I 

115TH CONGRESS 

1ST SESSION H. R. 4541 

To extend funding for certain public health programs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 4, 2017 

Mrs. MURPHY of Florida (for herself, Mr. NEAL, and Mr. PALLONE) introduced the following bill; which was referred to the Committee on Energy 

and Commerce, and in addition to the Committee on Ways and Means, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To extend funding for certain public health programs, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Continuing Community 

5 Health and Medical Professional Programs to Improve 

6 Our Nation and Keep Insurance Delivery Stable Act of 

7 2017’’ or the ‘‘CHAMPION KIDS Act of 2017’’. 

8 SEC. 2. TABLE OF CONTENTS. 

9 The table of contents of this Act is as follows: 


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Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—MEDICAID AND PUBLIC HEALTH EXTENDERS 

Sec. 101. Extension for community health centers and the National Health 

Service Corps. 

Sec. 102. Extension for special diabetes programs. 

Sec. 103. Reauthorization of program of payments to teaching health centers 

that operate graduate medical education programs. 

Sec. 104. Extension for family-to-family health information centers. 

Sec. 105. Youth empowerment program; personal responsibility education. 

Sec. 106. Decreasing reduction in Medicaid DSH allotments. 

Sec. 107. Increase in territorial cap for Medicaid payments. 

Sec. 108. Puerto Rico and United States Virgin Island Disaster Relief Medicaid. 

Sec. 109. Delay of Bipartisan Budget Act of 2013 third-party liability provisions. 

TITLE II—CHIP 

Sec. 201. Five-year funding extension of the Children’s Health Insurance Program. 

Sec. 202. Extension of certain programs and demonstration projects. 

Sec. 203. Extension of outreach and enrollment program. 

Sec. 204. Extension of additional Federal financial participation for CHIP. 

TITLE III—OFFSET 

Sec. 301. Implementation of Office of Inspector General recommendation to 

delay certain Medicare plan prepayments. 

1 TITLE I—MEDICAID AND PUBLIC 

2 HEALTH EXTENDERS 

3 SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS 

4 AND THE NATIONAL HEALTH SERVICE 

5 CORPS. 

6 (a) COMMUNITY HEALTH CENTERS FUNDING.—Sec7 tion 10503(b)(1)(E) of the Patient Protection and Afford8 able Care Act (42 U.S.C. 254b–2(b)(1)(E)) is amended 

9 by striking ‘‘2017’’ and inserting ‘‘2019’’. 


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1 (b) OTHER COMMUNITY HEALTH CENTERS PROVI2 SIONS.—Section 330 of the Public Health Service Act (42 

3 U.S.C. 254b) is amended— 

4 (1) in subsection (b)(1)(A)(ii), by striking 

5 ‘‘abuse’’ and inserting ‘‘use disorder’’; 

6 (2) in subsection (b)(2)(A), by striking ‘‘abuse’’ 

7 and inserting ‘‘use disorder’’; 

8 (3) in subsection (c)— 

9 (A) in paragraph (1), by striking subpara10 graphs (B) through (D); 

11 (B) by striking ‘‘(1) IN GENERAL’’ and all 

12 that follows through ‘‘The Secretary’’ and in13 serting the following: 

14 ‘‘(1) CENTERS.—The Secretary’’; and 

15 (C) in paragraph (1), as amended, by re16 designating clauses (i) through (v) as subpara17 graphs (A) through (E) and moving the margin 

18 of each of such redesignated subparagraph 2 

19 ems to the left; 

20 (4) by striking subsection (d) and inserting the 

21 following: 

22 ‘‘(d) IMPROVING QUALITY OF CARE.— 

23 ‘‘(1) SUPPLEMENTAL AWARDS.—The Secretary 

24 may award supplemental grant funds to health cen25 ters funded under this section to implement eviVerDate Sep 11 2014 04:43 Dec 09, 2017 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4541.IH H4541

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1 dence-based models for increasing access to high2 quality primary care services, which may include 

3 models related to— 

4 ‘‘(A) improving the delivery of care for in5 dividuals with multiple chronic conditions; 

6 ‘‘(B) workforce configuration; 

7 ‘‘(C) reducing the cost of care; 

8 ‘‘(D) enhancing care coordination; 

9 ‘‘(E) expanding the use of telehealth and 

10 technology-enabled collaborative learning and 

11 capacity building models; 

12 ‘‘(F) care integration, including integration 

13 of behavioral health, mental health, or sub14 stance use disorder services; and 

15 ‘‘(G) addressing emerging public health or 

16 substance use disorder issues to meet the health 

17 needs of the population served by the health 

18 center. 

19 ‘‘(2) SUSTAINABILITY.—In making supple20 mental awards under this subsection, the Secretary 

21 may consider whether the health center involved has 

22 submitted a plan for continuing the activities funded 

23 under this subsection after supplemental funding is 

24 expended. 


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1 ‘‘(3) SPECIAL CONSIDERATION.—The Secretary 

2 may give special consideration to applications for 

3 supplemental funding under this subsection that 

4 seek to address significant barriers to access to care 

5 in areas with a greater shortage of health care pro6 viders and health services relative to the national av7 erage.’’; 

8 (5) in subsection (e)(1)— 

9 (A) in subparagraph (B)— 

10 (i) by striking ‘‘2 years’’ and inserting 

11 ‘‘1 year’’; and 

12 (ii) by adding at the end the fol13 lowing: ‘‘The Secretary shall not make a 

14 grant under this paragraph unless the ap15 plicant provides assurances to the Sec16 retary that within 120 days of receiving 

17 grant funding for the operation of the 

18 health center, the applicant will submit, for 

19 approval by the Secretary, an implementa20 tion plan to meet the requirements of sub21 section (l)(3). The Secretary may extend 

22 such 120-day period for achieving compli23 ance upon a demonstration of good cause 

24 by the health center.’’; and 

25 (B) in subparagraph (C)— 


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1 (i) in the subparagraph heading, by 

2 striking ‘‘AND PLANS’’; 

3 (ii) by striking ‘‘or plan (as described 

4 in subparagraphs (B) and (C) of sub5 section (c)(1))’’; 

6 (iii) by striking ‘‘or plan, including 

7 the purchase’’ and inserting the following: 

8 ‘‘including— 

9 ‘‘(i) the purchase’’; 

10 (iv) by inserting ‘‘, which may include 

11 data and information systems’’ after ‘‘of 

12 equipment’’; 

13 (v) by striking the period at the end 

14 and inserting a semicolon; and 

15 (vi) by adding at the end the fol16 lowing: 

17 ‘‘(ii) the provision of training and 

18 technical assistance; and 

19 ‘‘(iii) other activities that— 

20 ‘‘(I) reduce costs associated with 

21 the provision of health services; 

22 ‘‘(II) improve access to, and 

23 availability of, health services provided 

24 to individuals served by the centers; 


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1 ‘‘(III) enhance the quality and 

2 coordination of health services; or 

3 ‘‘(IV) improve the health status 

4 of communities.’’; 

5 (6) in subsection (e)(5)(B)— 

6 (A) in the heading of subparagraph (B), by 

7 striking ‘‘AND PLANS’’; and 

8 (B) by striking ‘‘and subparagraphs (B) 

9 and (C) of subsection (c)(1) to a health center 

10 or to a network or plan’’ and inserting ‘‘to a 

11 health center or to a network’’; 

12 (7) by striking subsection (s); 

13 (8) by redesignating subsections (g) through (r) 

14 as subsections (h) through (s), respectively; 

15 (9) by inserting after subsection (f), the fol16 lowing: 

17 ‘‘(g) NEW ACCESS POINTS AND EXPANDED SERV18 ICES.— 

19 ‘‘(1) APPROVAL OF NEW ACCESS POINTS.— 

20 ‘‘(A) IN GENERAL.—The Secretary may 

21 approve applications for grants under subpara22 graph (A) or (B) of subsection (e)(1) to estab23 lish new delivery sites. 

24 ‘‘(B) SPECIAL CONSIDERATION.—In car25 rying out subparagraph (A), the Secretary may 


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1 give special consideration to applicants that 

2 have demonstrated the new delivery site will be 

3 located within a sparsely populated area, or an 

4 area which has a level of unmet need that is 

5 higher relative to other applicants. 

6 ‘‘(C) CONSIDERATION OF APPLICATIONS.— 

7 In carrying out subparagraph (A), the Sec8 retary shall approve applications for grants 

9 under subparagraphs (A) and (B) of subsection 

10 (e)(1) in such a manner that the ratio of the 

11 medically underserved populations in rural 

12 areas which may be expected to use the services 

13 provided by the applicants involved to the medi14 cally underserved populations in urban areas 

15 which may be expected to use the services pro16 vided by the applicants is not less than two to 

17 three or greater than three to two. 

18 ‘‘(D) SERVICE AREA OVERLAP.—If in car19 rying out subparagraph (A) the applicant pro20 poses to serve an area that is currently served 

21 by another health center funded under this sec22 tion, the Secretary may consider whether the 

23 award of funding to an additional health center 

24 in the area can be justified based on the unmet 


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1 need for additional services within the 

2 catchment area. 

3 ‘‘(2) APPROVAL OF EXPANDED SERVICE APPLI4 CATIONS.— 

5 ‘‘(A) IN GENERAL.—The Secretary may 

6 approve applications for grants under subpara7 graph (A) or (B) of subsection (e)(1) to expand 

8 the capacity of the applicant to provide required 

9 primary health services described in subsection 

10 (b)(1) or additional health services described in 

11 subsection (b)(2). 

12 ‘‘(B) PRIORITY EXPANSION PROJECTS.—In 

13 carrying out subparagraph (A), the Secretary 

14 may give special consideration to expanded 

15 service applications that seek to address emerg16 ing public health or behavioral health, mental 

17 health, or substance abuse issues through in18 creasing the availability of additional health 

19 services described in subsection (b)(2) in an 

20 area in which there are significant barriers to 

21 accessing care. 

22 ‘‘(C) CONSIDERATION OF APPLICATIONS.— 

23 In carrying out subparagraph (A), the Sec24 retary shall approve applications for applicants 

25 in such a manner that the ratio of the medically 


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1 underserved populations in rural areas which 

2 may be expected to use the services provided by 

3 the applicants involved to the medically under4 served populations in urban areas which may be 

5 expected to use the services provided by such 

6 applicants is not less than two to three or 

7 greater than three to two.’’; 

8 (10) in subsection (i) (as so redesignated)— 

9 (A) in paragraph (1), by striking ‘‘and 

10 children and youth at risk of homelessness’’ and 

11 inserting ‘‘, children and youth at risk of home12 lessness, homeless veterans, and veterans at 

13 risk of homelessness’’; and 

14 (B) in paragraph (5)— 

15 (i) by striking subparagraph (B); 

16 (ii) by redesignating subparagraph 

17 (C) as subparagraph (B); and 

18 (iii) in subparagraph (B) (as so redes19 ignated)— 

20 (I) in the subparagraph heading, 

21 by striking ‘‘ABUSE’’ and inserting 

22 ‘‘USE DISORDER’’; and 

23 (II) by striking ‘‘abuse’’ and in24 serting ‘‘use disorder’’; 

25 (11) in subsection (l) (as so redesignated)— 


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1 (A) in paragraph (2)— 

2 (i) in the paragraph heading, by in3 serting ‘‘UNMET’’ before ‘‘NEED’’; 

4 (ii) in the matter preceding subpara5 graph (A), by inserting ‘‘and an applica6 tion for a grant under subsection (g)’’ 

7 after ‘‘subsection (e)(1)’’; 

8 (iii) in subparagraph (A), by inserting 

9 ‘‘unmet’’ before ‘‘need for health services’’; 

10 (iv) in subparagraph (B), by striking 

11 ‘‘and’’ at the end; 

12 (v) in subparagraph (C), by striking 

13 the period at the end and inserting ‘‘; 

14 and’’; and 

15 (vi) by adding after subparagraph (C) 

16 the following: 

17 ‘‘(D) in the case of an application for a 

18 grant pursuant to subsection (g)(1), a dem19 onstration that the applicant has consulted with 

20 appropriate State and local government agen21 cies, and health care providers regarding the 

22 need for the health services to be provided at 

23 the proposed delivery site.’’; 

24 (B) in paragraph (3)— 


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1 (i) in the matter preceding subpara2 graph (A), by inserting ‘‘or subsection (g)’’ 

3 after ‘‘subsection (e)(1)(B)’’; 

4 (ii) in subparagraph (B), by striking 

5 ‘‘in the catchment area of the center’’ and 

6 inserting ‘‘, including other health care 

7 providers that provide care within the 

8 catchment area, local hospitals, and spe9 cialty providers in the catchment area of 

10 the center, to provide access to services not 

11 available through the health center and to 

12 reduce the non-urgent use of hospital 

13 emergency departments’’; 

14 (iii) in subparagraph (H)(ii), by in15 serting ‘‘who shall be directly employed by 

16 the center’’ after ‘‘approves the selection of 

17 a director for the center’’; 

18 (iv) in subparagraph (L), by striking 

19 ‘‘and’’ at the end; 

20 (v) in subparagraph (M), by striking 

21 the period and inserting ‘‘; and’’; and 

22 (vi) by inserting after subparagraph 

23 (M), the following: 

24 ‘‘(N) the center has written policies and 

25 procedures in place to ensure the appropriate 


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1 use of Federal funds in compliance with appli2 cable Federal statutes, regulations, and the 

3 terms and conditions of the Federal award.’’; 

4 and 

5 (C) by striking paragraph (4); 

6 (12) in subsection (m) (as so redesignated), by 

7 adding at the end the following: ‘‘Funds expended to 

8 carry out activities under this subsection and oper9 ational support activities under subsection (n) shall 

10 not exceed 3 percent of the amount appropriated for 

11 this section for the fiscal year involved.’’; 

12 (13) in subsection (q) (as so redesignated), by 

13 striking ‘‘grants for new health centers under sub14 sections (c) and (e)’’ and inserting ‘‘operating grants 

15 under subsection (e), applications for new access 

16 points and expanded service pursuant to subsection 

17 (g)’’; 

18 (14) in subsection (r)(4) (as so redesignated), 

19 by adding at the end the following: ‘‘A waiver pro20 vided by the Secretary under this paragraph may 

21 not remain in effect for more than 1 year and may 

22 not be extended after such period. An entity may not 

23 receive more than one waiver under this paragraph 

24 in consecutive years.’’; 

25 (15) in subsection (s)(3) (as so redesignated)— 


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1 (A) by striking ‘‘appropriate committees of 

2 Congress a report concerning the distribution of 

3 funds under this section’’ and inserting the fol4 lowing: ‘‘Committee on Health, Education, 

5 Labor, and Pensions of the Senate, and the 

6 Committee on Energy and Commerce of the 

7 House of Representatives, a report including, at 

8 a minimum— 

9 ‘‘(A) the distribution of funds for carrying 

10 out this section’’; 

11 (B) by striking ‘‘populations. Such report 

12 shall include an assessment’’ and inserting the 

13 following: ‘‘populations; 

14 ‘‘(B) an assessment’’; 

15 (C) by striking ‘‘and the rationale for any 

16 substantial changes in the distribution of 

17 funds.’’ and inserting a semicolon; and 

18 (D) by adding at the end the following: 

19 ‘‘(C) the distribution of awards and fund20 ing for new or expanded services in each of 

21 rural areas and urban areas; 

22 ‘‘(D) the distribution of awards and fund23 ing for establishing new access points, and the 

24 number of new access points created; 


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1 ‘‘(E) the amount of unexpended funding 

2 for loan guarantees and loan guarantee author3 ity under title XVI; 

4 ‘‘(F) the rationale for any substantial 

5 changes in the distribution of funds; 

6 ‘‘(G) the rate of closures for health centers 

7 and access points; 

8 ‘‘(H) the number and reason for any 

9 grants awarded pursuant to subsection 

10 (e)(1)(B); and 

11 ‘‘(I) the number and reason for any waiv12 ers provided pursuant to subsection (r)(4).’’; 

13 and 

14 (16) in subsection (s) (as so redesignated) by 

15 adding at the end the following new paragraph: 

16 ‘‘(5) FUNDING FOR PARTICIPATION OF HEALTH

17 CENTERS IN ALL OF US RESEARCH PROGRAM.—In 

18 addition to any amounts made available pursuant to 

19 paragraph (1) of this subsection, section 402A of 

20 this Act, or section 10503 of the Patient Protection 

21 and Affordable Care Act, there is authorized to be 

22 appropriated, and there is appropriated, out of any 

23 monies in the Treasury not otherwise appropriated, 

24 to the Secretary $25,000,000 for fiscal year 2018 to 

25 support the participation of health centers in the All 


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1 of Us Research Program under the Precision Medi2 cine Initiative under section 498E of this Act.’’. 

3 (c) NATIONAL HEALTH SERVICE CORPS.—Section 

4 10503(b)(2)(E) of the Patient Protection and Affordable 

5 Care Act (42 U.S.C. 254b–2(b)(2)(E)) is amended by 

6 striking ‘‘2017’’ and inserting ‘‘2019’’. 

7 (d) CONFORMING AMENDMENT.—Section 3014(h)(1) 

8 of title 18, United States Code, is amended by striking 

9 ‘‘, as amended by section 221 of the Medicare Access and 

10 CHIP Reauthorization Act of 2015,’’. 

11 SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 

12 (a) SPECIAL DIABETES PROGRAM FOR TYPE I DIA13 BETES.—Section 330B(b)(2)(C) of the Public Health 

14 Service Act (42 U.S.C. 254c–2(b)(2)(C)) is amended by 

15 striking ‘‘2017’’ and inserting ‘‘2019’’. 

16 (b) SPECIAL DIABETES PROGRAM FOR INDIANS.— 

17 Section 330C(c)(2) of the Public Health Service Act (42 

18 U.S.C. 254c–3(c)(2)) is amended— 

19 (1) in subparagraph (C), by striking ‘‘and’’ at 

20 the end; 

21 (2) in subparagraph (D), by striking the period 

22 at the end and inserting ‘‘and $112,500,000 for the 

23 period consisting of the second, third, and fourth 

24 quarters of fiscal year 2018; and’’; and 

25 (3) by adding at the end the following: 


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1 ‘‘(E) $150,000,000 for fiscal year 2019.’’. 

2 SEC. 103. REAUTHORIZATION OF PROGRAM OF PAYMENTS 

3 TO TEACHING HEALTH CENTERS THAT OPER4 ATE GRADUATE MEDICAL EDUCATION PRO5 GRAMS. 

6 (a) PAYMENTS.—Subsection (a) of section 340H of 

7 the Public Health Service Act (42 U.S.C. 256h) is amend8 ed to read as follows: 

9 ‘‘(a) PAYMENTS.— 

10 ‘‘(1) IN GENERAL.—Subject to subsection 

11 (h)(2), the Secretary shall make payments under 

12 this section for direct expenses and indirect expenses 

13 to qualified teaching health centers that are listed as 

14 sponsoring institutions by the relevant accrediting 

15 body for— 

16 ‘‘(A) maintenance of existing approved 

17 graduate medical residency training programs; 

18 ‘‘(B) expansion of existing approved grad19 uate medical residency training programs; and 

20 ‘‘(C) establishment of new approved grad21 uate medical residency training programs, as 

22 appropriate. 

23 ‘‘(2) PRIORITY.—In making payments pursuant 

24 to paragraph (1)(C), the Secretary shall give priority 

25 to qualified teaching health centers that— 


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1 ‘‘(A) serve a health professional shortage 

2 area with a designation in effect under section 

3 332 or a medically underserved community (as 

4 defined in section 799B); or 

5 ‘‘(B) are located in a rural area (as de6 fined in section 1886(d)(2)(D) of the Social Se7 curity Act).’’. 

8 (b) FUNDING.—Subsection (g) of section 340H of the 

9 Public Health Service Act (42 U.S.C. 256h) is amended— 

10 (1) by striking ‘‘To carry out’’ and inserting 

11 the following: 

12 ‘‘(1) IN GENERAL.—To carry out’’; 

13 (2) by striking ‘‘and $15,000,000 for the first 

14 quarter of fiscal year 2018’’ and inserting ‘‘, 

15 $15,000,000 for the first quarter of fiscal year 

16 2018, $111,500,000 for the period consisting of the 

17 second, third, and fourth quarters of fiscal year 

18 2018, and $126,500,000 for fiscal year 2019, to re19 main available until expended’’; and 

20 (3) by adding at the end the following: 

21 ‘‘(2) ADMINISTRATIVE EXPENSES.—Of the 

22 amount made available to carry out this section for 

23 any fiscal year, the Secretary may not use more 

24 than 5 percent of such amount for the expenses of 

25 administering this section.’’. 


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1 (c) ANNUAL REPORTING.—Subsection (h)(1) of sec2 tion 340H of the Public Health Service Act (42 U.S.C. 

3 256h) is amended— 

4 (1) by redesignating subparagraph (D) as sub5 paragraph (H); and 

6 (2) by inserting after subparagraph (C) the fol7 lowing: 

8 ‘‘(D) The number of patients treated by 

9 residents described in paragraph (4). 

10 ‘‘(E) The number of visits by patients 

11 treated by residents described in paragraph (4). 

12 ‘‘(F) Of the number of residents described 

13 in paragraph (4) who completed their residency 

14 training at the end of such residency academic 

15 year, the number and percentage of such resi16 dents entering primary care practice (meaning 

17 any of the areas of practice listed in the defini18 tion of a primary care residency program in 

19 section 749A). 

20 ‘‘(G) Of the number of residents described 

21 in paragraph (4) who completed their residency 

22 training at the end of such residency academic 

23 year, the number and percentage of such resi24 dents who entered practice at a health care fa25 cility— 


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1 ‘‘(i) primarily serving a health profes2 sional shortage area with a designation in 

3 effect under section 332 or a medically un4 derserved community (as defined in section 

5 799B); or 

6 ‘‘(ii) located in a rural area (as de7 fined in section 1886(d)(2)(D) of the So8 cial Security Act).’’. 

9 (d) REPORT ON TRAINING COSTS.—Not later than 

10 March 31, 2019, the Secretary of Health and Human 

11 Services shall submit to the Congress a report on the di12 rect graduate expenses of approved graduate medical resi13 dency training programs, and the indirect expenses associ14 ated with the additional costs of teaching residents, of 

15 qualified teaching health centers (as such terms are used 

16 or defined in section 340H of the Public Health Service 

17 Act (42 U.S.C. 256h)). 

18 (e) DEFINITION.—Subsection (j) of section 340H of 

19 the Public Health Service Act (42 U.S.C. 256h) is amend20 ed— 

21 (1) by redesignating paragraphs (2) and (3) as 

22 paragraphs (3) and (4), respectively; and 

23 (2) by inserting after paragraph (1) the fol24 lowing: 


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1 ‘‘(2) NEW APPROVED GRADUATE MEDICAL

2 RESIDENCY TRAINING PROGRAM.—The term ‘new 

3 approved graduate medical residency training pro4 gram’ means an approved graduate medical resi5 dency training program for which the sponsoring 

6 qualified teaching health center has not received a 

7 payment under this section for a previous fiscal year 

8 (other than pursuant to subsection (a)(1)(C)).’’. 

9 (f) TECHNICAL CORRECTION.—Subsection (f) of sec10 tion 340H (42 U.S.C. 256h) is amended by striking ‘‘hos11 pital’’ each place it appears and inserting ‘‘teaching health 

12 center’’. 

13 (g) PAYMENTS FOR PREVIOUS FISCAL YEARS.—The 

14 provisions of section 340H of the Public Health Service 

15 Act (42 U.S.C. 256h), as in effect on the day before the 

16 date of enactment of this Act, shall continue to apply with 

17 respect to payments under such section for fiscal years 

18 before fiscal year 2018. 

19 SEC. 104. EXTENSION FOR FAMILY-TO-FAMILY HEALTH IN20 FORMATION CENTERS. 

21 Section 501(c) of the Social Security Act (42 U.S.C. 

22 701(c)) is amended— 

23 (1) in paragraph (1)(A)— 

24 (A) in clause (v), by striking ‘‘and’’ at the 

25 end; 


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1 (B) in clause (vi), by striking the period at 

2 the end and inserting ‘‘; and’’; and 

3 (C) by adding at the end the following new 

4 clause: 

5 ‘‘(vii) $6,000,000 for each of fiscal years 2018 

6 and 2019.’’; 

7 (2) in paragraph (3)(C), by inserting before the 

8 period the following: ‘‘, and with respect to fiscal 

9 years 2018 and 2019, such centers shall also be de10 veloped in all territories and at least one such center 

11 shall be developed for Indian tribes’’; and 

12 (3) by amending paragraph (5) to read as fol13 lows: 

14 ‘‘(5) For purposes of this subsection— 

15 ‘‘(A) the term ‘Indian tribe’ has the meaning 

16 given such term in section 4 of the Indian Health 

17 Care Improvement Act (25 U.S.C. 1603); 

18 ‘‘(B) the term ‘State’ means each of the 50 

19 States and the District of Columbia; and 

20 ‘‘(C) the term ‘territory’ means Puerto Rico, 

21 Guam, American Samoa, the Virgin Islands, and the 

22 Northern Mariana Islands.’’. 

23 SEC. 105. YOUTH EMPOWERMENT PROGRAM; PERSONAL 

24 RESPONSIBILITY EDUCATION. 

25 (a) YOUTH EMPOWERMENT PROGRAM.— 


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1 (1) IN GENERAL.—Section 510 of the Social 

2 Security Act (42 U.S.C. 710) is amended to read as 

3 follows: 

4 ‘‘SEC. 510. YOUTH EMPOWERMENT PROGRAM. 

5 ‘‘(a) IN GENERAL.— 

6 ‘‘(1) ALLOTMENTS TO STATES.—For the pur7 pose described in subsection (b), the Secretary shall, 

8 for each of fiscal years 2018 and 2019, allot to each 

9 State which has transmitted an application for the 

10 fiscal year under section 505(a) an amount equal to 

11 the product of— 

12 ‘‘(A) the amount appropriated pursuant to 

13 subsection (e)(1) for the fiscal year, minus the 

14 amount reserved under subsection (e)(2) for the 

15 fiscal year; and 

16 ‘‘(B) the proportion that the number of 

17 low-income children in the State bears to the 

18 total of such numbers of children for all the 

19 States. 

20 ‘‘(2) OTHER ALLOTMENTS.— 

21 ‘‘(A) OTHER ENTITIES.—For the purpose 

22 described in subsection (b), the Secretary shall, 

23 for each of fiscal years 2018 and 2019, for any 

24 State which has not transmitted an application 

25 for the fiscal year under section 505(a), allot to 


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1 one or more entities in the State the amount 

2 that would have been allotted to the State 

3 under paragraph (1) if the State had submitted 

4 such an application. 

5 ‘‘(B) PROCESS.—The Secretary shall select 

6 the recipients of allotments under subparagraph 

7 (A) by means of a competitive grant process 

8 under which— 

9 ‘‘(i) not later than 30 days after the 

10 deadline for the State involved to submit 

11 an application for the fiscal year under 

12 section 505(a), the Secretary publishes a 

13 notice soliciting grant applications; and 

14 ‘‘(ii) not later than 120 days after 

15 such deadline, all such applications must 

16 be submitted. 

17 ‘‘(b) PURPOSE.— 

18 ‘‘(1) IN GENERAL.—Except for research under 

19 paragraph (5) and information collection and report20 ing under paragraph (6), the purpose of an allot21 ment under subsection (a) to a State (or to another 

22 entity in the State pursuant to subsection (a)(2)) is 

23 to enable the State or other entity to implement edu24 cation exclusively on sexual risk avoidance (meaning 

25 voluntarily refraining from sexual activity). 


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1 ‘‘(2) REQUIRED COMPONENTS.—Education on 

2 sexual risk avoidance pursuant to an allotment 

3 under this section shall— 

4 ‘‘(A) ensure that the unambiguous and pri5 mary emphasis and context for each topic de6 scribed in paragraph (3) is a message to youth 

7 that normalizes the optimal health behavior of 

8 avoiding nonmarital sexual activity; 

9 ‘‘(B) be medically accurate and complete; 

10 ‘‘(C) be age-appropriate; and 

11 ‘‘(D) be based on adolescent learning and 

12 developmental theories for the age group receiv13 ing the education. 

14 ‘‘(3) TOPICS.—Education on sexual risk avoid15 ance pursuant to an allotment under this section 

16 shall address each of the following topics: 

17 ‘‘(A) The holistic individual and societal 

18 benefits associated with personal responsibility, 

19 self-regulation, goal setting, healthy decision20 making, and a focus on the future. 

21 ‘‘(B) The advantage of refraining from 

22 nonmarital sexual activity in order to improve 

23 the future prospects and physical and emotional 

24 health of youth. 


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1 ‘‘(C) The increased likelihood of avoiding 

2 poverty when youth attain self-sufficiency and 

3 emotional maturity before engaging in sexual 

4 activity. 

5 ‘‘(D) The foundational components of 

6 healthy relationships and their impact on the 

7 formation of healthy marriages and safe and 

8 stable families. 

9 ‘‘(E) How other youth risk behaviors, such 

10 as drug and alcohol usage, increase the risk for 

11 teen sex. 

12 ‘‘(F) How to resist and avoid, and receive 

13 help regarding, sexual coercion and dating vio14 lence, recognizing that even with consent teen 

15 sex remains a youth risk behavior. 

16 ‘‘(4) CONTRACEPTION.—Education on sexual 

17 risk avoidance pursuant to an allotment under this 

18 section shall ensure that— 

19 ‘‘(A) any information provided on contra20 ception is medically accurate and ensures that 

21 students understand that contraception offers 

22 physical risk reduction, but not risk elimination; 

23 and 


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1 ‘‘(B) the education does not include dem2 onstrations, simulations, or distribution of con3 traceptive devices. 

4 ‘‘(5) RESEARCH.— 

5 ‘‘(A) IN GENERAL.—A State or other enti6 ty receiving an allotment pursuant to subsection 

7 (a) may use up to 20 percent of such allotment 

8 to build the evidence base for sexual risk avoid9 ance education by conducting or supporting re10 search. 

11 ‘‘(B) REQUIREMENTS.—Any research con12 ducted or supported pursuant to subparagraph 

13 (A) shall be— 

14 ‘‘(i) rigorous; 

15 ‘‘(ii) evidence-based; and 

16 ‘‘(iii) designed and conducted by inde17 pendent researchers who have experience 

18 in conducting and publishing research in 

19 peer-reviewed outlets. 

20 ‘‘(6) INFORMATION COLLECTION AND REPORT21 ING.—A State or other entity receiving an allotment 

22 pursuant to subsection (a) shall, as specified by the 

23 Secretary— 


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1 ‘‘(A) collect information on the programs 

2 and activities funded through the allotment; 

3 and 

4 ‘‘(B) submit reports to the Secretary on 

5 the data from such programs and activities. 

6 ‘‘(c) NATIONAL EVALUATION.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall— 

8 ‘‘(A) in consultation with appropriate State 

9 and local agencies, conduct one or more rig10 orous evaluations of the education funded 

11 through this section and associated data; and 

12 ‘‘(B) submit a report to the Congress on 

13 the results of such evaluations, together with a 

14 summary of the information collected pursuant 

15 to subsection (b)(6). 

16 ‘‘(2) CONSULTATION.—In conducting the eval17 uations required by paragraph (1), including the es18 tablishment of evaluation methodologies, the Sec19 retary shall consult with relevant stakeholders. 

20 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.— 

21 ‘‘(1) Sections 503, 507, and 508 apply to allot22 ments under subsection (a) to the same extent and 

23 in the same manner as such sections apply to allot24 ments under section 502(c). 


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1 ‘‘(2) Sections 505 and 506 apply to allotments 

2 under subsection (a) to the extent determined by the 

3 Secretary to be appropriate. 

4 ‘‘(e) FUNDING.— 

5 ‘‘(1) IN GENERAL.—To carry out this section, 

6 there is appropriated, out of any money in the 

7 Treasury not otherwise appropriated, $75,000,000 

8 for each of fiscal years 2018 and 2019. 

9 ‘‘(2) RESERVATION.—The Secretary shall re10 serve, for each of fiscal years 2018 and 2019, not 

11 more than 20 percent of the amount appropriated 

12 pursuant to paragraph (1) for administering the 

13 program under this section, including the conducting 

14 of national evaluations and the provision of technical 

15 assistance to the recipients of allotments.’’. 

16 (2) EFFECTIVE DATE.—The amendment made 

17 by this section takes effect on October 1, 2017. 

18 (b) PERSONAL RESPONSIBILITY EDUCATION.— 

19 (1) IN GENERAL.—Section 513 of the Social 

20 Security Act (42 U.S.C. 713) is amended— 

21 (A) in subsection (a)(1)(A), by striking 

22 ‘‘2017’’ and inserting ‘‘2019’’; 

23 (B) in subsection (a)(4)— 


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1 (i) in subparagraph (A), by striking 

2 ‘‘2017’’ each place it appears and inserting 

3 ‘‘2019’’; and 

4 (ii) in subparagraph (B)— 

5 (I) in the subparagraph heading, 

6 by striking ‘‘3-YEAR GRANTS’’ and in7 serting ‘‘COMPETITIVE PREP

8 GRANTS’’; and 

9 (II) in clause (i), by striking ‘‘so10 licit applications to award 3-year 

11 grants in each of fiscal years 2012 

12 through 2017’’ and inserting ‘‘con13 tinue through fiscal year 2019 grants 

14 awarded for any of fiscal years 2015 

15 through 2017’’; 

16 (C) in subsection (c)(1), by inserting after 

17 ‘‘youth with HIV/AIDS,’’ the following: ‘‘vic18 tims of human trafficking,’’; and 

19 (D) in subsection (f), by striking ‘‘2017’’ 

20 and inserting ‘‘2019’’. 

21 (2) EFFECTIVE DATE.—The amendments made 

22 by this subsection take effect on October 1, 2017. 


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1 SEC. 106. DECREASING REDUCTION IN MEDICAID DSH AL2 LOTMENTS. 

3 Section 1923(f)(7)(A) of the Social Security Act (42 

4 U.S.C. 1396r–4(f)(7)(A)) is amended— 

5 (1) in clause (i), in the matter preceding sub6 clause (I), by striking ‘‘2018’’ and inserting ‘‘2023’’; 

7 and 

8 (2) in clause (ii), by striking subclauses (I) 

9 through (VIII) and inserting the following: 

10 ‘‘(I) $5,000,000,000 for fiscal 

11 year 2023; 

12 ‘‘(II) $5,500,000,000 for fiscal 

13 year 2024; and 

14 ‘‘(III) $6,000,000,000 for fiscal 

15 year 2025.’’. 

16 SEC. 107. INCREASE IN TERRITORIAL CAP FOR MEDICAID 

17 PAYMENTS. 

18 Section 1108(g)(5) of the Social Security Act (42 

19 U.S.C. 1308(g)(5)) is amended— 

20 (1) in subparagraph (A)— 

21 (A) by striking ‘‘subparagraph (B)’’ and 

22 inserting ‘‘subparagraphs (B), (C), and (D)’’; 

23 and 

24 (B) by striking ‘‘2019’’ and inserting 

25 ‘‘2022’’; and 


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1 (2) by adding at the end the following new sub2 paragraphs: 

3 ‘‘(C) The amount of the increase otherwise pro4 vided under subparagraph (A) for— 

5 ‘‘(i) Puerto Rico shall, after application of 

6 subparagraph (B), be further increased by 

7 $1,600,000,000 for each of fiscal years 2018 

8 through 2022; and 

9 ‘‘(ii) the Virgin Islands shall be further in10 creased by $55,000,000 for each of fiscal years 

11 2018 through 2022. 

12 ‘‘(D) The amount of the increase otherwise pro13 vided under subparagraph (A) for Guam, the North14 ern Mariana Islands, and America Samoa, respec15 tively, shall be further increased by such amounts 

16 that the total amount of increases under this sub17 paragraph is equal to $150,000,000. In applying the 

18 previous sentence, the Secretary shall increase 

19 amounts for such territories in such a proportion as 

20 would be applied under subparagraph (A) if such 

21 territories were the only territories to which such 

22 subparagraph applied.’’. 


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1 SEC. 108. PUERTO RICO AND UNITED STATES VIRGIN IS2 LAND DISASTER RELIEF MEDICAID. 

3 (a) SIMPLIFIED ELIGIBILITY DETERMINATIONS AND

4 REDETERMINATIONS.— 

5 (1) IN GENERAL.—Notwithstanding any provi6 sion of title XIX of the Social Security Act (42 

7 U.S.C. 1396 et seq.), a State shall, as a condition 

8 of participation in the Medicaid program under such 

9 title and without submitting an amendment to the 

10 State Medicaid plan— 

11 (A) use streamlined procedures described 

12 in paragraph (2) in processing applications and 

13 determining and redetermining eligibility for 

14 medical assistance under the State Medicaid 

15 plan for DRM-eligible Maria Survivors during 

16 the DRM coverage period; and 

17 (B) provide, in the case of such a Survivor, 

18 for medical assistance under the State Medicaid 

19 plan to such Survivor during such period based 

20 on the family income level eligibility require21 ments established under the State Medicaid 

22 plan or, if higher, under the State Medicaid 

23 plan of the State in which such Survivor resided 

24 as of September 17, 2017. 

25 (2) STREAMLINED PROCEDURES.—The stream26 lined procedures described in this paragraph, with 


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1 respect to a State and an applicant for medical as2 sistance under the State Medicaid plan, are the fol3 lowing: 

4 (A) COMMON APPLICATION FORM.—Use of 

5 a common 1-page application form developed by 

6 the Secretary of Health and Human Services, 

7 in consultation with the National Association of 

8 State Medicaid Directors. Such form shall— 

9 (i) require an applicant to provide an 

10 expected address for the duration of the 

11 DRM coverage period and to agree to up12 date that information if it changes during 

13 such period; 

14 (ii) include notice regarding the pen15 alties for making a fraudulent application; 

16 (iii) require the applicant to assign to 

17 the State any rights of the applicant (or 

18 any other person who is a DRM-eligible 

19 Maria Survivor and on whose behalf the 

20 applicant has the legal authority to execute 

21 an assignment of such rights) under any 

22 group health plan or other third-party cov23 erage for health care; and 

24 (iv) require the applicant to list any 

25 health insurance coverage which the appliVerDate Sep 11 2014 04:43 Dec 09, 2017 Jkt 079200 PO 00000 Frm 00034 Fmt 6652 Sfmt 6201 E:\BILLS\H4541.IH H4541

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1 cant was enrolled in immediately prior to 

2 submitting such application. 

3 (B) SELF-ATTESTATION.—Self-attestation 

4 by the applicant for medical assistance under 

5 the State Medicaid plan that the applicant is a 

6 DRM-eligible Maria Survivor, including with re7 spect to citizenship, identity, immigration sta8 tus, and income requirements. 

9 (C) NO DOCUMENTATION.—No require10 ment for documentation evidencing the basis on 

11 which the applicant qualifies to be a DRM-eligi12 ble Maria Survivor. 

13 (D) ISSUANCE OF ELIGIBILITY CARD.— 

14 Issuance of a DRM assistance eligibility card to 

15 an applicant who completes such application, 

16 including the self-attestation required under 

17 subparagraph (B). Such card shall be valid as 

18 long as the DRM coverage period is in effect 

19 and shall be accompanied by notice of the ter20 mination date for the DRM coverage period 

21 and, if applicable, notice that such termination 

22 date may be extended. If the President extends 

23 the DRM coverage period, the State shall notify 

24 DRM-eligible Maria Survivors enrolled in the 


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1 State Medicaid plan of the new termination 

2 date for the DRM coverage period. 

3 (E) DEEMED ELIGIBILITY.—If an appli4 cant completes the application and presents it 

5 to a provider or facility participating in the 

6 State Medicaid plan that is qualified to make 

7 presumptive eligibility determinations under 

8 such plan (which at a minimum shall consist of 

9 facilities identified in section 1902(a)(55) of the 

10 Social Security Act (42 U.S.C. 1396a(a)(55)) 

11 and it appears to the provider that the appli12 cant is a DRM-eligible Maria Survivor based on 

13 the information in the application, the applicant 

14 will be deemed to be a DRM-eligible Maria Sur15 vivor eligible for medical assistance under the 

16 State Medicaid plan. 

17 (F) CONTINUOUS ELIGIBILITY.—Contin18 uous eligibility, without the need for any rede19 termination of eligibility, for the duration of the 

20 DRM coverage period. 

21 (b) NO CONTINUATION OF DRM ASSISTANCE.— 

22 (1) IN GENERAL.—Except as provided in para23 graphs (2) and (3), no DRM assistance shall be pro24 vided after the end of the DRM coverage period. 


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1 (2) PRESUMPTIVE ELIGIBILITY.—In the case of 

2 any DRM-eligible Maria Survivor who is receiving 

3 DRM assistance from a State in accordance with 

4 this section and who, as of the end of the DRM cov5 erage period, has an application pending for medical 

6 assistance under the State Medicaid plan for periods 

7 beginning after the end of such period, the State 

8 shall provide such Survivor with a period of pre9 sumptive eligibility for medical assistance under the 

10 State Medicaid plan (not to exceed 60 days) until a 

11 determination with respect to the Survivor’s applica12 tion has been made. 

13 (3) PREGNANT WOMEN.—In the case of a 

14 DRM-eligible Maria Survivor who is receiving DRM 

15 assistance from a State in accordance with this sec16 tion and whose pregnancy ended during the 60-day 

17 period prior to the end of the DRM coverage period, 

18 or who is pregnant as of the end of such period, 

19 such Survivor shall continue to be eligible for DRM 

20 assistance after the end of the DRM coverage pe21 riod, including (but not limited to) all pregnancy-re22 lated and postpartum medical assistance available 

23 under the State Medicaid plan, through the end of 

24 the month in which the 60-day period (beginning on 

25 the last day of her pregnancy) ends. 


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1 (c) TREATMENT OF MARIA SURVIVORS PROVIDED

2 ASSISTANCE PRIOR TO DATE OF ENACTMENT.—Any 

3 Maria Survivor who is provided medical assistance under 

4 a State Medicaid plan in accordance with guidance from 

5 the Secretary during the period that begins on September 

6 17, 2017, and ends on the date of enactment of this Act 

7 shall be treated as a DRM-eligible Maria Survivor, without 

8 the need to file an additional application, for purposes of 

9 eligibility for medical assistance under this section. 

10 (d) SCOPE OF COVERAGE.— 

11 (1) IN GENERAL.—A State providing medical 

12 assistance under a State Medicaid plan to a DRM13 eligible Maria Survivor pursuant to this section shall 

14 provide medical assistance that is either— 

15 (A) equal in amount and scope to the med16 ical assistance that would otherwise be made 

17 available to such Survivor if the Survivor were 

18 a State resident enrolled in the State Medicaid 

19 plan; or 

20 (B) if greater in amount and scope, equal 

21 in amount and scope to the medical assistance 

22 that would have been made available to such 

23 Survivor under the State Medicaid plan of the 

24 State in which such Survivor resided as of Sep25 tember 17, 2017. 


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1 Coverage for such medical assistance for DRM-eligi2 ble Maria Survivors shall be retroactive to items and 

3 services furnished on or after September 17, 2017 

4 (or in the case of applications for DRM assistance 

5 submitted after January 1, 2018, the first day of 

6 the 5th month preceding the date on which such ap7 plication is submitted). 

8 (2) CHILDREN BORN TO PREGNANT WOMEN.— 

9 In the case of a child born to a DRM-eligible Maria 

10 Survivor who is provided DRM assistance during the 

11 DRM coverage period, such child shall be treated as 

12 having been born to a pregnant woman eligible for 

13 medical assistance under the State Medicaid plan 

14 and shall be eligible for medical assistance under 

15 such plan in accordance with section 1902(e)(4) of 

16 the Social Security Act (42 U.S.C. 1396a(e)(4)). 

17 The Federal medical assistance percentage applica18 ble to the State Medicaid plan shall apply to medical 

19 assistance provided to a child under such plan in ac20 cordance with the preceding sentence and Federal 

21 payments for such assistance shall not be considered 

22 to be payments under this section. 

23 (e) 100 PERCENT FEDERAL MATCHING PAY24 MENTS.— 


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1 (1) IN GENERAL.—Notwithstanding section 

2 1905(b) of the Social Security Act (42 U.S.C. 

3 1396d(b)), subject to paragraph (2), the Federal 

4 medical assistance percentage or the Federal match5 ing rate otherwise applied under section 1903(a) of 

6 such Act (42 U.S.C. 1396b(a)) shall be 100 percent 

7 for— 

8 (A) providing DRM assistance to DRM-eli9 gible Maria Survivors during the DRM coverage 

10 period in accordance with this section; 

11 (B) costs directly attributable to adminis12 trative activities related to the provision of such 

13 DRM assistance; and 

14 (C) DRM assistance provided in accord15 ance with paragraph (2) or (3) of subsection 

16 (b) after the end of the DRM coverage period. 

17 (2) LIMITATION.— 

18 (A) TERRITORIES.—Payments provided to 

19 a State that is a territory (as defined in section 

20 1108(c)(1) of the Social Security Act (42 

21 U.S.C. 1308(c)(1))) in accordance with this 

22 subsection shall be subject to subsections (f) 

23 and (g) of section 1108 of the Social Security 

24 Act (42 U.S.C. 1308). 

25 (B) OTHER STATES.— 


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1 (i) IN GENERAL.—In the case of 

2 States not described in subparagraph (A), 

3 the difference between— 

4 (I) the total amount of payments 

5 made to such States in accordance 

6 with this subsection, by reason of the 

7 Federal medical assistance percentage 

8 or the Federal matching rate applied 

9 under paragraph (1); and 

10 (II) the total amount of pay11 ments that would otherwise be made 

12 to such States if the Federal medical 

13 assistance percentage and the Federal 

14 matching rate under section 1905(b) 

15 of the Social Security Act and 

16 1903(a) of such Act were applied, 

17 may not exceed the amount appropriated 

18 under clause (ii). 

19 (ii) APPROPRIATIONS.—There are ap20 propriated, out of any amounts in the 

21 Treasury not otherwise appropriated, 

22 $1,000,000,000 for the DRM coverage pe23 riod for purposes of making payments in 

24 accordance with this subsection to States 

25 not described in subparagraph (A). 


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1 (3) EXEMPTION FROM ERROR RATE PEN2 ALTIES.—All payments attributable to providing 

3 DRM assistance in accordance with this section shall 

4 be disregarded for purposes of section 1903(u) of 

5 the Social Security Act (42 U.S.C. 1396b(u)). 

6 (f) VERIFICATION OF STATUS AS A MARIA SUR7 VIVOR.— 

8 (1) IN GENERAL.—A State shall make a good 

9 faith effort to verify the status of an individual who 

10 is enrolled in the State Medicaid plan as a DRM-eli11 gible Maria Survivor under the provisions of this 

12 section. Such effort shall not delay the determina13 tion of the eligibility of the Survivor for DRM assist14 ance under this section. 

15 (2) EVIDENCE OF VERIFICATION.—A State may 

16 satisfy the verification requirement under paragraph 

17 (1) with respect to an individual by showing that the 

18 State obtained information from the Social Security 

19 Administration, the Internal Revenue Service, or the 

20 State Medicaid Agency for the State from which the 

21 individual is from (if the individual was not a resi22 dent of such State on any day during the week pre23 ceding September 17, 2017). 

24 (g) PROVIDER PAYMENT RATES.—In the case of any 

25 DRM assistance provided in accordance with this section 


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1 to a DRM-eligible Maria Survivor that is covered under 

2 the State Medicaid plan (as applied without regard to this 

3 section) the State shall pay a provider of such assistance 

4 the same payment rate as the State would otherwise pay 

5 for the assistance if the assistance were provided under 

6 the State Medicaid plan (or, if no such payment rate ap7 plies under the State Medicaid plan, the usual and cus8 tomary prevailing rate for the item or service for the com9 munity in which it is provided). 

10 (h) APPLICATION TO INDIVIDUALS ELIGIBLE FOR

11 MEDICAL ASSISTANCE.—Nothing in this section shall be 

12 construed as affecting any rights accorded to an individual 

13 who is a recipient of medical assistance under a State 

14 Medicaid plan who is determined to be a DRM-eligible 

15 Maria Survivor but the provision of DRM assistance to 

16 such individual shall be limited to the provision of such 

17 assistance in accordance with this section. 

18 (i) DEFINITIONS.—In this section: 

19 (1) DRM ASSISTANCE.—The term ‘‘DRM as20 sistance’’ means medical assistance under a State 

21 Medicaid plan for a DRM-eligible Maria Survivor 

22 during the DRM coverage period. 

23 (2) DRM COVERAGE PERIOD.— 

24 (A) IN GENERAL.—The term ‘‘DRM cov25 erage period’’ means the period beginning on 


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1 September 17, 2017, and, subject to subpara2 graph (B), ending on the date that is 24 

3 months after the date of enactment of this Act. 

4 (B) SECRETARY AUTHORITY TO EXTEND

5 DRM COVERAGE PERIOD.—The Secretary may 

6 extend the DRM coverage period for an addi7 tional 12 months. Any reference to the term 

8 ‘‘DRM coverage period’’ in this section shall in9 clude any extension under this subparagraph. 

10 (3) DRM-ELIGIBLE MARIA SURVIVOR DE11 FINED.— 

12 (A) IN GENERAL.—The term ‘‘DRM-eligi13 ble Maria Survivor’’ means a Maria Survivor 

14 whose family income does not exceed the income 

15 eligibility standard which would apply to the 

16 Survivor under the State Medicaid plan of the 

17 State in which the Survivor applies for medical 

18 assistance. 

19 (B) NO RESOURCES, RESIDENCY, OR CAT20 EGORICAL ELIGIBILITY REQUIREMENTS.—Eligi21 bility under subparagraph (A) shall be deter22 mined without application of any resources test, 

23 State residency, or categorical eligibility re24 quirements. 


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1 (C) DEFINITION OF CHILD.—For purposes 

2 of subparagraph (A), a DRM-eligible Maria 

3 Survivor shall be determined to be a ‘‘child’’ in 

4 accordance with the definition of ‘‘child’’ under 

5 the State Medicaid plan. 

6 (4) MARIA SURVIVOR.— 

7 (A) IN GENERAL.—The term ‘‘Maria Sur8 vivor’’ means an individual who, on any day 

9 during the week preceding September 17, 2017, 

10 had a primary residence in Puerto Rico or the 

11 Virgin Islands. 

12 (B) TREATMENT OF CURRENT MEDICAID

13 BENEFICIARIES.—Nothing in this section shall 

14 be construed as preventing an individual who is 

15 otherwise entitled to medical assistance under a 

16 State Medicaid plan from being treated as a 

17 Maria Survivor under this section. 

18 (C) TREATMENT OF HOMELESS PER19 SONS.—For purposes of this section, in the case 

20 of an individual who was homeless on any day 

21 during the week described in subparagraph (A), 

22 the individual’s ‘‘residence’’ shall be deemed to 

23 be the place of residence as otherwise deter24 mined for such an individual under title XIX of 


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1 the Social Security Act (42 U.S.C. 1396 et 

2 seq.). 

3 (5) SECRETARY.—The term ‘‘Secretary’’ means 

4 the Secretary of Health and Human Services. 

5 (6) STATE.—The term ‘‘State’’ has the mean6 ing given that term for purposes of title XIX of the 

7 Social Security Act (42 U.S.C. 1396 et seq.). 

8 (7) STATE MEDICAID PLAN.—The term ‘‘State 

9 Medicaid plan’’ means a State plan under title XIX 

10 of the Social Security Act (42 U.S.C. 1396 et seq.) 

11 (or a waiver of such plan). 

12 SEC. 109. DELAY OF BIPARTISAN BUDGET ACT OF 2013 

13 THIRD-PARTY LIABILITY PROVISIONS. 

14 (a) IN GENERAL.—Section 202(c) of the Bipartisan 

15 Budget Act of 2013 (Public Law 113–67; 127 Stat. 1177; 

16 42 U.S.C. 1396a note), as amended by section 211 of the 

17 Protecting Access to Medicare Act of 2014 (Public Law 

18 113–93; 128 Stat. 1047; 42 U.S.C. 1396a note) and sec19 tion 220 of the Medicare Access and CHIP Reauthoriza20 tion Act of 2015 (Public Law 114–10), is amended by 

21 striking ‘‘2017’’ and inserting ‘‘2019’’. 

22 (b) EFFECTIVE DATE; TREATMENT.—The amend23 ment made by subparagraph (A) shall take effect on Sep24 tember 30, 2017, and shall apply with respect to claims 

25 pending, generated, or filed after such date. 


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1 TITLE II—CHIP 

2 SEC. 201. FIVE-YEAR FUNDING EXTENSION OF THE CHIL3 DREN’S HEALTH INSURANCE PROGRAM. 

4 (a) APPROPRIATION; TOTAL ALLOTMENT.—Section 

5 2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) 

6 is amended— 

7 (1) in paragraph (19), by striking ‘‘and’’; 

8 (2) in paragraph (20), by striking the period at 

9 the end and inserting a semicolon; and 

10 (3) by adding at the end the following new 

11 paragraphs: 

12 ‘‘(21) for fiscal year 2018, $21,500,000,000; 

13 ‘‘(22) for fiscal year 2019, $22,600,000,000; 

14 ‘‘(23) for fiscal year 2020, $23,700,000,000; 

15 ‘‘(24) for fiscal year 2021, $24,800,000,000; 

16 and 

17 ‘‘(25) for fiscal year 2022, for purposes of mak18 ing 2 semi-annual allotments— 

19 ‘‘(A) $2,850,000,000 for the period begin20 ning on October 1, 2021, and ending on March 

21 31, 2022; and 

22 ‘‘(B) $2,850,000,000 for the period begin23 ning on April 1, 2022, and ending on Sep24 tember 30, 2022.’’. 

25 (b) ALLOTMENTS.— 


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1 (1) IN GENERAL.—Section 2104(m) of the So2 cial Security Act (42 U.S.C. 1397dd(m)) is amend3 ed— 

4 (A) in paragraph (2)— 

5 (i) in the heading, by striking 

6 ‘‘THROUGH 2016’’ and inserting 

7 ‘‘THROUGH 2022’’; and 

8 (ii) in subparagraph (B)— 

9 (I) in the matter preceding clause 

10 (i), by striking ‘‘(19)’’ and inserting 

11 ‘‘(24)’’; 

12 (II) in clause (ii), in the matter 

13 preceding subclause (I), by inserting 

14 ‘‘(other than fiscal year 2022)’’ after 

15 ‘‘even-numbered fiscal year’’; and 

16 (III) in clause (ii)(I), by inserting 

17 ‘‘(or, in the case of fiscal year 2018, 

18 under paragraph (4))’’ after ‘‘clause 

19 (i)’’; 

20 (B) in paragraph (5)— 

21 (i) by striking ‘‘or (4)’’ and inserting 

22 ‘‘(4), or (10)’’; and 

23 (ii) by striking ‘‘or 2017’’ and insert24 ing ‘‘, 2017, or 2022’’; 

25 (C) in paragraph (7)— 


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1 (i) in subparagraph (A), by striking 

2 ‘‘2017’’ and inserting ‘‘2022’’; 

3 (ii) in subparagraph (B), in the mat4 ter preceding clause (i), by inserting ‘‘(or, 

5 in the case of fiscal year 2018, by not later 

6 than the date that is 60 days after the 

7 date of the enactment of the CHAMPION 

8 KIDS Act of 2017)’’ after ‘‘before the Au9 gust 31 preceding the beginning of the fis10 cal year’’; and 

11 (iii) in the matter following subpara12 graph (B), by striking ‘‘or fiscal year 

13 2016’’ and inserting ‘‘fiscal year 2016, fis14 cal year 2018, fiscal year 2020, or fiscal 

15 year 2022’’; 

16 (D) in paragraph (9)— 

17 (i) in the heading, by striking ‘‘FISCAL

18 YEARS 2015 AND 2017’’ and inserting 

19 ‘‘CERTAIN FISCAL YEARS’’; 

20 (ii) by striking ‘‘or (4)’’ and inserting 

21 ‘‘, (4), or (10)’’; and 

22 (iii) by striking ‘‘or fiscal year 2017’’ 

23 and inserting ‘‘, 2017, or 2022’’; and 

24 (E) by adding at the end the following new 

25 paragraph: 


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1 ‘‘(10) FOR FISCAL YEAR 2022.— 

2 ‘‘(A) FIRST HALF.—Subject to paragraphs 

3 (5) and (7), from the amount made available 

4 under subparagraph (A) of paragraph (25) of 

5 subsection (a) for the semi-annual period de6 scribed in such subparagraph, increased by the 

7 amount of the appropriation for such period 

8 under section 201(b)(3) of the CHAMPION 

9 KIDS Act of 2017, the Secretary shall compute 

10 a State allotment for each State (including the 

11 District of Columbia and each commonwealth 

12 and territory) for such semi-annual period in an 

13 amount equal to the first half ratio (described 

14 in subparagraph (D)) of the amount described 

15 in subparagraph (C). 

16 ‘‘(B) SECOND HALF.—Subject to para17 graphs (5) and (7), from the amount made 

18 available under subparagraph (B) of paragraph 

19 (25) of subsection (a) for the semi-annual pe20 riod described in such subparagraph, the Sec21 retary shall compute a State allotment for each 

22 State (including the District of Columbia and 

23 each commonwealth and territory) for such 

24 semi-annual period in an amount equal to the 


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1 amount made available under such subpara2 graph, multiplied by the ratio of— 

3 ‘‘(i) the amount of the allotment to 

4 such State under subparagraph (A), to 

5 ‘‘(ii) the total of the amount of all of 

6 the allotments made available under such 

7 subparagraph. 

8 ‘‘(C) FULL YEAR AMOUNT BASED ON

9 GROWTH FACTOR UPDATED AMOUNT.—The 

10 amount described in this subparagraph for a 

11 State is equal to the sum of— 

12 ‘‘(i) the amount of the State allotment 

13 for fiscal year 2021 determined under 

14 paragraph (2)(B)(i); and 

15 ‘‘(ii) the amount of any payments 

16 made to the State under subsection (n) for 

17 fiscal year 2021, 

18 multiplied by the allotment increase factor 

19 under paragraph (6) for fiscal year 2022. 

20 ‘‘(D) FIRST HALF RATIO.—The first half 

21 ratio described in this subparagraph is the ratio 

22 of— 

23 ‘‘(i) the sum of— 

24 ‘‘(I) the amount made available 

25 under subsection (a)(25)(A); and 


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1 ‘‘(II) the amount of the appro2 priation for such period under section 

3 201(b)(3) of the CHAMPION KIDS 

4 Act of 2017, to 

5 ‘‘(ii) the sum of— 

6 ‘‘(I) the amount described in 

7 clause (i); and 

8 ‘‘(II) the amount made available 

9 under subsection (a)(25)(B).’’. 

10 (2) TECHNICAL AMENDMENT.—Section 

11 2104(m)(2)(A) of such Act (42 U.S.C. 

12 1397dd(m)(2)(A)) is amended by striking ‘‘the allot13 ment increase factor under paragraph (5)’’ each 

14 place it appears and inserting ‘‘the allotment in15 crease factor under paragraph (6)’’. 

16 (3) ONE-TIME APPROPRIATION FOR FISCAL

17 YEAR 2022.—There is appropriated to the Secretary 

18 of Health and Human Services, out of any money in 

19 the Treasury not otherwise appropriated, 

20 $20,200,000,000 to accompany the allotment made 

21 for the period beginning on October 1, 2021, and 

22 ending on March 31, 2022, under paragraph 

23 (25)(A) of section 2104(a) of the Social Security Act 

24 (42 U.S.C. 1397dd(a)) (as added by subsection 

25 (a)(3)), to remain available until expended. Such 


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1 amount shall be used to provide allotments to States 

2 under paragraph (10) of section 2104(m) of such 

3 Act (as added by subsection (b)(1)(E)) for the first 

4 6 months of fiscal year 2022 in the same manner as 

5 allotments are provided under subsection (a)(25)(A) 

6 of such section 2104 and subject to the same terms 

7 and conditions as apply to the allotments provided 

8 from such subsection (a)(25)(A). 

9 (c) EXTENSION OF THE CHILD ENROLLMENT CON10 TINGENCY FUND.—Section 2104(n) of the Social Security 

11 Act (42 U.S.C. 1397dd(n)) is amended— 

12 (1) in paragraph (2)— 

13 (A) in subparagraph (A)(ii)— 

14 (i) by striking ‘‘2010, 2011, 2012, 

15 2013, 2014, and 2016’’ and inserting 

16 ‘‘2010 through 2014, 2016, and 2018 

17 through 2021’’; and 

18 (ii) by striking ‘‘fiscal year 2015 and 

19 fiscal year 2017’’ and inserting ‘‘fiscal 

20 years 2015, 2017, and 2022’’; and 

21 (B) in subparagraph (B)— 

22 (i) by striking ‘‘2010, 2011, 2012, 

23 2013, 2014, and 2016’’ and inserting 

24 ‘‘2010 through 2014, 2016, and 2018 

25 through 2021’’; and 


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1 (ii) by striking ‘‘fiscal year 2015 and 

2 fiscal year 2017’’ and inserting ‘‘fiscal year 

3 2015, 2017, and 2022’’; and 

4 (2) in paragraph (3)(A), in the matter pre5 ceding clause (i), by striking ‘‘or a semi-annual allot6 ment period for fiscal year 2015 or 2017’’ and in7 serting ‘‘or in any of fiscal years 2018 through 2021 

8 (or a semi-annual allotment period for fiscal year 

9 2015, 2017, or 2022)’’. 

10 (d) EXTENSION OF QUALIFYING STATES OPTION.— 

11 Section 2105(g)(4) of the Social Security Act (42 U.S.C. 

12 1397ee(g)(4)) is amended— 

13 (1) in the heading, by striking ‘‘THROUGH

14 2017’’ and inserting ‘‘THROUGH 2022’’; and 

15 (2) in subparagraph (A), by striking ‘‘2017’’ 

16 and inserting ‘‘2022’’. 

17 (e) EXTENSION OF EXPRESS LANE ELIGIBILITY OP18 TION.—Section 1902(e)(13)(I) of the Social Security Act 

19 (42 U.S.C. 1396a(e)(13)(I)) is amended by striking 

20 ‘‘2017’’ and inserting ‘‘2022’’. 

21 (f) ASSURANCE OF AFFORDABILITY STANDARD FOR

22 CHILDREN AND FAMILIES.— 

23 (1) IN GENERAL.—Section 2105(d)(3) of the 

24 Social Security Act (42 U.S.C. 1397ee(d)(3)) is 

25 amended— 


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1 (A) in the paragraph heading, by striking 

2 ‘‘UNTIL OCTOBER 1, 2019’’ and inserting 

3 ‘‘THROUGH SEPTEMBER 30, 2022’’; and 

4 (B) in subparagraph (A), in the matter 

5 preceding clause (i)— 

6 (i) by striking ‘‘2019’’ and inserting 

7 ‘‘2022’’; and 

8 (ii) by striking ‘‘The preceding sen9 tence shall not be construed as preventing 

10 a State during such period’’ and inserting 

11 ‘‘During the period that begins on October 

12 1, 2019, and ends on September 30, 2022, 

13 the preceding sentence shall only apply 

14 with respect to children in families whose 

15 income does not exceed 300 percent of the 

16 poverty line (as defined in section 

17 2110(c)(5)) applicable to a family of the 

18 size involved. The preceding sentences shall 

19 not be construed as preventing a State 

20 during any such periods’’. 

21 (2) CONFORMING AMENDMENTS.—Section 

22 1902(gg)(2) of the Social Security Act (42 U.S.C. 

23 1396a(gg)(2)) is amended— 


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1 (A) in the paragraph heading, by striking 

2 ‘‘UNTIL OCTOBER 1, 2019’’ and inserting 

3 ‘‘THROUGH SEPTEMBER 30, 2022’’; and 

4 (B) by striking ‘‘September 30, 2019,’’ 

5 and inserting ‘‘September 30, 2022 (but during 

6 the period that begins on October 1, 2019, and 

7 ends on September 30, 2022, only with respect 

8 to children in families whose income does not 

9 exceed 300 percent of the poverty line (as de10 fined in section 2110(c)(5)) applicable to a fam11 ily of the size involved)’’. 

12 SEC. 202. EXTENSION OF CERTAIN PROGRAMS AND DEM13 ONSTRATION PROJECTS. 

14 (a) CHILDHOOD OBESITY DEMONSTRATION

15 PROJECT.—Section 1139A(e)(8) of the Social Security 

16 Act (42 U.S.C. 1320b–9a(e)(8)) is amended— 

17 (1) by striking ‘‘and $10,000,000’’ and insert18 ing ‘‘, $10,000,000’’; and 

19 (2) by inserting after ‘‘2017’’ the following: ‘‘, 

20 and $25,000,000 for the period of fiscal years 2018 

21 through 2022’’. 

22 (b) PEDIATRIC QUALITY MEASURES PROGRAM.— 

23 Section 1139A(i) of the Social Security Act (42 U.S.C. 

24 1320b–9a(i)) is amended— 


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1 (1) by striking ‘‘Out of any’’ and inserting the 

2 following: 

3 ‘‘(1) IN GENERAL.—Out of any’’; 

4 (2) by striking ‘‘there is appropriated for each’’ 

5 and inserting ‘‘there is appropriated— 

6 ‘‘(A) for each’’; 

7 (3) by striking ‘‘, and there is appropriated for 

8 the period’’ and inserting ‘‘; 

9 ‘‘(B) for the period’’; 

10 (4) by striking ‘‘. Funds appropriated under 

11 this subsection shall remain available until ex12 pended’’ and inserting ‘‘; and’’; and 

13 (5) by adding at the end the following: 

14 ‘‘(C) for the period of fiscal years 2018 

15 through 2022, $75,000,000 for the purpose of 

16 carrying out this section (other than sub17 sections (e), (f), and (g)). 

18 ‘‘(2) AVAILABILITY.—Funds appropriated 

19 under this subsection shall remain available until ex20 pended.’’. 

21 SEC. 203. EXTENSION OF OUTREACH AND ENROLLMENT 

22 PROGRAM. 

23 (a) EXTENSION AND REAUTHORIZATION.—Section 

24 2113 of the Social Security Act (42 U.S.C. 1397mm) is 

25 amended— 


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1 (1) in subsection (a)(1), by striking ‘‘2017’’ and 

2 inserting ‘‘2022’’; and 

3 (2) in subsection (g)— 

4 (A) by striking ‘‘and $40,000,000’’ and in5 serting ‘‘, $40,000,000’’; and 

6 (B) by inserting after ‘‘2017’’ the fol7 lowing: ‘‘, and $100,000,000 for the period of 

8 fiscal years 2018 through 2022’’. 

9 (b) MAKING ORGANIZATIONS THAT USE PARENT

10 MENTORS ELIGIBLE TO RECEIVE GRANTS.—Section 

11 2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) 

12 is amended— 

13 (1) in paragraph (1)(E), by striking ‘‘or com14 munity-based doula programs’’ and inserting ‘‘, com15 munity-based doula programs, or parent mentors’’; 

16 and 

17 (2) by adding at the end the following new 

18 paragraph: 

19 ‘‘(5) PARENT MENTOR.—The term ‘parent 

20 mentor’ means an individual who— 

21 ‘‘(A) is a parent or guardian of at least 

22 one child who is an eligible child under this title 

23 or title XIX; and 

24 ‘‘(B) is trained to assist families with chil25 dren who have no health insurance coverage 


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1 with respect to improving the social deter2 minants of the health of such children, includ3 ing by providing— 

4 ‘‘(i) education about health insurance 

5 coverage, including, with respect to obtain6 ing such coverage, eligibility criteria and 

7 application and renewal processes; 

8 ‘‘(ii) assistance with completing and 

9 submitting applications for health insur10 ance coverage and renewal; 

11 ‘‘(iii) a liaison between families and 

12 representatives of State plans under title 

13 XIX or State child health plans under this 

14 title; 

15 ‘‘(iv) guidance on identifying medical 

16 and dental homes and community phar17 macies for children; and 

18 ‘‘(v) assistance and referrals to suc19 cessfully address social determinants of 

20 children’s health, including poverty, food 

21 insufficiency, housing, and environmental 

22 hazards.’’. 

23 (c) EXCLUSION FROM MODIFIED ADJUSTED GROSS

24 INCOME.—Section 1902 of the Social Security Act (42 

25 U.S.C. 1396a) is amended— 


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1 (1) in subsection (a)(17), by striking ‘‘(e)(14), 

2 (e)(14)’’ and inserting ‘‘(e)(14), (e)(15)’’; 

3 (2) in subsection (e), in the first paragraph 

4 (14), relating to income determined using modified 

5 adjusted gross income, by adding at the end the fol6 lowing new subparagraph: 

7 ‘‘(J) EXCLUSION OF PARENT MENTOR

8 COMPENSATION FROM INCOME DETERMINA9 TION.—Any nominal amount received by an in10 dividual as compensation, including a stipend, 

11 for participation as a parent mentor (as defined 

12 in paragraph (5) of section 2113(f)) in an activ13 ity or program funded through a grant under 

14 such section shall be disregarded for purposes 

15 of determining the income eligibility of such in16 dividual for medical assistance under the State 

17 plan or any waiver of such plan.’’; and 

18 (3) in subsection (e), by striking ‘‘(14) EXCLU19 SION’’ and inserting ‘‘(15) EXCLUSION’’. 

20 SEC. 204. EXTENSION OF ADDITIONAL FEDERAL FINANCIAL 

21 PARTICIPATION FOR CHIP. 

22 Section 2105(b) of the Social Security Act (42 U.S.C. 

23 1397ee(b)) is amended in the second sentence by inserting 

24 ‘‘and during the period that begins on October 1, 2019, 

25 and ends on September 30, 2020, the enhanced FMAP 


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1 determined for a State for a fiscal year (or for any portion 

2 of a fiscal year occurring during such period) shall be in3 creased by 11.5 percentage points’’ after ‘‘23 percentage 

4 points,’’. 

5 TITLE III—OFFSET 

6 SEC. 301. IMPLEMENTATION OF OFFICE OF INSPECTOR 

7 GENERAL RECOMMENDATION TO DELAY CER8 TAIN MEDICARE PLAN PREPAYMENTS. 

9 (a) MEDICARE ADVANTAGE PAYMENTS.—Section 

10 1853(a)(1) of the Social Security Act (42 U.S.C. 1395w– 

11 23(a)(1)) is amended— 

12 (1) in subparagraph (A), in the matter pre13 ceding clause (i)— 

14 (A) by striking ‘‘subsections (e), (g), (i), 

15 and (l)’’ and inserting ‘‘subparagraph (J), sub16 sections (e), (g), (i), and (l),’’; and 

17 (B) by inserting ‘‘(or, for months begin18 ning with January 2019, on the date specified 

19 in subparagraph (J))’’ after ‘‘in advance’’; and 

20 (2) by adding at the end the following new sub21 paragraph: 

22 ‘‘(J) TIMING OF PAYMENTS.— 

23 ‘‘(i) IN GENERAL.—With respect to 

24 monthly payments under this section for 

25 months in a year (beginning with 2019), 


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1 the date specified in this subparagraph 

2 with respect to a payment for a month is 

3 the first business day occurring on or after 

4 the applicable date defined in clause (ii). 

5 ‘‘(ii) APPLICABLE DATE.—For pur6 poses of clause (i), with respect to a year 

7 (beginning with 2019), the term ‘applicable 

8 date’ means, with respect to a payment 

9 for— 

10 ‘‘(I) January of such year, Janu11 ary 2nd; 

12 ‘‘(II) February of such year, 

13 February 5th; 

14 ‘‘(III) March of such year, March 

15 10th; 

16 ‘‘(IV) April of such year, April 

17 15th; 

18 ‘‘(V) May of such year, May 

19 20th; 

20 ‘‘(VI) June of such year, June 

21 25th; 

22 ‘‘(VII) July and each succeeding 

23 month (other than December) of such 

24 year, the first day of the next month; 

25 and 


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1 ‘‘(VIII) December of such year, 

2 December 24th.’’. 

3 (b) CONFORMING AMENDMENT TO PART D.—Section 

4 1860D–15(d)(1) of the Social Security Act (42 U.S.C. 

5 1395w–115(d)(1)) is amended by inserting ‘‘and shall be 

6 made consistent with the timing of monthly payments to 

7 MA organizations under section 1853(a)(1)(J)’’ after ‘‘as 

8 the Secretary determines’’. 

Æ 


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