The provision of services or
programs under this subsection to or on behalf of a
child described in paragraph (2) shall not be
considered to be receipt of aid or assistance under the
State plan under this part for purposes of eligibility
for any other program established under this Act.
``(B) Candidates in kinship care.--A child
described in paragraph (2) for whom such services or
programs under this subsection are provided for more
than 6 months while in the home of a kin caregiver, and
who would satisfy the AFDC eligibility requirement of
section 472(a)(3)(A)(ii)(II) but for residing in the
home of the caregiver for more than 6 months, is deemed
to satisfy that requirement for purposes of determining
whether the child is eligible for foster care
maintenance payments under section 472.''.
(b) Definition.--Section 475 of such Act (42 U.S.C. 675) is amended
by adding at the end the following:
``(13) The term `child who is a candidate for foster care'
means, a child who is identified in a prevention plan under
section 471(e)(4)(A) as being at imminent risk of entering
foster care (without regard to whether the child would be
eligible for foster care maintenance payments under section 472
or is or would be eligible for adoption assistance or kinship
guardianship assistance payments under section 473) but who can
remain safely in the child's home or in a kinship placement as
long as services or programs specified in section 471(e)(1)
that are necessary to prevent the entry of the child into
foster care are provided. The term includes a child whose
adoption or guardianship arrangement is at risk of a disruption
or dissolution that would result in a foster care placement.''.
(c) Payments Under Title IV-E.--Section 474(a) of such Act (42
U.S.C. 674(a)) is amended--
(1) in paragraph (5), by striking the period at the end and
inserting ``; plus''; and
(2) by adding at the end the following:
``(6) subject to section 471(e)--
``(A) for each quarter--
``(i) subject to clause (ii)--
``(I) beginning after September 30,
2019, and before October 1, 2026, an
amount equal to 50 percent of the total
amount expended during the quarter for
the provision of services or programs
specified in subparagraph (A) or (B) of
section 471(e)(1) that are provided in
accordance with promising, supported,
or well-supported practices that meet
the applicable criteria specified for
the practices in section 471(e)(4)(C);
and
``(II) beginning after September
30, 2026, an amount equal to the
Federal medical assistance percentage
(which shall be as defined in section
1905(b), in the case of a State other
than the District of Columbia, or 70
percent, in the case of the District of
Columbia) of the total amount expended
during the quarter for the provision of
services or programs specified in
subparagraph (A) or (B) of section
471(e)(1) that are provided in
accordance with promising, supported,
or well-supported practices that meet
the applicable criteria specified for
the practices in section 471(e)(4)(C)
(or, with respect to the payments made
during the quarter under a cooperative
agreement or contract entered into by
the State and an Indian tribe, tribal
organization, or tribal consortium for
the administration or payment of funds
under this part, an amount equal to the
Federal medical assistance percentage
that would apply under section 479B(d)
(in this paragraph referred to as the
`tribal FMAP') if the Indian tribe,
tribal organization, or tribal
consortium made the payments under a
program operated under that section,
unless the tribal FMAP is less than the
Federal medical assistance percentage
that applies to the State); except that
``(ii) not less than 50 percent of the
total amount expended by a State under clause
(i) for a fiscal year shall be for the
provision of services or programs specified in
subparagraph (A) or (B) of section 471(e)(1)
that are provided in accordance with well-
supported practices; plus
``(B) for each quarter specified in subparagraph
(A), an amount equal to the sum of the following
proportions of the total amount expended during the
quarter--
``(i) 50 percent of so much of the
expenditures as are found necessary by the
Secretary for the proper and efficient
administration of the State plan for the
provision of services or programs specified in
section 471(e)(1), including expenditures for
activities approved by the Secretary that
promote the development of necessary processes
and procedures to establish and implement the
provision of the services and programs for
individuals who are eligible for the services
and programs and expenditures attributable to
data collection and reporting; and
``(ii) 50 percent of so much of the
expenditures with respect to the provision of
services and programs specified in section
471(e)(1) as are for training of personnel
employed or preparing for employment by the
State agency or by the local agency
administering the plan in the political
subdivision and of the members of the staff of
State-licensed or State-approved child welfare
agencies providing services to children
described in section 471(e)(2) and their
parents or kin caregivers, including on how to
determine who are individuals eligible for the
services or programs, how to identify and
provide appropriate services and programs, and
how to oversee and evaluate the ongoing
appropriateness of the services and
programs.''.
(d) Technical Assistance and Best Practices, Clearinghouse, and
Data Collection and Evaluations.--Section 476 of such Act (42 U.S.C.
676) is amended by adding at the end the following:
``(d) Technical Assistance and Best Practices, Clearinghouse, Data
Collection, and Evaluations Relating to Prevention Services and
Programs.--
``(1) Technical assistance and best practices.--The
Secretary shall provide to States and, as applicable, to Indian
tribes, tribal organizations, and tribal consortia, technical
assistance regarding the provision of services and programs
described in section 471(e)(1) and shall disseminate best
practices with respect to the provision of the services and
programs, including how to plan and implement a well-designed
and rigorous evaluation of a promising, supported, or well-
supported practice.
``(2) Clearinghouse of promising, supported, and well-
supported practices.--The Secretary shall, directly or through
grants, contracts, or interagency agreements, evaluate research
on the practices specified in clauses (iii), (iv), and (v),
respectively, of section 471(e)(4)(C), and programs that meet
the requirements described in section 427(a)(1), including
culturally specific, or location- or population-based
adaptations of the practices, to identify and establish a
public clearinghouse of the practices that satisfy each
category described by such clauses. In addition, the
clearinghouse shall include information on the specific
outcomes associated with each practice, including whether the
practice has been shown to prevent child abuse and neglect and
reduce the likelihood of foster care placement by supporting
birth families and kinship families and improving targeted
supports for pregnant and parenting youth and their children.
``(3) Data collection and evaluations.--The Secretary,
directly or through grants, contracts, or interagency
agreements, may collect data and conduct evaluations with
respect to the provision of services and programs described in
section 471(e)(1) for purposes of assessing the extent to which
the provision of the services and programs--
``(A) reduces the likelihood of foster care
placement;
``(B) increases use of kinship care arrangements;
or
``(C) improves child well-being.
``(4) Reports to congress.--
``(A) In general.--The Secretary shall submit to
the Committee on Finance of the Senate and the
Committee on Ways and Means of the House of
Representatives periodic reports based on the provision
of services and programs described in section 471(e)(1)
and the activities carried out under this subsection.
``(B) Public availability.--The Secretary shall
make the reports to the Congress submitted under this
paragraph publicly available.
``(5) Appropriation.--Out of any money in the Treasury of
the United States not otherwise appropriated, there are
appropriated to the Secretary $1,000,000 for fiscal year 2018
and each fiscal year thereafter to carry out this
subsection.''.
(e) Application to Programs Operated by Indian Tribal
Organizations.--
(1) In general.--Section 479B of such Act (42 U.S.C. 679c)
is amended--
(A) in subsection (c)(1)--
(i) in subparagraph (C)(i)--
(I) in subclause (II), by striking
``and'' after the semicolon;
(II) in subclause (III), by
striking the period at the end and
inserting ``; and''; and
(III) by adding at the end the
following:
``(IV) at the option of the tribe,
organization, or consortium, services
and programs specified in section
471(e)(1) to children described in
section 471(e)(2) and their parents or
kin caregivers, in accordance with
section 471(e) and subparagraph (E).'';
and
(ii) by adding at the end the following:
``(E) Prevention services and programs for children
and their parents and kin caregivers.--
``(i) In general.--In the case of a tribe,
organization, or consortium that elects to
provide services and programs specified in
section 471(e)(1) to children described in
section 471(e)(2) and their parents or kin
caregivers under the plan, the Secretary shall
specify the requirements applicable to the
provision of the services and programs. The
requirements shall, to the greatest extent
practicable, be consistent with the
requirements applicable to States under section
471(e) and shall permit the provision of the
services and programs in the form of services
and programs that are adapted to the culture
and context of the tribal communities served.
``(ii) Performance measures.--The Secretary
shall establish specific performance measures
for each tribe, organization, or consortium
that elects to provide services and programs
specified in section 471(e)(1). The performance
measures shall, to the greatest extent
practicable, be consistent with the prevention
services measures required for States under
section 471(e)(6) but shall allow for
consideration of factors unique to the
provision of the services by tribes,
organizations, or consortia.''; and
(B) in subsection (d)(1), by striking ``and (5)''
and inserting ``(5), and (6)(A)''.
(2) Conforming amendment.--The heading for subsection (d)
of section 479B of such Act (42 U.S.C. 679c) is amended by
striking ``for Foster Care Maintenance and Adoption Assistance
Payments''.
(f) Application to Programs Operated by Territories.--Section
1108(a)(2) of the Social Security Act (42 U.S.C. 1308(a)(2)) is amended
by striking ``or 413(f)'' and inserting ``413(f), or 474(a)(6)''.
SEC. 2622. FOSTER CARE MAINTENANCE PAYMENTS FOR CHILDREN WITH PARENTS
IN A LICENSED RESIDENTIAL FAMILY-BASED TREATMENT FACILITY
FOR SUBSTANCE ABUSE.
(a) In General.--Section 472 of the Social Security Act (42 U.S.C.
672) is amended--
(1) in subsection (a)(2)(C), by striking ``or'' and
inserting ``, with a parent residing in a licensed residential
family-based treatment facility, but only to the extent
permitted under subsection (j), or in a''; and
(2) by adding at the end the following:
``(j) Children Placed With a Parent Residing in a Licensed
Residential Family-based Treatment Facility for Substance Abuse.--
``(1) In general.--Notwithstanding the preceding provisions
of this section, a child who is eligible for foster care
maintenance payments under this section, or who would be
eligible for the payments if the eligibility were determined
without regard to paragraphs (1)(B) and (3) of subsection (a),
shall be eligible for the payments for a period of not more
than 12 months during which the child is placed with a parent
who is in a licensed residential family-based treatment
facility for substance abuse, but only if--
``(A) the recommendation for the placement is
specified in the child's case plan before the
placement;
``(B) the treatment facility provides, as part of
the treatment for substance abuse, parenting skills
training, parent education, and individual and family
counseling; and
``(C) the substance abuse treatment, parenting
skills training, parent education, and individual and
family counseling is provided under an organizational
structure and treatment framework that involves
understanding, recognizing, and responding to the
effects of all types of trauma and in accordance with
recognized principles of a trauma-informed approach and
trauma-specific interventions to address the
consequences of trauma and facilitate healing.
``(2) Application.--With respect to children for whom
foster care maintenance payments are made under paragraph (1),
only the children who satisfy the requirements of paragraphs
(1)(B) and (3) of subsection (a) shall be considered to be
children with respect to whom foster care maintenance payments
are made under this section for purposes of subsection (h) or
section 473(b)(3)(B).''.
(b) Conforming Amendment.--Section 474(a)(1) of such Act (42 U.S.C.
674(a)(1)) is amended by inserting ``subject to section 472(j),''
before ``an amount equal to the Federal'' the first place it appears.
SEC. 2623. TITLE IV-E PAYMENTS FOR EVIDENCE-BASED KINSHIP NAVIGATOR
PROGRAMS.
Section 474(a) of the Social Security Act (42 U.S.C. 674(a)), as
amended by section 2621(c) of this Act, is amended--
(1) in paragraph (6), by striking the period at the end and
inserting ``; plus''; and
(2) by adding at the end the following:
``(7) an amount equal to 50 percent of the amounts expended
by the State during the quarter as the Secretary determines are
for kinship navigator programs that meet the requirements
described in section 427(a)(1) and that the Secretary
determines are operated in accordance with promising,
supported, or well-supported practices that meet the applicable
criteria specified for the practices in section 471(e)(4)(C),
without regard to whether the expenditures are incurred on
behalf of children who are, or are potentially, eligible for
foster care maintenance payments under this part.''.
Subchapter B--Enhanced Support Under Title IV-B
SEC. 2631. ELIMINATION OF TIME LIMIT FOR FAMILY REUNIFICATION SERVICES
WHILE IN FOSTER CARE AND PERMITTING TIME-LIMITED FAMILY
REUNIFICATION SERVICES WHEN A CHILD RETURNS HOME FROM
FOSTER CARE.
(a) In General.--Section 431(a)(7) of the Social Security Act (42
U.S.C. 629a(a)(7)) is amended--
(1) in the paragraph heading, by striking ``Time-limited
family'' and inserting ``Family''; and
(2) in subparagraph (A)--
(A) by striking ``time-limited family'' and
inserting ``family'';
(B) by inserting ``or a child who has been returned
home'' after ``child care institution''; and
(C) by striking ``, but only during the 15-month
period that begins on the date that the child, pursuant
to section 475(5)(F), is considered to have entered
foster care'' and inserting ``and to ensure the
strength and stability of the reunification. In the
case of a child who has been returned home, the
services and activities shall only be provided during
the 15-month period that begins on the date that the
child returns home''.
(b) Conforming Amendments.--
(1) Section 430 of such Act (42 U.S.C. 629) is amended in
the matter preceding paragraph (1), by striking ``time-
limited''.
(2) Subsections (a)(4), (a)(5)(A), and (b)(1) of section
432 of such Act (42 U.S.C. 629b) are amended by striking
``time-limited'' each place it appears.
SEC. 2632. REDUCING BUREAUCRACY AND UNNECESSARY DELAYS WHEN PLACING
CHILDREN IN HOMES ACROSS STATE LINES.
(a) State Plan Requirement.--
(1) In general.--Section 471(a)(25) of the Social Security
Act (42 U.S.C. 671(a)(25)) is amended--
(A) by striking ``provide'' and inserting
``provides''; and
(B) by inserting ``, which, in the case of a State
other than the Commonwealth of Puerto Rico, the United
States Virgin Islands, Guam, and American Samoa, not
later than October 1, 2027, shall include the use of an
electronic interstate case-processing system'' before
the first semicolon.
(2) Exemption of indian tribes.--Section 479B(c) of such
Act (42 U.S.C. 679c(c)) is amended by adding at the end the
following:
``(4) Inapplicability of state plan requirement to have in
effect procedures providing for the use of an electronic
interstate case-processing system.--The requirement in section
471(a)(25) that a State plan provide that the State shall have
in effect procedures providing for the use of an electronic
interstate case-processing system shall not apply to an Indian
tribe, tribal organization, or tribal consortium that elects to
operate a program under this part.''.
(b) Funding for the Development of an Electronic Interstate Case-
processing System to Expedite the Interstate Placement of Children in
Foster Care or Guardianship, or for Adoption.--Section 437 of such Act
(42 U.S.C. 629g) is amended by adding at the end the following:
``(g) Funding for the Development of an Electronic Interstate Case-
processing System to Expedite the Interstate Placement of Children in
Foster Care or Guardianship, or for Adoption.--
``(1) Purpose.--The purpose of this subsection is to
facilitate the development of an electronic interstate case-
processing system for the exchange of data and documents to
expedite the placements of children in foster, guardianship, or
adoptive homes across State lines.
``(2) Requirements.--A State that seeks funding under this
subsection shall submit to the Secretary the following
information:
``(A) A description of the goals and outcomes to be
achieved, which goals and outcomes must result in--
``(i) reducing the time it takes for a
child to be provided with a safe and
appropriate permanent living arrangement across
State lines;
``(ii) improving administrative processes
and reducing costs in the foster care system;
and
``(iii) the secure exchange of relevant
case files and other necessary materials in
real time, and timely communications and
placement decisions regarding interstate
placements of children.
``(B) A description of the activities to be funded
in whole or in part with the funds, including the
sequencing of the activities.
``(C) A description of the strategies for
integrating programs and services for children who are
placed across State lines.
``(D) Such other information as the Secretary may
require.
``(3) Funding authority.--The Secretary may provide funds
to a State that complies with paragraph (2). In providing funds
under this subsection, the Secretary shall prioritize States
that are not yet connected with the electronic interstate case-
processing system referred to in paragraph (1).
``(4) Use of funds.--A State to which funding is provided
under this subsection shall use the funding to support the
State in connecting with, or enhancing or expediting services
provided under, the electronic interstate case-processing
system referred to in paragraph (1).
``(5) Evaluations.--Not later than 1 year after the final
year in which funds are awarded under this subsection, the
Secretary shall submit to the Congress, and make available to
the general public by posting on a website, a report that
contains the following information:
``(A) How using the electronic interstate case-
processing system developed pursuant to paragraph (4)
has changed the time it takes for children to be placed
across State lines.
``(B) The number of cases subject to the Interstate
Compact on the Placement of Children that were
processed through the electronic interstate case-
processing system, and the number of interstate child
placement cases that were processed outside the
electronic interstate case-processing system, by each
State in each year.
``(C) The progress made by States in implementing
the electronic interstate case-processing system.
``(D) How using the electronic interstate case-
processing system has affected various metrics related
to child safety and well-being, including the time it
takes for children to be placed across State lines.
``(E) How using the electronic interstate case-
processing system has affected administrative costs and
caseworker time spent on placing children across State
lines.
``(6) Data integration.--The Secretary, in consultation
with the Secretariat for the Interstate Compact on the
Placement of Children and the States, shall assess how the
electronic interstate case-processing system developed pursuant
to paragraph (4) could be used to better serve and protect
children that come to the attention of the child welfare
system, by--
``(A) connecting the system with other data systems
(such as systems operated by State law enforcement and
judicial agencies, systems operated by the Federal
Bureau of Investigation for the purposes of the
Innocence Lost National Initiative, and other systems);
``(B) simplifying and improving reporting related
to paragraphs (34) and (35) of section 471(a) regarding
children or youth who have been identified as being a
sex trafficking victim or children missing from foster
care; and
``(C) improving the ability of States to quickly
comply with background check requirements of section
471(a)(20), including checks of child abuse and neglect
registries as required by section 471(a)(20)(B).''.
(c) Reservation of Funds to Improve the Interstate Placement of
Children.--Section 437(b) of such Act (42 U.S.C. 629g(b)) is amended by
adding at the end the following:
``(4) Improving the interstate placement of children.--The
Secretary shall reserve $5,000,000 of the amount made available
for fiscal year 2018 for grants under subsection (g), and the
amount so reserved shall remain available through fiscal year
2022.''.
SEC. 2633. ENHANCEMENTS TO GRANTS TO IMPROVE WELL-BEING OF FAMILIES
AFFECTED BY SUBSTANCE ABUSE.
Section 437(f) of the Social Security Act (42 U.S.C. 629g(f)) is
amended--
(1) in the subsection heading, by striking ``Increase the
Well-being of, and to Improve the Permanency Outcomes for,
Children Affected by'' and inserting ``Implement IV-E
Prevention Services, and Improve the Well-being of, and Improve
Permanency Outcomes for, Children and Families Affected by
Heroin, Opioids, and Other'';
(2) by striking paragraph (2) and inserting the following:
``(2) Regional partnership defined.--In this subsection,
the term `regional partnership' means a collaborative agreement
(which may be established on an interstate, State, or
intrastate basis) entered into by the following:
``(A) Mandatory partners for all partnership
grants.--
``(i) The State child welfare agency that
is responsible for the administration of the
State plan under this part and part E.
``(ii) The State agency responsible for
administering the substance abuse prevention
and treatment block grant provided under
subpart II of part B of title XIX of the Public
Health Service Act.
``(B) Mandatory partners for partnership grants
proposing to serve children in out-of-home
placements.--If the partnership proposes to serve
children in out-of-home placements, the Juvenile Court
or Administrative Office of the Court that is most
appropriate to oversee the administration of court
programs in the region to address the population of
families who come to the attention of the court due to
child abuse or neglect.
``(C) Optional partners.--At the option of the
partnership, any of the following:
``(i) An Indian tribe or tribal consortium.
``(ii) Nonprofit child welfare service
providers.
``(iii) For-profit child welfare service
providers.
``(iv) Community health service providers,
including substance abuse treatment providers.
``(v) Community mental health providers.
``(vi) Local law enforcement agencies.
``(vii) School personnel.
``(viii) Tribal child welfare agencies (or
a consortia of the agencies).
``(ix) Any other providers, agencies,
personnel, officials, or entities that are
related to the provision of child and family
services under a State plan approved under this
subpart.
``(D) Exception for regional partnerships where the
lead applicant is an indian tribe or tribal
consortia.--If an Indian tribe or tribal consortium
enters into a regional partnership for purposes of this
subsection, the Indian tribe or tribal consortium--
``(i) may (but is not required to) include
the State child welfare agency as a partner in
the collaborative agreement;
``(ii) may not enter into a collaborative
agreement only with tribal child welfare
agencies (or a consortium of the agencies); and
``(iii) if the condition described in
paragraph (2)(B) applies, may include tribal
court organizations in lieu of other judicial
partners.'';
(3) in paragraph (3)--
(A) in subparagraph (A)--
(i) by striking ``2012 through 2016'' and
inserting ``2017 through 2021''; and
(ii) by striking ``$500,000 and not more
than $1,000,000'' and inserting ``$250,000 and
not more than $1,000,000'';
(B) in subparagraph (B)--
(i) in the subparagraph heading, by
inserting ``; planning'' after ``approval'';
(ii) in clause (i), by striking ``clause
(ii)'' and inserting ``clauses (ii) and
(iii)''; and
(iii) by adding at the end the following:
``(iii) Sufficient planning.--A grant
awarded under this subsection shall be
disbursed in two phases: a planning phase (not
to exceed 2 years) and an implementation phase.
The total disbursement to a grantee for the
planning phase may not exceed $250,000, and may
not exceed the total anticipated funding for
the implementation phase.''; and
(C) by adding at the end the following:
``(D) Limitation on payment for a fiscal year.--No
payment shall be made under subparagraph (A) or (C) for
a fiscal year until the Secretary determines that the
eligible partnership has made sufficient progress in
meeting the goals of the grant and that the members of
the eligible partnership are coordinating to a
reasonable degree with the other members of the
eligible partnership.'';
(4) in paragraph (4)--
(A) in subparagraph (B)--
(i) in clause (i), by inserting ``,
parents, and families'' after ``children'';
(ii) in clause (ii), by striking ``safety
and permanence for such children; and'' and
inserting ``safe, permanent caregiving
relationships for the children;'';
(iii) in clause (iii), by striking ``or''
and inserting ``increase reunification rates
for children who have been placed in out-of-
home care, or decrease''; and
(iv) by redesignating clause (iii) as
clause (v) and inserting after clause (ii) the
following:
``(iii) improve the substance abuse
treatment outcomes for parents including
retention in treatment and successful
completion of treatment;
``(iv) facilitate the implementation,
delivery, and effectiveness of prevention
services and programs under section 471(e);
and'';
(B) in subparagraph (D), by striking ``where
appropriate,''; and
(C) by striking subparagraphs (E) and (F) and
inserting the following:
``(E) A description of a plan for sustaining the
services provided by or activities funded under the
grant after the conclusion of the grant period,
including through the use of prevention services and
programs under section 471(e) and other funds provided
to the State for child welfare and substance abuse
prevention and treatment services.
``(F) Additional information needed by the
Secretary to determine that the proposed activities and
implementation will be consistent with research or
evaluations showing which practices and approaches are
most effective.'';
(5) in paragraph (5)(A), by striking ``abuse treatment''
and inserting ``use disorder treatment including medication
assisted treatment and in-home substance abuse disorder
treatment and recovery'';
(6) in paragraph (7)--
(A) by striking ``and'' at the end of subparagraph
(C); and
(B) by redesignating subparagraph (D) as
subparagraph (E) and inserting after subparagraph (C)
the following:
``(D) demonstrate a track record of successful
collaboration among child welfare, substance abuse
disorder treatment and mental health agencies; and'';
(7) in paragraph (8)--
(A) in subparagraph (A)--
(i) by striking ``establish indicators that
will be'' and inserting ``review indicators
that are''; and
(ii) by striking ``in using funds made
available under such grants to achieve the
purpose of this subsection'' and inserting
``and establish a set of core indicators
related to child safety, parental recovery,
parenting capacity, and family well-being. In
developing the core indicators, to the extent
possible, indicators shall be made consistent
with the outcome measures described in section
471(e)(6)''; and
(B) in subparagraph (B)--
(i) in the matter preceding clause (i), by
inserting ``base the performance measures on
lessons learned from prior rounds of regional
partnership grants under this subsection, and''
before ``consult''; and
(ii) by striking clauses (iii) and (iv) and
inserting the following:
``(iii) Other stakeholders or
constituencies as determined by the
Secretary.'';
(8) in paragraph (9)(A), by striking clause (i) and
inserting the following:
``(i) Semiannual reports.--Not later than
September 30 of each fiscal year in which a
recipient of a grant under this subsection is
paid funds under the grant, and every 6 months
thereafter, the grant recipient shall submit to
the Secretary a report on the services provided
and activities carried out during the reporting
period, progress made in achieving the goals of
the program, the number of children, adults,
and families receiving services, and such
additional information as the Secretary
determines is necessary. The report due not
later than September 30 of the last such fiscal
year shall include, at a minimum, data on each
of the performance indicators included in the
evaluation of the regional partnership.''; and
(9) in paragraph (10), by striking ``2012 through 2016''
and inserting ``2017 through 2021''.
Subchapter C--Miscellaneous
SEC. 2641. REVIEWING AND IMPROVING LICENSING STANDARDS FOR PLACEMENT IN
A RELATIVE FOSTER FAMILY HOME.
(a) Identification of Reputable Model Licensing Standards.--Not
later than October 1, 2018, the Secretary of Health and Human Services
shall identify reputable model licensing standards with respect to the
licensing of foster family homes (as defined in section 472(c)(1) of
the Social Security Act).
(b) State Plan Requirement.--Section 471(a) of the Social Security
Act (42 U.S.C. 671(a)) is amended--
(1) in paragraph (34)(B), by striking ``and'' after the
semicolon;
(2) in paragraph (35)(B), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following:
``(36) provides that, not later than April 1, 2019, the
State shall submit to the Secretary information addressing--
``(A) whether the State licensing standards are in
accord with model standards identified by the
Secretary, and if not, the reason for the specific
deviation and a description as to why having a standard
that is reasonably in accord with the corresponding
national model standards is not appropriate for the
State;
``(B) whether the State has elected to waive
standards established in 471(a)(10)(A) for relative
foster family homes (pursuant to waiver authority
provided by 471(a)(10)(D)), a description of which
standards the State most commonly waives, and if the
State has not elected to waive the standards, the
reason for not waiving these standards;
``(C) if the State has elected to waive standards
specified in subparagraph (B), how caseworkers are
trained to use the waiver authority and whether the
State has developed a process or provided tools to
assist caseworkers in waiving nonsafety standards per
the authority provided in 471(a)(10)(D) to quickly
place children with relatives; and
``(D) a description of the steps the State is
taking to improve caseworker training or the process,
if any; and''.
SEC. 2642. DEVELOPMENT OF A STATEWIDE PLAN TO PREVENT CHILD ABUSE AND
NEGLECT FATALITIES.
Section 422(b)(19) of the Social Security Act (42 U.S.C.
622(b)(19)) is amended to read as follows:
``(19) document steps taken to track and prevent child
maltreatment deaths by including--
``(A) a description of the steps the State is
taking to compile complete and accurate information on
the deaths required by Federal law to be reported by
the State agency referred to in paragraph (1),
including gathering relevant information on the deaths
from the relevant organizations in the State including
entities such as State vital statistics department,
child death review teams, law enforcement agencies,
offices of medical examiners, or coroners; and
``(B) a description of the steps the State is
taking to develop and implement a comprehensive,
statewide plan to prevent the fatalities that involves
and engages relevant public and private agency
partners, including those in public health, law
enforcement, and the courts.''.
SEC. 2643. MODERNIZING THE TITLE AND PURPOSE OF TITLE IV-E.
(a) Part Heading.--The heading for part E of title IV of the Social
Security Act (42 U.S.C. 670 et seq.) is amended to read as follows:
``PART E--FEDERAL PAYMENTS FOR FOSTER CARE, PREVENTION, AND
PERMANENCY''.
(b) Purpose.--The first sentence of section 470 of such Act (42
U.S.C. 670) is amended--
(1) by striking ``1995) and'' and inserting ``1995),'';
(2) by inserting ``kinship guardianship assistance, and
prevention services or programs specified in section
471(e)(1),'' after ``needs,''; and
(3) by striking ``(commencing with the fiscal year which
begins October 1, 1980)''.
SEC. 2644. EFFECTIVE DATES.
(a) Effective Dates.--
(1) In general.--Except as provided in paragraph (2),
subject to subsection (b), the amendments made by this chapter
shall take effect on October 1, 2018.
(2) Exceptions.--The amendments made by sections 2621(d),
2641, and 2643 shall take effect on the date of enactment of
this Act.
(b) Transition Rule.--
(1) In general.--In the case of a State plan under part B
or E of title IV of the Social Security Act which the Secretary
of Health and Human Services determines requires State
legislation (other than legislation appropriating funds) in
order for the plan to meet the additional requirements imposed
by the amendments made by this chapter, the State plan shall
not be regarded as failing to comply with the requirements of
such part solely on the basis of the failure of the plan to
meet such additional requirements before the first day of the
first calendar quarter beginning after the close of the first
regular session of the State legislature that begins after the
date of enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year legislative
session, each year of the session shall be deemed to be a
separate regular session of the State legislature.
(2) Application to programs operated by indian tribal
organizations.--In the case of an Indian tribe, tribal
organization, or tribal consortium which the Secretary of
Health and Human Services determines requires time to take
action necessary to comply with the additional requirements
imposed by the amendments made by this chapter (whether the
tribe, organization, or tribal consortium has a plan under
section 479B of the Social Security Act or a cooperative
agreement or contract entered into with a State), the Secretary
shall provide the tribe, organization, or tribal consortium
with such additional time as the Secretary determines is
necessary for the tribe, organization, or tribal consortium to
take the action to comply with the additional requirements
before being regarded as failing to comply with the
requirements.
CHAPTER 2--ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A
FOSTER FAMILY HOME
SEC. 2651. LIMITATION ON FEDERAL FINANCIAL PARTICIPATION FOR PLACEMENTS
THAT ARE NOT IN FOSTER FAMILY HOMES.
(a) Limitation on Federal Financial Participation.--
(1) In general.--Section 472 of the Social Security Act (42
U.S.C. 672), as amended by section 2622 of this Act, is
amended--
(A) in subsection (a)(2)(C), by inserting ``, but
only to the extent permitted under subsection (k)''
after ``institution''; and
(B) by adding at the end the following:
``(k) Limitation on Federal Financial Participation.--
``(1) In general.--Beginning with the third week for which
foster care maintenance payments are made under this section on
behalf of a child placed in a child-care institution, no
Federal payment shall be made to the State under section
474(a)(1) for amounts expended for foster care maintenance
payments on behalf of the child unless--
``(A) the child is placed in a child-care
institution that is a setting specified in paragraph
(2) (or is placed in a licensed residential family-
based treatment facility consistent with subsection
(j)); and
``(B) in the case of a child placed in a qualified
residential treatment program (as defined in paragraph
(4)), the requirements specified in paragraph (3) and
section 475A(c) are met.
``(2) Specified settings for placement.--The settings for
placement specified in this paragraph are the following:
``(A) A qualified residential treatment program (as
defined in paragraph (4)).
``(B) A setting specializing in providing prenatal,
post-partum, or parenting supports for youth.
``(C) In the case of a child who has attained 18
years of age, a supervised setting in which the child
is living independently.
``(D) A setting providing high-quality residential
care and supportive services to children and youth who
have been found to be, or are at risk of becoming, sex
trafficking victims, in accordance with section
471(a)(9)(C).
``(3) Assessment to determine appropriateness of placement
in a qualified residential treatment program.--
``(A) Deadline for assessment.--In the case of a
child who is placed in a qualified residential
treatment program, if the assessment required under
section 475A(c)(1) is not completed within 30 days
after the placement is made, no Federal payment shall
be made to the State under section 474(a)(1) for any
amounts expended for foster care maintenance payments
on behalf of the child during the placement.
``(B) Deadline for transition out of placement.--If
the assessment required under section 475A(c)(1)
determines that the placement of a child in a qualified
residential treatment program is not appropriate, a
court disapproves such a placement under section
475A(c)(2), or a child who has been in an approved
placement in a qualified residential treatment program
is going to return home or be placed with a fit and
willing relative, a legal guardian, or an adoptive
parent, or in a foster family home, Federal payments
shall be made to the State under section 474(a)(1) for
amounts expended for foster care maintenance payments
on behalf of the child while the child remains in the
qualified residential treatment program only during the
period necessary for the child to transition home or to
such a placement. In no event shall a State receive
Federal payments under section 474(a)(1) for amounts
expended for foster care maintenance payments on behalf
of a child who remains placed in a qualified
residential treatment program after the end of the 30-
day period that begins on the date a determination is
made that the placement is no longer the recommended or
approved placement for the child.
``(4) Qualified residential treatment program.--For
purposes of this part, the term `qualified residential
treatment program' means a program that--
``(A) has a trauma-informed treatment model that is
designed to address the needs, including clinical needs
as appropriate, of children with serious emotional or
behavioral disorders or disturbances and, with respect
to a child, is able to implement the treatment
identified for the child by the assessment of the child
required under section 475A(c);
``(B) subject to paragraphs (5) and (6), has
registered or licensed nursing staff and other licensed
clinical staff who--
``(i) provide care within the scope of
their practice as defined by State law;
``(ii) are on-site in accordance with the
treatment model referred to in subparagraph
(A); and
``(iii) are available 24 hours a day and 7
days a week;
``(C) to extent appropriate, and in accordance with
the child's best interests, facilitates participation
of family members in the child's treatment program;
``(D) facilitates outreach to the family members of
the child, including siblings, documents how the
outreach is made (including contact information), and
maintains contact information for any known biological
family and fictive kin of the child;
``(E) documents how family members are integrated
into the treatment process for the child, including
post-discharge, and how sibling connections are
maintained;
``(F) provides discharge planning and family-based
aftercare support for at least 6 months post-discharge;
and
``(G) is licensed in accordance with section
471(a)(10) and is accredited by any of the following
independent, not-for-profit organizations:
``(i) The Commission on Accreditation of
Rehabilitation Facilities (CARF).
``(ii) The Joint Commission on
Accreditation of Healthcare Organizations
(JCAHO).
``(iii) The Council on Accreditation (COA).
``(iv) Any other independent, not-for-
profit accrediting organization approved by the
Secretary.
``(5) Administrative costs.--The prohibition in paragraph
(1) on Federal payments under section 474(a)(1) shall not be
construed as prohibiting Federal payments for administrative
expenditures incurred on behalf of a child placed in a child-
care institution and for which payment is available under
section 474(a)(3).
``(6) Rule of construction.--The requirements in paragraph
(4)(B) shall not be construed as requiring a qualified
residential treatment program to acquire nursing and behavioral
health staff solely through means of a direct employer to
employee relationship.''.
(2) Conforming amendment.--Section 474(a)(1) of such Act
(42 U.S.C. 674(a)(1)), as amended by section 2622(b) of this
Act, is amended by striking ``section 472(j)'' and inserting
``subsections (j) and (k) of section 472''.
(b) Definition of Foster Family Home, Child-care Institution.--
Section 472(c) of such Act (42 U.S.C. 672(c)(1)) is amended to read as
follows:
``(c) Definitions.--For purposes of this part:
``(1) Foster family home.--
``(A) In general.--The term `foster family home'
means the home of an individual or family--
``(i) that is licensed or approved by the
State in which it is situated as a foster
family home that meets the standards
established for the licensing or approval; and
``(ii) in which a child in foster care has
been placed in the care of an individual, who
resides with the child and who has been
licensed or approved by the State to be a
foster parent--
``(I) that the State deems capable
of adhering to the reasonable and
prudent parent standard;
``(II) that provides 24-hour
substitute care for children placed
away from their parents or other
caretakers; and
``(III) that provides the care for
not more than six children in foster
care.
``(B) State flexibility.--The number of foster
children that may be cared for in a home under
subparagraph (A) may exceed the numerical limitation in
subparagraph (A)(ii)(III), at the option of the State,
for any of the following reasons:
``(i) To allow a parenting youth in foster
care to remain with the child of the parenting
youth.
``(ii) To allow siblings to remain
together.
``(iii) To allow a child with an
established meaningful relationship with the
family to remain with the family.
``(iv) To allow a family with special
training or skills to provide care to a child
who has a severe disability.
``(C) Rule of construction.--Subparagraph (A) shall
not be construed as prohibiting a foster parent from
renting the home in which the parent cares for a foster
child placed in the parent's care.
``(2) Child-care institution.--
``(A) In general.--The term `child-care
institution' means a private child-care institution, or
a public child-care institution which accommodates no
more than 25 children, which is licensed by the State
in which it is situated or has been approved by the
agency of the State responsible for licensing or
approval of institutions of this type as meeting the
standards established for the licensing.
``(B) Supervised settings.--In the case of a child
who has attained 18 years of age, the term shall
include a supervised setting in which the individual is
living independently, in accordance with such
conditions as the Secretary shall establish in
regulations.
``(C) Exclusions.--The term shall not include
detention facilities, forestry camps, training schools,
or any other facility operated primarily for the
detention of children who are determined to be
delinquent.''.
(c) Training for State Judges, Attorneys, and Other Legal Personnel
in Child Welfare Cases.--Section 438(b)(1) of such Act (42 U.S.C.
629h(b)(1)) is amended in the matter preceding subparagraph (A) by
inserting ``shall provide for the training of judges, attorneys, and
other legal personnel in child welfare cases on Federal child welfare
policies and payment limitations with respect to children in foster
care who are placed in settings that are not a foster family home,''
after ``with respect to the child,''.
(d) Assurance of Nonimpact on Juvenile Justice System.--
(1) State plan requirement.--Section 471(a) of such Act (42
U.S.C. 671(a)), as amended by section 2641 of this Act, is
further amended by adding at the end the following:
``(37) includes a certification that, in response to the
limitation imposed under section 472(k) with respect to foster
care maintenance payments made on behalf of any child who is
placed in a setting that is not a foster family home, the State
will not enact or advance policies or practices that would
result in a significant increase in the population of youth in
the State's juvenile justice system.''.
(2) GAO study and report.--The Comptroller General of the
United States shall evaluate the impact, if any, on State
juvenile justice systems of the limitation imposed under
section 472(k) of the Social Security Act (as added by
subsection (a)(1) of this section) on foster care maintenance
payments made on behalf of any child who is placed in a setting
that is not a foster family home, in accordance with the
amendments made by subsections (a) and (b) of this section. In
particular, the Comptroller General shall evaluate the extent
to which children in foster care who also are subject to the
juvenile justice system of the State are placed in a facility
under the jurisdiction of the juvenile justice system and
whether the lack of available congregate care placements under
the jurisdiction of the child welfare systems is a contributing
factor to that result. Not later than December 31, 2024, the
Comptroller General shall submit to Congress a report on the
results of the evaluation.
SEC. 2652. ASSESSMENT AND DOCUMENTATION OF THE NEED FOR PLACEMENT IN A
QUALIFIED RESIDENTIAL TREATMENT PROGRAM.
Section 475A of the Social Security Act (42 U.S.C. 675a) is amended
by adding at the end the following:
``(c) Assessment, Documentation, and Judicial Determination
Requirements for Placement in a Qualified Residential Treatment
Program.--In the case of any child who is placed in a qualified
residential treatment program (as defined in section 472(k)(4)), the
following requirements shall apply for purposes of approving the case
plan for the child and the case system review procedure for the child:
``(1)(A) Within 30 days of the start of each placement in
such a setting, a qualified individual (as defined in
subparagraph (D)) shall--
``(i) assess the strengths and needs of the child
using an age-appropriate, evidence-based, validated,
functional assessment tool approved by the Secretary;
``(ii) determine whether the needs of the child can
be met with family members or through placement in a
foster family home or, if not, which setting from among
the settings specified in section 472(k)(2) would
provide the most effective and appropriate level of
care for the child in the least restrictive environment
and be consistent with the short- and long-term goals
for the child, as specified in the permanency plan for
the child; and
``(iii) develop a list of child-specific short- and
long-term mental and behavioral health goals.
``(B)(i) The State shall assemble a family and permanency
team for the child in accordance with the requirements of
clauses (ii) and (iii). The qualified individual conducting the
assessment required under subparagraph (A) shall work in
conjunction with the family of, and permanency team for, the
child while conducting and making the assessment.
``(ii) The family and permanency team shall consist of all
appropriate biological family members, relative, and fictive
kin of the child, as well as, as appropriate, professionals who
are a resource to the family of the child, such as teachers,
medical or mental health providers who have treated the child,
or clergy. In the case of a child who has attained age 14, the
family and permanency team shall include the members of the
permanency planning team for the child that are selected by the
child in accordance with section 475(5)(C)(iv).
``(iii) The State shall document in the child's case plan--
``(I) the reasonable and good faith effort of the
State to identify and include all such individuals on
the family of, and permanency team for, the child;
``(II) all contact information for members of the
family and permanency team, as well as contact
information for other family members and fictive kin
who are not part of the family and permanency team;
``(III) evidence that meetings of the family and
permanency team, including meetings relating to the
assessment required under subparagraph (A), are held at
a time and place convenient for family;
``(IV) if reunification is the goal, evidence
demonstrating that the parent from whom the child was
removed provided input on the members of the family and
permanency team;
``(V) evidence that the assessment required under
subparagraph (A) is determined in conjunction with the
family and permanency team;
``(VI) the placement preferences of the family and
permanency team relative to the assessment that
recognizes children should be placed with their
siblings unless there is a finding by the court that
such placement is contrary to their best interest; and
``(VII) if the placement preferences of the family
and permanency team and child are not the placement
setting recommended by the qualified individual
conducting the assessment under subparagraph (A), the
reasons why the preferences of the team and of the
child were not recommended.
``(C) In the case of a child who the qualified individual
conducting the assessment under subparagraph (A) determines
should not be placed in a foster family home, the qualified
individual shall specify in writing the reasons why the needs
of the child cannot be met by the family of the child or in a
foster family home. A shortage or lack of foster family homes
shall not be an acceptable reason for determining that the
needs of the child cannot be met in a foster family home. The
qualified individual also shall specify in writing why the
recommended placement in a qualified residential treatment
program is the setting that will provide the child with the
most effective and appropriate level of care in the least
restrictive environment and how that placement is consistent
with the short- and long-term goals for the child, as specified
in the permanency plan for the child.
``(D)(i) Subject to clause (ii), in this subsection, the
term `qualified individual' means a trained professional or
licensed clinician who is not an employee of the State agency
and who is not connected to, or affiliated with, any placement
setting in which children are placed by the State.
``(ii) The Secretary may approve a request of a State to
waive any requirement in clause (i) upon a submission by the
State, in accordance with criteria established by the
Secretary, that certifies that the trained professionals or
licensed clinicians with responsibility for performing the
assessments described in subparagraph (A) shall maintain
objectivity with respect to determining the most effective and
appropriate placement for a child.
``(2) Within 60 days of the start of each placement in a
qualified residential treatment program, a family or juvenile
court or another court (including a tribal court) of competent
jurisdiction, or an administrative body appointed or approved
by the court, independently, shall--
``(A) consider the assessment, determination, and
documentation made by the qualified individual
conducting the assessment under paragraph (1);
``(B) determine whether the needs of the child can
be met through placement in a foster family home or, if
not, whether placement of the child in a qualified
residential treatment program provides the most
effective and appropriate level of care for the child
in the least restrictive environment and whether that
placement is consistent with the short- and long-term
goals for the child, as specified in the permanency
plan for the child; and
``(C) approve or disapprove the placement.
``(3) The written documentation made under paragraph (1)(C)
and documentation of the determination and approval or
disapproval of the placement in a qualified residential
treatment program by a court or administrative body under
paragraph (2) shall be included in and made part of the case
plan for the child.
``(4) As long as a child remains placed in a qualified
residential treatment program, the State agency shall submit
evidence at each status review and each permanency hearing held
with respect to the child--
``(A) demonstrating that ongoing assessment of the
strengths and needs of the child continues to support
the determination that the needs of the child cannot be
met through placement in a foster family home, that the
placement in a qualified residential treatment program
provides the most effective and appropriate level of
care for the child in the least restrictive
environment, and that the placement is consistent with
the short- and long-term goals for the child, as
specified in the permanency plan for the child;
``(B) documenting the specific treatment or service
needs that will be met for the child in the placement
and the length of time the child is expected to need
the treatment or services; and
``(C) documenting the efforts made by the State
agency to prepare the child to return home or to be
placed with a fit and willing relative, a legal
guardian, or an adoptive parent, or in a foster family
home.
``(5) In the case of any child who is placed in a qualified
residential treatment program for more than 12 consecutive
months or 18 nonconsecutive months (or, in the case of a child
who has not attained age 13, for more than 6 consecutive or
nonconsecutive months), the State agency shall submit to the
Secretary--
``(A) the most recent versions of the evidence and
documentation specified in paragraph (4); and
``(B) the signed approval of the head of the State
agency for the continued placement of the child in that
setting.''.
SEC. 2653. PROTOCOLS TO PREVENT INAPPROPRIATE DIAGNOSES.
(a) State Plan Requirement.--Section 422(b)(15)(A) of the Social
Security Act (42 U.S.C. 622(b)(15)(A)) is amended--
(1) in clause (vi), by striking ``and'' after the
semicolon;
(2) by redesignating clause (vii) as clause (viii); and
(3) by inserting after clause (vi) the following:
``(vii) the procedures and protocols the
State has established to ensure that children
in foster care placements are not
inappropriately diagnosed with mental illness,
other emotional or behavioral disorders,
medically fragile conditions, or developmental
disabilities, and placed in settings that are
not foster family homes as a result of the
inappropriate diagnoses; and''.
(b) Evaluation.--Section 476 of such Act (42 U.S.C. 676), as
amended by section 2621(d) of this Act, is further amended by adding at
the end the following:
``(e) Evaluation of State Procedures and Protocols to Prevent
Inappropriate Diagnoses of Mental Illness or Other Conditions.--The
Secretary shall conduct an evaluation of the procedures and protocols
established by States in accordance with the requirements of section
422(b)(15)(A)(vii). The evaluation shall analyze the extent to which
States comply with and enforce the procedures and protocols and the
effectiveness of various State procedures and protocols and shall
identify best practices. Not later than January 1, 2020, the Secretary
shall submit a report on the results of the evaluation to Congress.''.
SEC. 2654. ADDITIONAL DATA AND REPORTS REGARDING CHILDREN PLACED IN A
SETTING THAT IS NOT A FOSTER FAMILY HOME.
Section 479A(a)(7)(A) of the Social Security Act (42 U.S.C.
679b(a)(7)(A)) is amended by striking clauses (i) through (vi) and
inserting the following:
``(i) with respect to each such placement--
``(I) the type of the placement
setting, including whether the
placement is shelter care, a group home
and if so, the range of the child
population in the home, a residential
treatment facility, a hospital or
institution providing medical,
rehabilitative, or psychiatric care, a
setting specializing in providing
prenatal, post-partum, or parenting
supports, or some other kind of child-
care institution and if so, what kind;
``(II) the number of children in
the placement setting and the age,
race, ethnicity, and gender of each of
the children;
``(III) for each child in the
placement setting, the length of the
placement of the child in the setting,
whether the placement of the child in
the setting is the first placement of
the child and if not, the number and
type of previous placements of the
child, and whether the child has
special needs or another diagnosed
mental or physical illness or
condition; and
``(IV) the extent of any
specialized education, treatment,
counseling, or other services provided
in the setting; and
``(ii) separately, the number and ages of
children in the placements who have a
permanency plan of another planned permanent
living arrangement; and''.
SEC. 2655. CRIMINAL RECORDS CHECKS AND CHECKS OF CHILD ABUSE AND
NEGLECT REGISTRIES FOR ADULTS WORKING IN CHILD-CARE
INSTITUTIONS AND OTHER GROUP CARE SETTINGS.
(a) State Plan Requirement.--Section 471(a)(20) of the Social
Security Act (42 U.S.C. 671(a)(20)) is amended--
(1) in each of subparagraphs (A)(ii) and (B)(iii), by
striking ``and'' after the semicolon;
(2) in subparagraph (C), by adding ``and'' after the
semicolon; and
(3) by inserting after subparagraph (C) the following:
``(D) provides procedures for any child care institution,
including a group home, residential treatment center, shelter,
or other congregate care setting, to conduct criminal records
checks, including fingerprint-based checks of national crime
information databases (as defined in section 534(f)(3)(A) of
title 28, United States Code), and checks described in
subparagraph (B) of this paragraph, on any adult working in a
child-care institution, including a group home, residential
treatment center, shelter, or other congregate care setting,
unless the State reports to the Secretary the alternative
criminal records checks and child abuse registry checks the
State conducts on any adult working in a child-care
institution, including a group home, residential treatment
center, shelter, or other congregate care setting, and why the
checks specified in this subparagraph are not appropriate for
the State;''.
(b) Technical Amendments.--Subparagraphs (A) and (C) of section
471(a)(20) of the Social Security Act (42 U.S.C. 671(a)(20)) are each
amended by striking ``section 534(e)(3)(A)'' and inserting ``section
534(f)(3)(A)''.
SEC. 2656. EFFECTIVE DATES; APPLICATION TO WAIVERS.
(a) Effective Dates.--
(1) In general.--Subject to paragraph (2) and subsections
(b) through (d), the amendments made by this chapter shall take
effect on January 1, 2018.
(2) Transition rule.--In the case of a State plan under
part B or E of title IV of the Social Security Act which the
Secretary of Health and Human Services determines requires
State legislation (other than legislation appropriating funds)
in order for the plan to meet the additional requirements
imposed by the amendments made by this chapter, the State plan
shall not be regarded as failing to comply with the
requirements of such part solely on the basis of the failure of
the plan to meet the additional requirements before the first
day of the first calendar quarter beginning after the close of
the first regular session of the State legislature that begins
after the date of enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be deemed
to be a separate regular session of the State legislature.
(b) Limitation on Federal Financial Participation for Placements
That Are Not in Foster Family Homes and Related Provisions.--
(1) In general.--The amendments made by sections 2651(a),
2651(b), 2651(d), and 2652 shall take effect on October 1,
2019.
(2) State option to delay effective date for not more than
2 years.--If a State requests a delay in the effective date
provided for in paragraph (1), the Secretary of Health and
Human Services shall delay the effective date with respect to
the State for the amount of time requested by the State not to
exceed 2 years. If the effective date is so delayed for a
period with respect to a State under the preceding sentence,
then--
(A) notwithstanding section 2644, the date that the
amendments made by section 2621(c) take effect with
respect to the State shall be delayed for the period;
and
(B) in applying section 474(a)(6) of the Social
Security Act with respect to the State, ``on or after
the date this paragraph takes effect with respect to
the State'' is deemed to be substituted for ``after
September 30, 2019'' in subparagraph (A)(i)(I) of such
section.
(c) Criminal Records Checks and Checks of Child Abuse and Neglect
Registries for Adults Working in Child-care Institutions and Other
Group Care Settings.--The amendments made by section 2655 shall take
effect on October 1, 2018.
(d) Application to States With Waivers.--In the case of a State
that, on the date of enactment of this Act, has in effect a waiver
approved under section 1130 of the Social Security Act (42 U.S.C.
1320a-9), the amendments made by this chapter shall not apply with
respect to the State before the expiration (determined without regard
to any extensions) of the waiver to the extent the amendments are
inconsistent with the terms of the waiver.
CHAPTER 3--CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES
SEC. 2661. SUPPORTING AND RETAINING FOSTER FAMILIES FOR CHILDREN.
(a) Supporting and Retaining Foster Parents as a Family Support
Service.--Section 431(a)(2)(B) of the Social Security Act (42 U.S.C.
631(a)(2)(B)) is amended by redesignating clauses (iii) through (vi) as
clauses (iv) through (vii), respectively, and inserting after clause
(ii) the following:
``(iii) To support and retain foster
families so they can provide quality family-
based settings for children in foster care.''.
(b) Support for Foster Family Homes.--Section 436 of such Act (42
U.S.C. 629f) is amended by adding at the end the following:
``(c) Support for Foster Family Homes.--Out of any money in the
Treasury of the United States not otherwise appropriated, there are
appropriated to the Secretary for fiscal year 2018, $8,000,000 for the
Secretary to make competitive grants to States, Indian tribes, or
tribal consortia to support the recruitment and retention of high-
quality foster families to increase their capacity to place more
children in family settings, focused on States, Indian tribes, or
tribal consortia with the highest percentage of children in non-family
settings. The amount appropriated under this subparagraph shall remain
available through fiscal year 2022.''.
SEC. 2662. EXTENSION OF CHILD AND FAMILY SERVICES PROGRAMS.
(a) Extension of Stephanie Tubbs Jones Child Welfare Services
Program.--Section 425 of the Social Security Act (42 U.S.C. 625) is
amended by striking ``2012 through 2016'' and inserting ``2017 through
2021''.
(b) Extension of Promoting Safe and Stable Families Program
Authorizations.--
(1) In general.--Section 436(a) of such Act (42 U.S.C.
629f(a)) is amended by striking all that follows
``$345,000,000'' and inserting ``for each of fiscal years 2017
through 2021.''.
(2) Discretionary grants.--Section 437(a) of such Act (42
U.S.C. 629g(a)) is amended by striking ``2012 through 2016''
and inserting ``2017 through 2021''.
(c) Extension of Funding Reservations for Monthly Caseworker Visits
and Regional Partnership Grants.--Section 436(b) of such Act (42 U.S.C.
629f(b)) is amended--
(1) in paragraph (4)(A), by striking ``2012 through 2016''
and inserting ``2017 through 2021''; and
(2) in paragraph (5), by striking ``2012 through 2016'' and
inserting ``2017 through 2021''.
(d) Reauthorization of Funding for State Courts.--
(1) Extension of program.--Section 438(c)(1) of such Act
(42 U.S.C. 629h(c)(1)) is amended by striking ``2012 through
2016'' and inserting ``2017 through 2021''.
(2) Extension of federal share.--Section 438(d) of such Act
(42 U.S.C. 629h(d)) is amended by striking ``2012 through
2016'' and inserting ``2017 through 2021''.
(e) Repeal of Expired Provisions.--Section 438(e) of such Act (42
U.S.C. 629h(e)) is repealed.
SEC. 2663. IMPROVEMENTS TO THE JOHN H. CHAFEE FOSTER CARE INDEPENDENCE
PROGRAM AND RELATED PROVISIONS.
(a) Authority to Serve Former Foster Youth up to Age 23.--Section
477 of the Social Security Act (42 U.S.C. 677) is amended--
(1) in subsection (a)(5), by inserting ``(or 23 years of
age, in the case of a State with a certification under
subsection (b)(3)(A)(ii) to provide assistance and services to
youths who have aged out of foster care and have not attained
such age, in accordance with such subsection)'' after ``21
years of age'';
(2) in subsection (b)(3)(A)--
(A) by inserting ``(i)'' before ``A
certification'';
(B) by striking ``children who have left foster
care'' and all that follows through the period and
inserting ``youths who have aged out of foster care and
have not attained 21 years of age.''; and
(C) by adding at the end the following:
``(ii) If the State has elected under section
475(8)(B) to extend eligibility for foster care to all
children who have not attained 21 years of age, or if
the Secretary determines that the State agency
responsible for administering the State plans under
this part and part B uses State funds or any other
funds not provided under this part to provide services
and assistance for youths who have aged out of foster
care that are comparable to the services and assistance
the youths would receive if the State had made such an
election, the certification required under clause (i)
may provide that the State will provide assistance and
services to youths who have aged out of foster care and
have not attained 23 years of age.''; and
(3) in subsection (b)(3)(B), by striking ``children who
have left foster care'' and all that follows through the period
and inserting ``youths who have aged out of foster care and
have not attained 21 years of age (or 23 years of age, in the
case of a State with a certification under subparagraph (A)(i)
to provide assistance and services to youths who have aged out
of foster care and have not attained such age, in accordance
with subparagraph (A)(ii)).''.
(b) Authority to Redistribute Unspent Funds.--Section 477(d) of
such Act (42 U.S.C. 677(d)) is amended--
(1) in paragraph (4), by inserting ``or does not expend
allocated funds within the time period specified under section
477(d)(3)'' after ``provided by the Secretary''; and
(2) by adding at the end the following:
``(5) Redistribution of unexpended amounts.--
``(A) Availability of amounts.--To the extent that
amounts paid to States under this section in a fiscal
year remain unexpended by the States at the end of the
succeeding fiscal year, the Secretary may make the
amounts available for redistribution in the second
succeeding fiscal year among the States that apply for
additional funds under this section for that second
succeeding fiscal year.
``(B) Redistribution.--
``(i) In general.--The Secretary shall
redistribute the amounts made available under
subparagraph (A) for a fiscal year among
eligible applicant States. In this
subparagraph, the term `eligible applicant
State' means a State that has applied for
additional funds for the fiscal year under
subparagraph (A) if the Secretary determines
that the State will use the funds for the
purpose for which originally allotted under
this section.
``(ii) Amount to be redistributed.--The
amount to be redistributed to each eligible
applicant State shall be the amount so made
available multiplied by the State foster care
ratio, (as defined in subsection (c)(4), except
that, in such subsection, `all eligible
applicant States (as defined in subsection
(d)(5)(B)(i))' shall be substituted for `all
States').
``(iii) Treatment of redistributed
amount.--Any amount made available to a State
under this paragraph shall be regarded as part
of the allotment of the State under this
section for the fiscal year in which the
redistribution is made.
``(C) Tribes.--For purposes of this paragraph, the
term `State' includes an Indian tribe, tribal
organization, or tribal consortium that receives an
allotment under this section.''.
(c) Expanding and Clarifying the Use of Education and Training
Vouchers.--
(1) In general.--Section 477(i)(3) of such Act (42 U.S.C.
677(i)(3)) is amended--
(A) by striking ``on the date'' and all that
follows through ``23'' and inserting ``to remain
eligible until they attain 26''; and
(B) by inserting ``, but in no event may a youth
participate in the program for more than 5 years
(whether or not consecutive)'' before the period.
(2) Conforming amendment.--Section 477(i)(1) of such Act
(42 U.S.C. 677(i)(1)) is amended by inserting ``who have
attained 14 years of age'' before the period.
(d) Other Improvements.--Section 477 of such Act (42 U.S.C. 677),
as amended by subsections (a), (b), and (c) of this section, is
amended--
(1) in the section heading, by striking ``independence
program'' and inserting ``program for successful transition to
adulthood'';
(2) in subsection (a)--
(A) in paragraph (1)--
(i) by striking ``identify children who are
likely to remain in foster care until 18 years
of age and to help these children make the
transition to self-sufficiency by providing
services'' and inserting ``support all youth
who have experienced foster care at age 14 or
older in their transition to adulthood through
transitional services'';
(ii) by inserting ``and post-secondary
education'' after ``high school diploma''; and
(iii) by striking ``training in daily
living skills, training in budgeting and
financial management skills'' and inserting
``training and opportunities to practice daily
living skills (such as financial literacy
training and driving instruction)'';
(B) in paragraph (2), by striking ``who are likely
to remain in foster care until 18 years of age receive
the education, training, and services necessary to
obtain employment'' and inserting ``who have
experienced foster care at age 14 or older achieve
meaningful, permanent connections with a caring
adult'';
(C) in paragraph (3), by striking ``who are likely
to remain in foster care until 18 years of age prepare
for and enter postsecondary training and education
institutions'' and inserting ``who have experienced
foster care at age 14 or older engage in age or
developmentally appropriate activities, positive youth
development, and experiential learning that reflects
what their peers in intact families experience''; and
(D) by striking paragraph (4) and redesignating
paragraphs (5) through (8) as paragraphs (4) through
(7);
(3) in subsection (b)--
(A) in paragraph (2)(D), by striking
``adolescents'' and inserting ``youth''; and
(B) in paragraph (3)--
(i) in subparagraph (D)--
(I) by inserting ``including
training on youth development'' after
``to provide training''; and
(II) by striking ``adolescents
preparing for independent living'' and
all that follows through the period and
inserting ``youth preparing for a
successful transition to adulthood and
making a permanent connection with a
caring adult.'';
(ii) in subparagraph (H), by striking
``adolescents'' each place it appears and
inserting ``youth''; and
(iii) in subparagraph (K)--
(I) by striking ``an adolescent''
and inserting ``a youth''; and
(II) by striking ``the adolescent''
each place it appears and inserting
``the youth''; and
(4) in subsection (f), by striking paragraph (2) and
inserting the following:
``(2) Report to congress.--Not later than October 1, 2019,
the Secretary shall submit to the Committee on Ways and Means
of the House of Representatives and the Committee on Finance of
the Senate a report on the National Youth in Transition
Database and any other databases in which States report outcome
measures relating to children in foster care and children who
have aged out of foster care or left foster care for kinship
guardianship or adoption. The report shall include the
following:
``(A) A description of the reasons for entry into
foster care and of the foster care experiences, such as
length of stay, number of placement settings, case
goal, and discharge reason of 17-year-olds who are
surveyed by the National Youth in Transition Database
and an analysis of the comparison of that description
with the reasons for entry and foster care experiences
of children of other ages who exit from foster care
before attaining age 17.
``(B) A description of the characteristics of the
individuals who report poor outcomes at ages 19 and 21
to the National Youth in Transition Database.
``(C) Benchmarks for determining what constitutes a
poor outcome for youth who remain in or have exited
from foster care and plans the executive branch will
take to incorporate these benchmarks in efforts to
evaluate child welfare agency performance in providing
services to children transitioning from foster care.
``(D) An analysis of the association between types
of placement, number of overall placements, time spent
in foster care, and other factors, and outcomes at ages
19 and 21.
``(E) An analysis of the differences in outcomes
for children in and formerly in foster care at age 19
and 21 among States.''.
(e) Clarifying Documentation Provided to Foster Youth Leaving
Foster Care.--Section 475(5)(I) of such Act (42 U.S.C. 675(5)(I)) is
amended by inserting after ``REAL ID Act of 2005'' the following: ``,
and any official documentation necessary to prove that the child was
previously in foster care''.
CHAPTER 4--CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND
LEGAL GUARDIANSHIP
SEC. 2665. REAUTHORIZING ADOPTION AND LEGAL GUARDIANSHIP INCENTIVE
PROGRAMS.
(a) In General.--Section 473A of the Social Security Act (42 U.S.C.
673b) is amended--
(1) in subsection (b)(4), by striking ``2013 through 2015''
and inserting ``2016 through 2020'';
(2) in subsection (h)(1)(D), by striking ``2016'' and
inserting ``2021''; and
(3) in subsection (h)(2), by striking ``2016'' and
inserting ``2021''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect as if enacted on October 1, 2017.
CHAPTER 5--TECHNICAL CORRECTIONS
SEC. 2667. TECHNICAL CORRECTIONS TO DATA EXCHANGE STANDARDS TO IMPROVE
PROGRAM COORDINATION.
(a) In General.--Section 440 of the Social Security Act (42 U.S.C.
629m) is amended to read as follows:
``SEC. 440. DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPERABILITY.
``(a) Designation.--The Secretary shall, in consultation with an
interagency work group established by the Office of Management and
Budget and considering State government perspectives, by rule,
designate data exchange standards to govern, under this part and part
E--
``(1) necessary categories of information that State
agencies operating programs under State plans approved under
this part are required under applicable Federal law to
electronically exchange with another State agency; and
``(2) Federal reporting and data exchange required under
applicable Federal law.
``(b) Requirements.--The data exchange standards required by
paragraph (1) shall, to the extent practicable--
``(1) incorporate a widely accepted, non-proprietary,
searchable, computer-readable format, such as the Extensible
Markup Language;
``(2) contain interoperable standards developed and
maintained by intergovernmental partnerships, such as the
National Information Exchange Model;
``(3) incorporate interoperable standards developed and
maintained by Federal entities with authority over contracting
and financial assistance;
``(4) be consistent with and implement applicable
accounting principles;
``(5) be implemented in a manner that is cost-effective and
improves program efficiency and effectiveness; and
``(6) be capable of being continually upgraded as
necessary.
``(c) Rule of Construction.--Nothing in this subsection shall be
construed to require a change to existing data exchange standards found
to be effective and efficient.''.
(b) Effective Date.--Not later than the date that is 24 months
after the date of the enactment of this section, the Secretary of
Health and Human Services shall issue a proposed rule that--
(1) identifies federally required data exchanges, include
specification and timing of exchanges to be standardized, and
address the factors used in determining whether and when to
standardize data exchanges; and
(2) specifies State implementation options and describes
future milestones.
SEC. 2668. TECHNICAL CORRECTIONS TO STATE REQUIREMENT TO ADDRESS THE
DEVELOPMENTAL NEEDS OF YOUNG CHILDREN.
Section 422(b)(18) of the Social Security Act (42 U.S.C.
622(b)(18)) is amended by striking ``such children'' and inserting
``all vulnerable children under 5 years of age''.
CHAPTER 6--ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN
ADOPTION ASSISTANCE
SEC. 2669. DELAY OF ADOPTION ASSISTANCE PHASE-IN.
(a) In General.--The table in section 473(e)(1)(B) of the Social
Security Act (42 U.S.C. 673(e)(1)(B)) is amended by striking the last 2
rows and inserting the following:
----------------------------------------------------------------------------------------------------------------
``2017 through 2023.......................... 2
2024......................................... 2 (or, in the case of a child for whom an adoption assistance
agreement is entered into under this section on or after July 1,
2024, any age)
2025 or thereafter........................... any age.''.
----------------------------------------------------------------------------------------------------------------
(b) Effective Date.--The amendment made by this section shall take
effect on January 1, 2018.
SEC. 2670. GAO STUDY AND REPORT ON STATE REINVESTMENT OF SAVINGS
RESULTING FROM INCREASE IN ADOPTION ASSISTANCE.
(a) Study.--The Comptroller General of the United States shall
study the extent to which States are complying with the requirements of
section 473(a)(8) of the Social Security Act relating to the effects of
phasing out the AFDC income eligibility requirements for adoption
assistance payments under section 473 of the Social Security Act, as
enacted by section 402 of the Fostering Connections to Success and
Increasing Adoptions Act of 2008 (Public Law 110-351; 122 Stat. 3975)
and amended by section 206 of the Preventing Sex Trafficking and
Strengthening Families Act (Public Law 113-183; 128 Stat. 1919). In
particular, the Comptroller General shall analyze the extent to which
States are complying with the following requirements under section
473(a)(8)(D) of the Social Security Act:
(1) The requirement to spend an amount equal to the amount
of the savings (if any) in State expenditures under part E of
title IV of the Social Security Act resulting from phasing out
the AFDC income eligibility requirements for adoption
assistance payments under section 473 of such Act to provide to
children of families any service that may be provided under
part B or E of title IV of such Act.
(2) The requirement that a State shall spend not less than
30 percent of the amount of any savings described in paragraph
(1) on post-adoption services, post-guardianship services, and
services to support and sustain positive permanent outcomes for
children who otherwise might enter into foster care under the
responsibility of the State, with at least \2/3\ of the
spending by the State to comply with the 30 percent requirement
being spent on post-adoption and post-guardianship services.
(b) Report.--The Comptroller General of the United States shall
submit to the Committee on Finance of the Senate, the Committee on Ways
and Means of the House of Representatives, and the Secretary of Health
and Human Services a report that contains the results of the study
required by subsection (a), including recommendations to ensure
compliance with laws referred to in subsection (a).
Subtitle B--Supporting Social Impact Partnerships to Pay for Results
SEC. 2681. SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY FOR RESULTS.
Title XX of the Social Security Act (42 U.S.C. 1397 et seq.) is
amended--
(1) in the title heading, by striking ``TO STATES'' and
inserting ``AND PROGRAMS''; and
(2) by adding at the end the following:
``Subtitle C--Social Impact Demonstration Projects
``purposes
``Sec. 2051. The purposes of this subtitle are the following:
``(1) To improve the lives of families and individuals in
need in the United States by funding social programs that
achieve real results.
``(2) To redirect funds away from programs that, based on
objective data, are ineffective, and into programs that achieve
demonstrable, measurable results.
``(3) To ensure Federal funds are used effectively on
social services to produce positive outcomes for both service
recipients and taxpayers.
``(4) To establish the use of social impact partnerships to
address some of our Nation's most pressing problems.
``(5) To facilitate the creation of public-private
partnerships that bundle philanthropic or other private
resources with existing public spending to scale up effective
social interventions already being implemented by private
organizations, nonprofits, charitable organizations, and State
and local governments across the country.
``(6) To bring pay-for-performance to the social sector,
allowing the United States to improve the impact and
effectiveness of vital social services programs while
redirecting inefficient or duplicative spending.
``(7) To incorporate outcomes measurement and randomized
controlled trials or other rigorous methodologies for assessing
program impact.
``social impact partnership application
``Sec. 2052. (a) Notice.--Not later than 1 year after the date of
the enactment of this subtitle, the Secretary of the Treasury, in
consultation with the Federal Interagency Council on Social Impact
Partnerships, shall publish in the Federal Register a request for
proposals from States or local governments for social impact
partnership projects in accordance with this section.
``(b) Required Outcomes for Social Impact Partnership Project.--To
qualify as a social impact partnership project under this subtitle, a
project must produce one or more measurable, clearly defined outcomes
that result in social benefit and Federal, State, or local savings
through any of the following:
``(1) Increasing work and earnings by individuals in the
United States who are unemployed for more than 6 consecutive
months.
``(2) Increasing employment and earnings of individuals who
have attained 16 years of age but not 25 years of age.
``(3) Increasing employment among individuals receiving
Federal disability benefits.
``(4) Reducing the dependence of low-income families on
Federal means-tested benefits.
``(5) Improving rates of high school graduation.
``(6) Reducing teen and unplanned pregnancies.
``(7) Improving birth outcomes and early childhood health
and development among low-income families and individuals.
``(8) Reducing rates of asthma, diabetes, or other
preventable diseases among low-income families and individuals
to reduce the utilization of emergency and other high-cost
care.
``(9) Increasing the proportion of children living in two-
parent families.
``(10) Reducing incidences and adverse consequences of
child abuse and neglect.
``(11) Reducing the number of youth in foster care by
increasing adoptions, permanent guardianship arrangements,
reunifications, or placements with a fit and willing relative,
or by avoiding placing children in foster care by ensuring they
can be cared for safely in their own homes.
``(12) Reducing the number of children and youth in foster
care residing in group homes, child care institutions, agency-
operated foster homes, or other non-family foster homes, unless
it is determined that it is in the interest of the child's
long-term health, safety, or psychological well-being to not be
placed in a family foster home.
``(13) Reducing the number of children returning to foster
care.
``(14) Reducing recidivism among juvenile offenders,
individuals released from prison, or other high-risk
populations.
``(15) Reducing the rate of homelessness among our most
vulnerable populations.
``(16) Improving the health and well-being of those with
mental, emotional, and behavioral health needs.
``(17) Improving the educational outcomes of special-needs
or low-income children.
``(18) Improving the employment and well-being of returning
United States military members.
``(19) Increasing the financial stability of low-income
families.
``(20) Increasing the independence and employability of
individuals who are physically or mentally disabled.
``(21) Other measurable outcomes defined by the State or
local government that result in positive social outcomes and
Federal savings.
``(c) Application Required.--The notice described in subsection (a)
shall require a State or local government to submit an application for
the social impact partnership project that addresses the following:
``(1) The outcome goals of the project.
``(2) A description of each intervention in the project and
anticipated outcomes of the intervention.
``(3) Rigorous evidence demonstrating that the intervention
can be expected to produce the desired outcomes.
``(4) The target population that will be served by the
project.
``(5) The expected social benefits to participants who
receive the intervention and others who may be impacted.
``(6) Projected Federal, State, and local government costs
and other costs to conduct the project.
``(7) Projected Federal, State, and local government
savings and other savings, including an estimate of the savings
to the Federal Government, on a program-by-program basis and in
the aggregate, if the project is implemented and the outcomes
are achieved as a result of the intervention.
``(8) If savings resulting from the successful completion
of the project are estimated to accrue to the State or local
government, the likelihood of the State or local government to
realize those savings.
``(9) A plan for delivering the intervention through a
social impact partnership model.
``(10) A description of the expertise of each service
provider that will administer the intervention, including a
summary of the experience of the service provider in delivering
the proposed intervention or a similar intervention, or
demonstrating that the service provider has the expertise
necessary to deliver the proposed intervention.
``(11) An explanation of the experience of the State or
local government, the intermediary, or the service provider in
raising private and philanthropic capital to fund social
service investments.
``(12) The detailed roles and responsibilities of each
entity involved in the project, including any State or local
government entity, intermediary, service provider, independent
evaluator, investor, or other stakeholder.
``(13) A summary of the experience of the service provider
in delivering the proposed intervention or a similar
intervention, or a summary demonstrating the service provider
has the expertise necessary to deliver the proposed
intervention.
``(14) A summary of the unmet need in the area where the
intervention will be delivered or among the target population
who will receive the intervention.
``(15) The proposed payment terms, the methodology used to
calculate outcome payments, the payment schedule, and
performance thresholds.
``(16) The project budget.
``(17) The project timeline.
``(18) The criteria used to determine the eligibility of an
individual for the project, including how selected populations
will be identified, how they will be referred to the project,
and how they will be enrolled in the project.
``(19) The evaluation design.
``(20) The metrics that will be used in the evaluation to
determine whether the outcomes have been achieved as a result
of the intervention and how the metrics will be measured.
``(21) An explanation of how the metrics used in the
evaluation to determine whether the outcomes achieved as a
result of the intervention are independent, objective
indicators of impact and are not subject to manipulation by the
service provider, intermediary, or investor.
``(22) A summary explaining the independence of the
evaluator from the other entities involved in the project and
the evaluator's experience in conducting rigorous evaluations
of program effectiveness including, where available, well-
implemented randomized controlled trials on the intervention or
similar interventions.
``(23) The capacity of the service provider to deliver the
intervention to the number of participants the State or local
government proposes to serve in the project.
``(24) A description of whether and how the State or local
government and service providers plan to sustain the
intervention, if it is timely and appropriate to do so, to
ensure that successful interventions continue to operate after
the period of the social impact partnership.
``(d) Project Intermediary Information Required.--The application
described in subsection (c) shall also contain the following
information about any intermediary for the social impact partnership
project (whether an intermediary is a service provider or other
entity):
``(1) Experience and capacity for providing or facilitating
the provision of the type of intervention proposed.
``(2) The mission and goals.
``(3) Information on whether the intermediary is already
working with service providers that provide this intervention
or an explanation of the capacity of the intermediary to begin
working with service providers to provide the intervention.
``(4) Experience working in a collaborative environment
across government and nongovernmental entities.
``(5) Previous experience collaborating with public or
private entities to implement evidence-based programs.
``(6) Ability to raise or provide funding to cover
operating costs (if applicable to the project).
``(7) Capacity and infrastructure to track outcomes and
measure results, including--
``(A) capacity to track and analyze program
performance and assess program impact; and
``(B) experience with performance-based awards or
performance-based contracting and achieving project
milestones and targets.
``(8) Role in delivering the intervention.
``(9) How the intermediary would monitor program success,
including a description of the interim benchmarks and outcome
measures.
``(e) Feasibility Studies Funded Through Other Sources.--The notice
described in subsection (a) shall permit a State or local government to
submit an application for social impact partnership funding that
contains information from a feasibility study developed for purposes
other than applying for funding under this subtitle.
``awarding social impact partnership agreements
``Sec. 2053. (a) Timeline in Awarding Agreement.--Not later than 6
months after receiving an application in accordance with section 2052,
the Secretary, in consultation with the Federal Interagency Council on
Social Impact Partnerships, shall determine whether to enter into an
agreement for a social impact partnership project with a State or local
government.
``(b) Considerations in Awarding Agreement.--In determining whether
to enter into an agreement for a social impact partnership project (the
application for which was submitted under section 2052) the Secretary,
in consultation with the Federal Interagency Council on Social Impact
Partnerships and the head of any Federal agency administering a similar
intervention or serving a population similar to that served by the
project, shall consider each of the following:
``(1) The recommendations made by the Commission on Social
Impact Partnerships.
``(2) The value to the Federal Government of the outcomes
expected to be achieved if the outcomes specified in the
agreement are achieved as a result of the intervention.
``(3) The likelihood, based on evidence provided in the
application and other evidence, that the State or local
government in collaboration with the intermediary and the
service providers will achieve the outcomes.
``(4) The savings to the Federal Government if the outcomes
specified in the agreement are achieved as a result of the
intervention.
``(5) The savings to the State and local governments if the
outcomes specified in the agreement are achieved as a result of
the intervention.
``(6) The expected quality of the evaluation that would be
conducted with respect to the agreement.
``(7) The capacity and commitment of the State or local
government to sustain the intervention, if appropriate and
timely and if the intervention is successful, beyond the period
of the social impact partnership.
``(c) Agreement Authority.--
``(1) Agreement requirements.--In accordance with this
section, the Secretary, in consultation with the Federal
Interagency Council on Social Impact Partnerships and the head
of any Federal agency administering a similar intervention or
serving a population similar to that served by the project, may
enter into an agreement for a social impact partnership project
with a State or local government if the Secretary, in
consultation with the Federal Interagency Council on Social
Impact Partnerships, determines that each of the following
requirements are met:
``(A) The State or local government agrees to
achieve one or more outcomes as a result of the
intervention, as specified in the agreement and
validated by independent evaluation, in order to
receive payment.
``(B) The Federal payment to the State or local
government for each specified outcome achieved as a
result of the intervention is less than or equal to the
value of the outcome to the Federal Government over a
period not to exceed 10 years, as determined by the
Secretary, in consultation with the State or local
government.
``(C) The duration of the project does not exceed
10 years.
``(D) The State or local government has
demonstrated, through the application submitted under
section 2052, that, based on prior rigorous
experimental evaluations or rigorous quasi-experimental
studies, the intervention can be expected to achieve
each outcome specified in the agreement.
``(E) The State, local government, intermediary, or
service provider has experience raising private or
philanthropic capital to fund social service
investments (if applicable to the project).
``(F) The State or local government has shown that
each service provider has experience delivering the
intervention, a similar intervention, or has otherwise
demonstrated the expertise necessary to deliver the
intervention.
``(2) Payment.--The Secretary shall pay the State or local
government only if the independent evaluator described in
section 2055 determines that the social impact partnership
project has met the requirements specified in the agreement and
achieved an outcome as a result of the intervention, as
specified in the agreement and validated by independent
evaluation.
``(d) Notice of Agreement Award.--Not later than 30 days after
entering into an agreement under this section the Secretary shall
publish a notice in the Federal Register that includes, with regard to
the agreement, the following:
``(1) The outcome goals of the social impact partnership
project.
``(2) A description of each intervention in the project.
``(3) The target population that will be served by the
project.
``(4) The expected social benefits to participants who
receive the intervention and others who may be impacted.
``(5) The detailed roles, responsibilities, and purposes of
each Federal, State, or local government entity, intermediary,
service provider, independent evaluator, investor, or other
stakeholder.
``(6) The payment terms, the methodology used to calculate
outcome payments, the payment schedule, and performance
thresholds.
``(7) The project budget.
``(8) The project timeline.
``(9) The project eligibility criteria.
``(10) The evaluation design.
``(11) The metrics that will be used in the evaluation to
determine whether the outcomes have been achieved as a result
of each intervention and how these metrics will be measured.
``(12) The estimate of the savings to the Federal, State,
and local government, on a program-by-program basis and in the
aggregate, if the agreement is entered into and implemented and
the outcomes are achieved as a result of each intervention.
``(e) Authority to Transfer Administration of Agreement.--The
Secretary may transfer to the head of another Federal agency the
authority to administer (including making payments under) an agreement
entered into under subsection (c), and any funds necessary to do so.
``(f) Requirement on Funding Used to Benefit Children.--Not less
than 50 percent of all Federal payments made to carry out agreements
under this section shall be used for initiatives that directly benefit
children.
``feasibility study funding
``Sec. 2054. (a) Requests for Funding for Feasibility Studies.--
The Secretary shall reserve a portion of the amount made available to
carry out this subtitle to assist States or local governments in
developing feasibility studies to apply for social impact partnership
funding under section 2052. To be eligible to receive funding to assist
with completing a feasibility study, a State or local government shall
submit an application for feasibility study funding addressing the
following:
``(1) A description of the outcome goals of the social
impact partnership project.
``(2) A description of the intervention, including
anticipated program design, target population, an estimate
regarding the number of individuals to be served, and setting
for the intervention.
``(3) Evidence to support the likelihood that the
intervention will produce the desired outcomes.
``(4) A description of the potential metrics to be used.
``(5) The expected social benefits to participants who
receive the intervention and others who may be impacted.
``(6) Estimated costs to conduct the project.
``(7) Estimates of Federal, State, and local government
savings and other savings if the project is implemented and the
outcomes are achieved as a result of each intervention.
``(8) An estimated timeline for implementation and
completion of the project, which shall not exceed 10 years.
``(9) With respect to a project for which the State or
local government selects an intermediary to operate the
project, any partnerships needed to successfully execute the
project and the ability of the intermediary to foster the
partnerships.
``(10) The expected resources needed to complete the
feasibility study for the State or local government to apply
for social impact partnership funding under section 2052.
``(b) Federal Selection of Applications for Feasibility Study.--Not
later than 6 months after receiving an application for feasibility
study funding under subsection (a), the Secretary, in consultation with
the Federal Interagency Council on Social Impact Partnerships and the
head of any Federal agency administering a similar intervention or
serving a population similar to that served by the project, shall
select State or local government feasibility study proposals for
funding based on the following:
``(1) The recommendations made by the Commission on Social
Impact Partnerships.
``(2) The likelihood that the proposal will achieve the
desired outcomes.
``(3) The value of the outcomes expected to be achieved as
a result of each intervention.
``(4) The potential savings to the Federal Government if
the social impact partnership project is successful.
``(5) The potential savings to the State and local
governments if the project is successful.
``(c) Public Disclosure.--Not later than 30 days after selecting a
State or local government for feasibility study funding under this
section, the Secretary shall cause to be published on the website of
the Federal Interagency Council on Social Impact Partnerships
information explaining why a State or local government was granted
feasibility study funding.
``(d) Funding Restriction.--
``(1) Feasibility study restriction.--The Secretary may not
provide feasibility study funding under this section for more
than 50 percent of the estimated total cost of the feasibility
study reported in the State or local government application
submitted under subsection (a).
``(2) Aggregate restriction.--Of the total amount made
available to carry out this subtitle, the Secretary may not use
more than $10,000,000 to provide feasibility study funding to
States or local governments under this section.
``(3) No guarantee of funding.--The Secretary shall have
the option to award no funding under this section.
``(e) Submission of Feasibility Study Required.--Not later than 9
months after the receipt of feasibility study funding under this
section, a State or local government receiving the funding shall
complete the feasibility study and submit the study to the Federal
Interagency Council on Social Impact Partnerships.
``(f) Delegation of Authority.--The Secretary may transfer to the
head of another Federal agency the authorities provided in this section
and any funds necessary to exercise the authorities.
``evaluations
``Sec. 2055. (a) Authority to Enter Into Agreements.--For each
State or local government awarded a social impact partnership project
approved by the Secretary under this subtitle, the head of the relevant
agency, as recommended by the Federal Interagency Council on Social
Impact Partnerships and determined by the Secretary, shall enter into
an agreement with the State or local government to pay for all or part
of the independent evaluation to determine whether the State or local
government project has achieved a specific outcome as a result of the
intervention in order for the State or local government to receive
outcome payments under this subtitle.
``(b) Evaluator Qualifications.--The head of the relevant agency
may not enter into an agreement with a State or local government unless
the head determines that the evaluator is independent of the other
parties to the agreement and has demonstrated substantial experience in
conducting rigorous evaluations of program effectiveness including,
where available and appropriate, well-implemented randomized controlled
trials on the intervention or similar interventions.
``(c) Methodologies to Be Used.--The evaluation used to determine
whether a State or local government will receive outcome payments under
this subtitle shall use experimental designs using random assignment or
other reliable, evidence-based research methodologies, as certified by
the Federal Interagency Council on Social Impact Partnerships, that
allow for the strongest possible causal inferences when random
assignment is not feasible.
``(d) Progress Report.--
``(1) Submission of report.--The independent evaluator
shall--
``(A) not later than 2 years after a project has
been approved by the Secretary and biannually
thereafter until the project is concluded, submit to
the head of the relevant agency and the Federal
Interagency Council on Social Impact Partnerships a
written report summarizing the progress that has been
made in achieving each outcome specified in the
agreement; and
``(B) before the scheduled time of the first
outcome payment and before the scheduled time of each
subsequent payment, submit to the head of the relevant
agency and the Federal Interagency Council on Social
Impact Partnerships a written report that includes the
results of the evaluation conducted to determine
whether an outcome payment should be made along with
information on the unique factors that contributed to
achieving or failing to achieve the outcome, the
challenges faced in attempting to achieve the outcome,
and information on the improved future delivery of this
or similar interventions.
``(2) Submission to the secretary and congress.--Not later
than 30 days after receipt of the written report pursuant to
paragraph (1)(B), the Federal Interagency Council on Social
Impact Partnerships shall submit the report to the Secretary
and each committee of jurisdiction in the House of
Representatives and the Senate.
``(e) Final Report.--
``(1) Submission of report.--Within 6 months after the
social impact partnership project is completed, the independent
evaluator shall--
``(A) evaluate the effects of the activities
undertaken pursuant to the agreement with regard to
each outcome specified in the agreement; and
``(B) submit to the head of the relevant agency and
the Federal Interagency Council on Social Impact
Partnerships a written report that includes the results
of the evaluation and the conclusion of the evaluator
as to whether the State or local government has
fulfilled each obligation of the agreement, along with
information on the unique factors that contributed to
the success or failure of the project, the challenges
faced in attempting to achieve the outcome, and
information on the improved future delivery of this or
similar interventions.
``(2) Submission to the secretary and congress.--Not later
than 30 days after receipt of the written report pursuant to
paragraph (1)(B), the Federal Interagency Council on Social
Impact Partnerships shall submit the report to the Secretary
and each committee of jurisdiction in the House of
Representatives and the Senate.
``(f) Limitation on Cost of Evaluations.--Of the amount made
available under this subtitle for social impact partnership projects,
the Secretary may not obligate more than 15 percent to evaluate the
implementation and outcomes of the projects.
``(g) Delegation of Authority.--The Secretary may transfer to the
head of another Federal agency the authorities provided in this section
and any funds necessary to exercise the authorities.
``federal interagency council on social impact partnerships
``Sec. 2056. (a) Establishment.--There is established the Federal
Interagency Council on Social Impact Partnerships (in this section
referred to as the `Council') to--
``(1) coordinate with the Secretary on the efforts of
social impact partnership projects funded under this subtitle;
``(2) advise and assist the Secretary in the development
and implementation of the projects;
``(3) advise the Secretary on specific programmatic and
policy matter related to the projects;
``(4) provide subject-matter expertise to the Secretary
with regard to the projects;
``(5) certify to the Secretary that each State or local
government that has entered into an agreement with the
Secretary for a social impact partnership project under this
subtitle and each evaluator selected by the head of the
relevant agency under section 2055 has access to Federal
administrative data to assist the State or local government and
the evaluator in evaluating the performance and outcomes of the
project;
``(6) address issues that will influence the future of
social impact partnership projects in the United States;
``(7) provide guidance to the executive branch on the
future of social impact partnership projects in the United
States;
``(8) prior to approval by the Secretary, certify that each
State and local government application for a social impact
partnership contains rigorous, independent data and reliable,
evidence-based research methodologies to support the conclusion
that the project will yield savings to the State or local
government or the Federal Government if the project outcomes
are achieved;
``(9) certify to the Secretary, in the case of each
approved social impact partnership that is expected to yield
savings to the Federal Government, that the project will yield
a projected savings to the Federal Government if the project
outcomes are achieved, and coordinate with the relevant Federal
agency to produce an after-action accounting once the project
is complete to determine the actual Federal savings realized,
and the extent to which actual savings aligned with projected
savings; and
``(10) provide periodic reports to the Secretary and make
available reports periodically to Congress and the public on
the implementation of this subtitle.
``(b) Composition of Council.--The Council shall have 11 members,
as follows:
``(1) Chair.--The Chair of the Council shall be the
Director of the Office of Management and Budget.
``(2) Other members.--The head of each of the following
entities shall designate one officer or employee of the entity
to be a Council member:
``(A) The Department of Labor.
``(B) The Department of Health and Human Services.
``(C) The Social Security Administration.
``(D) The Department of Agriculture.
``(E) The Department of Justice.
``(F) The Department of Housing and Urban
Development.
``(G) The Department of Education.
``(H) The Department of Veterans Affairs.
``(I) The Department of the Treasury.
``(J) The Corporation for National and Community
Service.
``commission on social impact partnerships
``Sec. 2057. (a) Establishment.--There is established the
Commission on Social Impact Partnerships (in this section referred to
as the `Commission').
``(b) Duties.--The duties of the Commission shall be to--
``(1) assist the Secretary and the Federal Interagency
Council on Social Impact Partnerships in reviewing applications
for funding under this subtitle;
``(2) make recommendations to the Secretary and the Federal
Interagency Council on Social Impact Partnerships regarding the
funding of social impact partnership agreements and feasibility
studies; and
``(3) provide other assistance and information as requested
by the Secretary or the Federal Interagency Council on Social
Impact Partnerships.
``(c) Composition.--The Commission shall be composed of nine
members, of whom--
``(1) one shall be appointed by the President, who will
serve as the Chair of the Commission;
``(2) one shall be appointed by the Majority Leader of the
Senate;
``(3) one shall be appointed by the Minority Leader of the
Senate;
``(4) one shall be appointed by the Speaker of the House of
Representatives;
``(5) one shall be appointed by the Minority Leader of the
House of Representatives;
``(6) one shall be appointed by the Chairman of the
Committee on Finance of the Senate;
``(7) one shall be appointed by the ranking member of the
Committee on Finance of the Senate;
``(8) one member shall be appointed by the Chairman of the
Committee on Ways and Means of the House of Representatives;
and
``(9) one shall be appointed by the ranking member of the
Committee on Ways and Means of the House of Representatives.
``(d) Qualifications of Commission Members.--The members of the
Commission shall--
``(1) be experienced in finance, economics, pay for
performance, or program evaluation;
``(2) have relevant professional or personal experience in
a field related to one or more of the outcomes listed in this
subtitle; or
``(3) be qualified to review applications for social impact
partnership projects to determine whether the proposed metrics
and evaluation methodologies are appropriately rigorous and
reliant upon independent data and evidence-based research.
``(e) Timing of Appointments.--The appointments of the members of
the Commission shall be made not later than 120 days after the date of
the enactment of this subtitle, or, in the event of a vacancy, not
later than 90 days after the date the vacancy arises. If a member of
Congress fails to appoint a member by that date, the President may
select a member of the President's choice on behalf of the member of
Congress. Notwithstanding the preceding sentence, if not all
appointments have been made to the Commission as of that date, the
Commission may operate with no fewer than five members until all
appointments have been made.
``(f) Term of Appointments.--
``(1) In general.--The members appointed under subsection
(c) shall serve as follows:
``(A) Three members shall serve for 2 years.
``(B) Three members shall serve for 3 years.
``(C) Three members (one of which shall be Chair of
the Commission appointed by the President) shall serve
for 4 years.
``(2) Assignment of terms.--The Commission shall designate
the term length that each member appointed under subsection (c)
shall serve by unanimous agreement. In the event that unanimous
agreement cannot be reached, term lengths shall be assigned to
the members by a random process.
``(g) Vacancies.--Subject to subsection (e), in the event of a
vacancy in the Commission, whether due to the resignation of a member,
the expiration of a member's term, or any other reason, the vacancy
shall be filled in the manner in which the original appointment was
made and shall not affect the powers of the Commission.
``(h) Appointment Power.--Members of the Commission appointed under
subsection (c) shall not be subject to confirmation by the Senate.
``limitation on use of funds
``Sec. 2058. Of the amounts made available to carry out this
subtitle, the Secretary may not use more than $2,000,000 in any fiscal
year to support the review, approval, and oversight of social impact
partnership projects, including activities conducted by--
``(1) the Federal Interagency Council on Social Impact
Partnerships; and
``(2) any other agency consulted by the Secretary before
approving a social impact partnership project or a feasibility
study under section 2054.
``no federal funding for credit enhancements
``Sec. 2059. No amount made available to carry out this subtitle
may be used to provide any insurance, guarantee, or other credit
enhancement to a State or local government under which a Federal
payment would be made to a State or local government as the result of a
State or local government failing to achieve an outcome specified in an
agreement.
``availability of funds
``Sec. 2060. Amounts made available to carry out this subtitle
shall remain available until 10 years after the date of the enactment
of this subtitle.
``website
``Sec. 2061. The Federal Interagency Council on Social Impact
Partnerships shall establish and maintain a public website that shall
display the following:
``(1) A copy of, or method of accessing, each notice
published regarding a social impact partnership project
pursuant to this subtitle.
``(2) A copy of each feasibility study funded under this
subtitle.
``(3) For each State or local government that has entered
into an agreement with the Secretary for a social impact
partnership project, the website shall contain the following
information:
``(A) The outcome goals of the project.
``(B) A description of each intervention in the
project.
``(C) The target population that will be served by
the project.
``(D) The expected social benefits to participants
who receive the intervention and others who may be
impacted.
``(E) The detailed roles, responsibilities, and
purposes of each Federal, State, or local government
entity, intermediary, service provider, independent
evaluator, investor, or other stakeholder.
``(F) The payment terms, methodology used to
calculate outcome payments, the payment schedule, and
performance thresholds.
``(G) The project budget.
``(H) The project timeline.
``(I) The project eligibility criteria.
``(J) The evaluation design.
``(K) The metrics used to determine whether the
proposed outcomes have been achieved and how these
metrics are measured.
``(4) A copy of the progress reports and the final reports
relating to each social impact partnership project.
``(5) An estimate of the savings to the Federal, State, and
local government, on a program-by-program basis and in the
aggregate, resulting from the successful completion of the
social impact partnership project.
``regulations
``Sec. 2062. The Secretary, in consultation with the Federal
Interagency Council on Social Impact Partnerships, may issue
regulations as necessary to carry out this subtitle.
``definitions
``Sec. 2063. In this subtitle:
``(1) Agency.--The term `agency' has the meaning given that
term in section 551 of title 5, United States Code.
``(2) Intervention.--The term `intervention' means a
specific service delivered to achieve an impact through a
social impact partnership project.
``(3) Secretary.--The term `Secretary' means the Secretary
of the Treasury.
``(4) Social impact partnership project.--The term `social
impact partnership project' means a project that finances
social services using a social impact partnership model.
``(5) Social impact partnership model.--The term `social
impact partnership model' means a method of financing social
services in which--
``(A) Federal funds are awarded to a State or local
government only if a State or local government achieves
certain outcomes agreed on by the State or local
government and the Secretary; and
``(B) the State or local government coordinates
with service providers, investors (if applicable to the
project), and (if necessary) an intermediary to
identify--
``(i) an intervention expected to produce
the outcome;
``(ii) a service provider to deliver the
intervention to the target population; and
``(iii) investors to fund the delivery of
the intervention.
``(6) State.--The term `State' means each State of the
United States, the District of Columbia, each commonwealth,
territory or possession of the United States, and each
federally recognized Indian tribe.
``funding
``Sec. 2064. Out of any money in the Treasury of the United States
not otherwise appropriated, there is hereby appropriated $92,000,000
for fiscal year 2018 to carry out this subtitle.''.
Subtitle C--Modernizing Child Support Enforcement Fees
SEC. 2691. MODERNIZING CHILD SUPPORT ENFORCEMENT FEES.
(a) In General.-- Section 454(6)(B)(ii) of the Social Security Act
(42 U.S.C. 654(6)(B)(ii)) is amended--
(1) by striking ``$25'' and inserting ``$35''; and
(2) by striking ``$500'' each place it appears and
inserting ``$550''.
(b) Effective Date.--
(1) In general.--The amendment made by subsection (a) shall
take effect on the 1st day of the 1st fiscal year that begins
on or after the date of the enactment of this Act, and shall
apply to payments under part D of title IV of the Social
Security Act for calendar quarters beginning on or after such
1st day.
(2) Delay permitted if state legislation required.--If the
Secretary of Health and Human Services determines that State
legislation (other than legislation appropriating funds) is
required in order for a State plan developed pursuant to part D
of title IV of the Social Security Act to meet the requirement
imposed by the amendment made by subsection (a), the plan shall
not be regarded as failing to meet the requirement before the
1st day of the 1st calendar quarter beginning after the first
regular session of the State legislature that begins after the
date of the enactment of this Act. For purposes of the
preceding sentence, if the State has a 2-year legislative
session, each year of the session is deemed to be a separate
regular session of the State legislature.
Subtitle D--Increasing Efficiency of Prison Data Reporting
SEC. 2699. INCREASING EFFICIENCY OF PRISON DATA REPORTING.
(a) In General.--Section 1611(e)(1)(I)(i)(II) of the Social
Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is amended by striking
``30 days'' each place it appears and inserting ``15 days''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to any payment made by the Commissioner of Social
Security pursuant to section 1611(e)(1)(I)(i)(II) of the Social
Security Act (as amended by such subsection) on or after the date that
is 6 months after the date of enactment of this Act.
TITLE VII--OFFSETS
SEC. 2701. PAYMENT FOR EARLY DISCHARGES TO HOSPICE CARE.
(a) In General.--Section 1886(d)(5)(J) of the Social Security Act
(42 U.S.C. 1395ww(d)(5)(J)) is amended--
(1) in clause (ii)--
(A) in subclause (III), by striking ``or'' at the
end;
(B) by redesignating subclause (IV) as subclause
(V); and
(C) by inserting after subclause (III) the
following new subclause:
``(IV) for discharges occurring on
or after October 1, 2022, is provided
hospice care by a hospice program;
or''; and
(2) in clause (iv)--
(A) by inserting after the first sentence the
following new sentence: ``The Secretary shall include
in the proposed rule published for fiscal year 2023, a
description of the effect of clause (ii)(IV).''; and
(B) in subclause (I), by striking ``and (III)'' and
inserting ``(III), and, in the case of proposed and
final rules for fiscal year 2023 and subsequent fiscal
years, (IV)''.
(b) MedPAC Evaluation and Report on Hospital to Hospice
Transfers.--
(1) Evaluation.--The Medicare Payment Advisory Commission
(in this subsection referred to as the ``Commission'') shall
conduct an evaluation of the effects of the amendments made by
subsection (a), including the effects on--
(A) the numbers of discharges of patients from an
inpatient hospital setting to a hospice program;
(B) the lengths of stays of patients in an
inpatient hospital setting who are discharged to a
hospice program;
(C) spending under the Medicare program under title
XVIII of the Social Security Act; and
(D) other areas determined appropriate by the
Commission.
(2) Consideration.--In conducting the evaluation under
paragraph (1), the Commission shall consider factors such as
whether the timely access to hospice care by patients admitted
to a hospital has been affected through changes to hospital
policies or behaviors made as a result of such amendments.
(3) Preliminary results.--Not later than March 15, 2024,
the Commission shall provide Congress with preliminary results
on the evaluation being conducted under paragraph (1).
(4) Report.--Not later than March 15, 2025, the Commission
shall submit to Congress a report on the evaluation conducted
under paragraph (1).
SEC. 2702. HOME HEALTH MARKET BASKET REDUCTION.
Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C.
1395fff(b)(3)(B)) is amended--
(1) in clause (iii), in the last sentence, by inserting
before the period at the end the following: ``and for 2020
shall be 1.5 percent''; and
(2) in clause (vi), by inserting ``and 2020'' after
``except 2018''.
SEC. 2703. REDUCTION FOR NON-EMERGENCY ESRD AMBULANCE TRANSPORTS.
Section 1834(l)(15) of the Social Security Act (42. U.S.C.
1395m(l)(15)) is amended by striking ``on or after October 1, 2013''
and inserting ``during the period beginning on October 1, 2013, and
ending on September 30, 2018, and by 23 percent for such services
furnished on or after October 1, 2018''.
SEC. 2704. EXTENSION OF TARGET FOR RELATIVE VALUE ADJUSTMENTS FOR
MISVALUED SERVICES AND TRANSITIONAL PAYMENT RULES FOR
CERTAIN RADIATION THERAPY SERVICES UNDER THE PHYSICIAN
FEE SCHEDULE.
Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is
amended--
(1) in subsection (b)(11), by striking ``2017 and 2018''
and inserting ``2017, 2018, and 2019''; and
(2) in subsection (c)(2)--
(A) in subparagraph (K)(iv), by striking ``2017 and
2018'' and inserting ``2017, 2018, and 2019''; and
(B) in subparagraph (O), by striking ``2018'' and
inserting ``2019''.
SEC. 2705. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR MEDICARE
ADVANTAGE PLANS FAILING TO ACHIEVE MINIMUM QUALITY
RATINGS.
Section 1857(h)(3) of the Social Security Act (42 U.S.C. 1395w-
27(h)(3)) is amended by striking ``2018'' and inserting ``2027''.
SEC. 2706. MEDICARE IMPROVEMENT FUND.
Section 1898(b)(1) of the Social Security Act (42 U.S.C.
1395iii(b)(1)) is amended by striking ``during and after fiscal year
2021'' and all that follows through the period at the end and inserting
``during and after fiscal year 2021, $0.''.
SEC. 2707. PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES AND
OUTPATIENT OCCUPATIONAL THERAPY SERVICES FURNISHED BY A
THERAPY ASSISTANT.
Section 1834 of the Social Security Act (42 U.S.C. 1395m), as
amended by sections 2204 and 2414, is further amended by adding at the
end the following new subsection:
``(x) Payment for Outpatient Physical Therapy Services and
Outpatient Occupational Therapy Services Furnished by a Therapy
Assistant.--
``(1) In general.--In the case of an outpatient physical
therapy service or outpatient occupational therapy service
furnished on or after January 1, 2022, for which payment is
made under section 1848 or subsection (k), that is furnished in
whole or in part by a therapy assistant (as defined by the
Secretary), the amount of payment for such service shall be an
amount equal to 85 percent of the amount of payment otherwise
applicable for the service under this part. Nothing in the
preceding sentence shall be construed to change applicable
requirements with respect to such services.
``(2) Use of modifier.--
``(A) Establishment.--Not later than January 1,
2019, the Secretary shall establish a modifier to
indicate (in a form and manner specified by the
Secretary), in the case of an outpatient physical
therapy service or outpatient occupational therapy
service furnished in whole or in part by a therapy
assistant (as so defined), that the service was
furnished by a therapy assistant.
``(B) Required use.--Each request for payment, or
bill submitted, for an outpatient physical therapy
service or outpatient occupational therapy service
furnished in whole or in part by a therapy assistant
(as so defined) on or after January 1, 2020, shall
include the modifier established under subparagraph (A)
for each such service.
``(3) Implementation.--The Secretary shall implement this
subsection through notice and comment rulemaking.''.
SEC. 2708. CHANGES TO LONG-TERM CARE HOSPITAL PAYMENTS.
(a) Extension.--Section 1886(m)(6)(B)(i) of the Social Security Act
(42 U.S.C. 1395ww(m)(6)(B)(i)) is amended--
(1) in subclause (I), by striking ``fiscal year 2016 or
fiscal year 2017'' and inserting ``fiscal years 2016 through
2019''; and
(2) in subclause (II), by striking ``2018'' and inserting
``2020''.
(b) Temporary Adjustment to Site Neutral Payment Rates.--Section
1886(m)(6)(B) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(B)) is
amended--
(1) in clause (ii), in the matter preceding subclause (I),
by striking ``In this paragraph'' and inserting ``Subject to
clause (iv), in this paragraph''; and
(2) by adding at the end the following new clause:
``(iv) Adjustment.--For each of fiscal
years 2018 through 2026, the amount that would
otherwise apply under clause (ii)(I) for the
year (determined without regard to this clause)
shall be reduced by 4.6 percent.''.
SEC. 2709. NON-BUDGET NEUTRAL TRANSITIONAL PASS-THROUGH PAYMENT CHANGE
FOR CERTAIN PRODUCTS.
(a) In General.--Subsection 1833(t)(6)(A)(iv) of the Social
Security Act (42 U.S.C. 1395l(t)(6)(A)(iv)) is amended by inserting
``(except, beginning as of April 1, 2018, a biosimilar biological
product (as defined under section 1847A(c)(6)(H)))'' after
``biological''.
(b) Application.--The amendment made by subsection (a) shall apply
with respect to biosimilar biological products beginning on April 1,
2018, regardless of whether such products were receiving pass-through
status for an additional payment under section 1833(t)(6) of the Social
Security Act (42 U.S.C. 1395l(t)(6)) before such date. In the case of a
product that was receiving such an additional payment pursuant to
clause (iv) of subparagraph (A) of such section as of the day before
such date and after application of the amendment under subsection (a)
is not eligible for such an additional payment as of such date, such
product may not be eligible for such an additional payment pursuant to
any other clause of such subparagraph (A).
SEC. 2710. THIRD PARTY LIABILITY IN MEDICAID AND CHIP.
(a) Modification of Third Party Liability Rules Related to Special
Treatment of Certain Types of Care and Payments.--
(1) In general.--Section 1902(a)(25)(E) of the Social
Security Act (42 U.S.C. 1396a(a)(25)(E)) is amended, in the
matter preceding clause (i), by striking ``prenatal or''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect on the date of enactment of this Act.
(b) Delay in Effective Date and Repeal of Certain Bipartisan Budget
Act of 2013 Amendments.--
(1) Repeal.--Effective as of September 30, 2017, subsection
(b) of section 202 of the Bipartisan Budget Act of 2013 (Public
Law 113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) (including
any amendments made by such subsection) is repealed and the
provisions amended by such subsection shall be applied and
administered as if such amendments had never been enacted.
(2) Delay in effective date.--Subsection (c) of section 202
of the Bipartisan Budget Act of 2013 (Public Law 113-67; 127
Stat. 1177; 42 U.S.C. 1396a note) is amended to read as
follows:
``(c) Effective Date.--The amendments made by subsection (a) shall
take effect on October 1, 2019.''.
(3) Effective date; treatment.--The repeal and amendment
made by this subsection shall take effect as if enacted on
September 30, 2017, and shall apply with respect to any open
claims, including claims pending, generated, or filed, after
such date. The amendments made by subsections (a) and (b) of
section 202 of the Bipartisan Budget Act of 2013 (Public Law
113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) that took effect
on October 1, 2017, are null and void and section 1902(a)(25)
of the Social Security Act (42 U.S.C. 1396a(a)(25)) shall be
applied and administered as if such amendments had not taken
effect on such date.
(c) GAO Study and Report.--Not later than 18 months after the date
of enactment of this Act, the Comptroller General of the United States
shall submit a report to the Committee on Energy and Commerce of the
House of Representatives and the Committee on Finance of the Senate on
the impacts of the amendments made by subsections (a)(1) and (b)(2),
including--
(1) the impact, or potential effect, of such amendments on
access to prenatal and preventive pediatric care (including
early and periodic screening, diagnostic, and treatment
services) covered under State plans under such title (or
waivers of such plans);
(2) the impact, or potential effect, of such amendments on
access to services covered under such plans or waivers for
individuals on whose behalf child support enforcement is being
carried out by a State agency under part D of title IV of such
Act; and
(3) the impact, or potential effect, on providers of
services under such plans or waivers of delays in payment or
related issues that result from such amendments.
(d) Application to CHIP.--
(1) In general.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B) through (R)
as subparagraphs (C) through (S), respectively; and
(B) by inserting after subparagraph (A) the
following new subparagraph:
``(B) Section 1902(a)(25) (relating to third party
liability).''.
(2) Mandatory reporting.--Section 1902(a)(25)(I)(i) of the
Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is amended--
(A) by striking ``medical assistance under the
State plan'' and inserting ``medical assistance under a
State plan (or under a waiver of the plan)'';
(B) by striking ``(and, at State option, child''
and inserting ``and child''; and
(C) by striking ``title XXI)'' and inserting
``title XXI''.
SEC. 2711. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM INCOME FOR
PURPOSES OF INCOME ELIGIBILITY UNDER MEDICAID.
(a) In General.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(1) in subsection (a)(17), by striking ``(e)(14), (e)(14)''
and inserting ``(e)(14), (e)(15)''; and
(2) in subsection (e)(14), by adding at the end the
following new subparagraph:
``(K) Treatment of certain lottery winnings and
income received as a lump sum.--
``(i) In general.--In the case of an
individual who is the recipient of qualified
lottery winnings (pursuant to lotteries
occurring on or after January 1, 2018) or
qualified lump sum income (received on or after
such date) and whose eligibility for medical
assistance is determined based on the
application of modified adjusted gross income
under subparagraph (A), a State shall, in
determining such eligibility, include such
winnings or income (as applicable) as income
received--
``(I) in the month in which such
winnings or income (as applicable) is
received if the amount of such winnings
or income is less than $80,000;
``(II) over a period of 2 months if
the amount of such winnings or income
(as applicable) is greater than or
equal to $80,000 but less than $90,000;
``(III) over a period of 3 months
if the amount of such winnings or
income (as applicable) is greater than
or equal to $90,000 but less than
$100,000; and
``(IV) over a period of 3 months
plus 1 additional month for each
increment of $10,000 of such winnings
or income (as applicable) received, not
to exceed a period of 120 months (for
winnings or income of $1,260,000 or
more), if the amount of such winnings
or income is greater than or equal to
$100,000.
``(ii) Counting in equal installments.--For
purposes of subclauses (II), (III), and (IV) of
clause (i), winnings or income to which such
subclause applies shall be counted in equal
monthly installments over the period of months
specified under such subclause.
``(iii) Hardship exemption.--An individual
whose income, by application of clause (i),
exceeds the applicable eligibility threshold
established by the State, shall continue to be
eligible for medical assistance to the extent
that the State determines, under procedures
established by the State (in accordance with
standards specified by the Secretary), that the
denial of eligibility of the individual would
cause an undue medical or financial hardship as
determined on the basis of criteria established
by the Secretary.
``(iv) Notifications and assistance
required in case of loss of eligibility.--A
State shall, with respect to an individual who
loses eligibility for medical assistance under
the State plan (or a waiver of such plan) by
reason of clause (i)--
``(I) before the date on which the
individual loses such eligibility,
inform the individual--
``(aa) of the individual's
opportunity to enroll in a
qualified health plan offered
through an Exchange established
under title I of the Patient
Protection and Affordable Care
Act during the special
enrollment period specified in
section 9801(f)(3) of the
Internal Revenue Code of 1986
(relating to loss of Medicaid
or CHIP coverage); and
``(bb) of the date on which
the individual would no longer
be considered ineligible by
reason of clause (i) to receive
medical assistance under the
State plan or under any waiver
of such plan and be eligible to
reapply to receive such medical
assistance; and
``(II) provide technical assistance
to the individual seeking to enroll in
such a qualified health plan.
``(v) Qualified lottery winnings defined.--
In this subparagraph, the term `qualified
lottery winnings' means winnings from a
sweepstakes, lottery, or pool described in
paragraph (3) of section 4402 of the Internal
Revenue Code of 1986 or a lottery operated by a
multistate or multijurisdictional lottery
association, including amounts awarded as a
lump sum payment.
``(vi) Qualified lump sum income defined.--
In this subparagraph, the term `qualified lump
sum income' means income that is received as a
lump sum from monetary winnings from gambling
(as defined by the Secretary and including
gambling activities described in section
1955(b)(4) of title 18, United States Code).''.
(b) Rules of Construction.--
(1) Interception of lottery winnings allowed.--Nothing in
the amendment made by subsection (a)(2) shall be construed as
preventing a State from intercepting the State lottery winnings
awarded to an individual in the State to recover amounts paid
by the State under the State Medicaid plan under title XIX of
the Social Security Act (42 U.S.C. 1396 et seq.) for medical
assistance furnished to the individual.
(2) Applicability limited to eligibility of recipient of
lottery winnings or lump sum income.--Nothing in the amendment
made by subsection (a)(2) shall be construed, with respect to a
determination of household income for purposes of a
determination of eligibility for medical assistance under the
State plan under title XIX of the Social Security Act (42
U.S.C. 1396 et seq.) (or a waiver of such plan) made by
applying modified adjusted gross income under subparagraph (A)
of section 1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), as
limiting the eligibility for such medical assistance of any
individual that is a member of the household other than the
individual who received qualified lottery winnings or qualified
lump-sum income (as defined in subparagraph (K) of such section
1902(e)(14), as added by subsection (a)(2) of this section).
SEC. 2712. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
(1) in clause (i), in the matter preceding subclause (I),
by striking ``2018'' and inserting ``2020''; and
(2) in clause (ii), by striking subclauses (I) through
(VIII) and inserting the following:
``(I) $4,000,000,000 for fiscal
year 2020; and
``(II) $8,000,000,000 for each of
fiscal years 2021 through 2025.''.
SEC. 2713. MEDICAID IMPROVEMENT FUND RESCISSION.
Section 1941(b) of the Social Security Act (42 U.S.C 1396w-1(b)) is
amended--
(1) in paragraph (1), by striking ``$5,000,000'' and
inserting ``$0''; and
(2) in paragraph (3)(A) (as added by section 3006(2)(B) of
the Helping Ensure Access for Little Ones, Toddlers, and
Hopeful Youth by Keeping Insurance Delivery Stable Act (Public
Law 115-120)), by striking ``$980,000,000'' and inserting
``$0''.
SEC. 2714. SUNSETTING EXCLUSION OF BIOSIMILARS FROM MEDICARE PART D
COVERAGE GAP DISCOUNT PROGRAM.
Section 1860D-14A(g)(2)(A) of the Social Security Act (42 U.S.C.
1395w-114a(g)(2)(A)) is amended by inserting ``, with respect to a plan
year before 2019,'' after ``other than''.
SEC. 2715. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable Care Act
(42 U.S.C. 300u-11(b)) is amended by striking paragraphs (1) through
(9) and inserting the following new paragraphs:
``(1) for each of fiscal years 2018 and 2019, $900,000,000;
``(2) for each of fiscal years 2020 and 2021,
$1,000,000,000;
``(3) for each of fiscal years 2022 through 2027,
$1,100,000,000; and
``(4) for fiscal year 2028 and each subsequent fiscal year,
$2,000,000,000.''.
DIVISION G--BUDGETARY EFFECTS
SEC. 3001. BUDGETARY EFFECTS.
(a) In General.--The budgetary effects of division D and each
succeeding division shall not be entered on either PAYGO scorecard
maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act
of 2010.
(b) Senate PAYGO Scorecards.--The budgetary effects of division D
and each succeeding division shall not be entered on any PAYGO
scorecard maintained for purposes of section 4106 of H. Con. Res. 71
(115th Congress).
(c) Classification of Budgetary Effects.--Notwithstanding Rule 3 of
the Budget Scorekeeping Guidelines set forth in the joint explanatory
statement of the committee of conference accompanying Conference Report
105-217 and section 250(c)(8) of the Balanced Budget and Emergency
Deficit Control Act of 1985, the budgetary effects of division D and
each succeeding division shall not be estimated--
(1) for purposes of section 251 of such Act; and
(2) for purposes of paragraph (4)(C) of section 3 of the
Statutory Pay-As-You-Go Act of 2010 as being included in an
appropriation Act.
Attest:
Clerk.
115th CONGRESS
2d Session
H.R. 1892
_______________________________________________________________________
HOUSE AMENDMENT TO SENATE AMENDMENT