I 

115TH CONGRESS 

2D SESSION H. R. 4820 

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

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 18, 2018 

Mr. MCEACHIN (for himself, Ms. ROYBAL-ALLARD, Mr. CLAY, Mr. SERRANO, 

Mr. ESPAILLAT, Mr. DEUTCH, Mrs. NAPOLITANO, Mr. POCAN, Mr. LANGEVIN, Mr. RICHMOND, Mr. HUFFMAN, Mr. SCHRADER, Ms. ADAMS, Mr. 

MCNERNEY, Mr. GRIJALVA, Mr. BRENDAN F. BOYLE of Pennsylvania, 

Mr. CARSON of Indiana, Mr. SABLAN, Ms. BONAMICI, Mr. LARSON of 

Connecticut, Ms. JUDY CHU of California, Ms. DELBENE, Ms. NORTON, 

Mr. SCOTT of Virginia, Mr. COHEN, Mr. SEAN PATRICK MALONEY of 

New York, Ms. BARRAGA ́N, Ms. MATSUI, Ms. SCHAKOWSKY, Mr. VEASEY, 

Mr. SOTO, Ms. JAYAPAL, Mr. KEATING, Mr. AL GREEN of Texas, Mr. 

LOWENTHAL, Ms. WILSON of Florida, Ms. HANABUSA, Ms. CASTOR of 

Florida, Ms. SEWELL of Alabama, Mr. GOMEZ, Mr. LOEBSACK, Ms. 

WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Mr. THOMPSON of California, Mr. COURTNEY, Ms. ROSEN, Mr. TAKANO, Ms. PINGREE, Ms. 

KUSTER of New Hampshire, Mr. KHANNA, Mr. PANETTA, and Mr. 

KIHUEN) 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Advancing Seniors and 

3 Kids Act’’ or the ‘‘ASK Act’’. 

4 SEC. 2. TABLE OF CONTENTS. 

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

Sec. 1. Short title. 

Sec. 2. Table of contents. 

TITLE I—CHILDREN’S HEALTH INSURANCE PROGRAM 

Sec. 100. Short title. 

Sec. 101. Permanent extension of the Children’s Health Insurance Program. 

Sec. 102. Extension of certain programs and demonstration projects. 

Sec. 103. Extension of outreach and enrollment program. 

Sec. 104. Extension and reduction of additional Federal financial participation 

for CHIP. 

TITLE II—MEDICARE AND OTHER HEALTH EXTENDERS 

Subtitle A—Medicare Extenders and Related Policies 

Sec. 201. Extension of work GPCI floor. 

Sec. 202. Permanent repeal of the therapy caps. 

Sec. 203. Ground ambulance services cost reporting requirement. 

Sec. 204. Ground ambulance services cost reporting study. 

Sec. 205. Extension of ground ambulance services extenders. 

Sec. 206. Extension of increased inpatient hospital payment adjustment for certain low-volume hospitals. 

Sec. 207. Extension of the Medicare-Dependent Hospital (MDH) program. 

Sec. 208. Specialized Medicare Advantage plans for special needs individuals. 

Sec. 209. Expanding supplemental benefits to meet the needs of chronically ill 

Medicare Advantage enrollees. 

Sec. 210. Extension of consensus-based entity funding. 

Sec. 211. Extension of certain MIPPA funding provisions. 

Sec. 212. Extension of home health rural add-on. 

Subtitle B—Medicaid and Public Health Extenders 

Sec. 221. Extension for community health centers and the National Health 

Service Corps. 

Sec. 222. Extension for special diabetes programs. 

Sec. 223. Reauthorization of program of payments to teaching health centers 

that operate graduate medical education programs. 

Sec. 224. Extension for family-to-family health information centers. 

Sec. 225. Extension of abstinence education; extension of personal responsibility education program. 

Sec. 226. Extension of health workforce demonstration projects for low-income 

individuals. 

Sec. 227. Delay of reduction to Medicaid DSH allotments. 

Sec. 228. Delay of Bipartisan Budget Act of 2013 third-party liability provisions. 


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Subtitle C—Continuing the Maternal, Infant, and Early Childhood Home 

Visiting Program 

Sec. 231. Continuing evidence-based home visiting program. 

Sec. 232. Continuing to demonstrate results to help families. 

Sec. 233. Reviewing statewide needs to target resources. 

Sec. 234. Improving the likelihood of success in high-risk communities. 

Sec. 235. Option to fund evidence-based home visiting on a pay for outcome 

basis. 

Sec. 236. Data exchange standards for improved interoperability. 

Sec. 237. Allocation of funds. 

TITLE III—STRENGTHENING PROTECTIONS FOR SOCIAL 

SECURITY BENEFICIARIES ACT OF 2018 

Sec. 300. Short title. 

Subtitle A—Strengthening Oversight and Beneficiary Protection 

Sec. 301. Stronger monitoring of representative payees. 

Sec. 302. Reducing the burden on families. 

Sec. 303. Protecting beneficiaries through information sharing. 

Sec. 304. Clarifying overpayment liability for child in child welfare system. 

Sec. 305. Reports. 

Subtitle B—Improving Payee Selection and Quality 

Sec. 311. Advance designation of representative payees. 

Sec. 312. Prohibition on individuals convicted of certain crimes serving as representative payees. 

Sec. 313. Prohibition on individuals with representative payees serving as representative payees. 

Sec. 314. Reassessment of payee selection and replacement policies. 

1 TITLE I—CHILDREN’S HEALTH 

2 INSURANCE PROGRAM 

3 SEC. 100. SHORT TITLE. 

4 This title may be cited as the ‘‘Keeping Kids’ Insur5 ance Delivery Stable Act’’ or the ‘‘KIDS Act’’. 

6 SEC. 101. PERMANENT EXTENSION OF THE CHILDREN’S 

7 HEALTH INSURANCE PROGRAM. 

8 (a) FUNDING.— 

9 (1) IN GENERAL.—Section 2104(a) of the So10 cial Security Act (42 U.S.C. 1397dd(a)), as amend11 ed by section 3201(a) of the CHIP and Public 


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1 Health Funding Extension Act (division C of Public 

2 Law 115–96), is amended— 

3 (A) in paragraph (20)(B), by striking ‘‘; 

4 and’’ and inserting a semicolon; and 

5 (B) by striking paragraph (21) and insert6 ing the following new paragraphs: 

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

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

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

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

11 ‘‘(25) for fiscal year 2022, $25,900,000,000; 

12 ‘‘(26) for fiscal year 2023, $27,000,000,000; 

13 ‘‘(27) for fiscal year 2024, $28,100,000,000; 

14 ‘‘(28) for fiscal year 2025, $29,200,000,000; 

15 ‘‘(29) for fiscal year 2026, $30,300,000,000; 

16 ‘‘(30) for fiscal year 2027, $31,400,000,000; 

17 and 

18 ‘‘(31) for fiscal year 2028 and each subsequent 

19 fiscal year, the amount provided for the previous fis20 cal year, increased by the product of— 

21 ‘‘(A) 1 plus the percentage increase in the 

22 projected per capita amount of National Health 

23 Expenditures from the calendar year in which 

24 the previous fiscal year ends to the calendar 

25 year in which the fiscal year involved ends, as 


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1 most recently published by the Secretary before 

2 the beginning of the fiscal year; and 

3 ‘‘(B) 1 plus the percentage increase (if 

4 any) in the national population of children from 

5 July 1 in the previous fiscal year to July 1 in 

6 the fiscal year involved, as determined by the 

7 Secretary based on the most recent published 

8 estimates of the Bureau of the Census before 

9 the beginning of the fiscal year involved, plus 1 

10 percentage point.’’. 

11 (2) PREVENTION OF DUPLICATE APPROPRIA12 TIONS FOR FISCAL YEAR 2018.—Notwithstanding any 

13 other provision of law, insofar as funds have been 

14 appropriated under subsection (a)(21) of section 

15 2104 of the Social Security Act (42 U.S.C. 1397dd), 

16 as such subsection is in effect on the day before the 

17 date of the enactment of this Act, to provide allot18 ments to States under the State Children’s Health 

19 Insurance Program established under title XXI of 

20 the Social Security Act (42 U.S.C. 1397aa et seq.) 

21 (whether implemented under title XIX, XXI, or 

22 both, of the Social Security Act) for fiscal year 

23 2018— 

24 (A) any amounts that are so appropriated 

25 that are not so allotted and obligated before the 


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1 date of the enactment of this Act, are re2 scinded; and 

3 (B) any amount provided for CHIP allot4 ments to a State under this section (and the 

5 amendments made by this section) for such fis6 cal year shall be reduced by the amount of such 

7 appropriations so allotted and obligated before 

8 such date. 

9 (b) ALLOTMENTS.—Section 2104(m) of the Social 

10 Security Act (42 U.S.C. 1397dd(m)), as amended by sec11 tion 3201(b) of the CHIP and Public Health Funding Ex12 tension Act (division C of Public Law 115–96), is amend13 ed— 

14 (1) in paragraph (2)(B)— 

15 (A) in the matter preceding clause (i), by 

16 striking ‘‘(19)’’ and inserting ‘‘(31)’’; and 

17 (B) in clause (ii)— 

18 (i) in the matter preceding subclause 

19 (I), by striking ‘‘and paragraph (10)’’; and 

20 (ii) in subclause (I), by inserting ‘‘(or, 

21 in the case of fiscal year 2018, under para22 graph (4))’’ after ‘‘clause (i)’’; 

23 (2) in paragraph (5), by striking ‘‘, 2017, or 

24 2018’’ and inserting ‘‘or 2017’’; 

25 (3) in paragraph (7)— 


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1 (A) in subparagraph (A), by striking ‘‘and 

2 ending with fiscal year 2017’’; 

3 (B) in subparagraph (B), in the matter 

4 preceding clause (i), by inserting ‘‘(or, in the 

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

6 date that is 60 days after the date of the enact7 ment of the KIDS Act)’’ after ‘‘before the Au8 gust 31 preceding the beginning of the fiscal 

9 year’’; and 

10 (C) in the matter following subparagraph 

11 (B), by striking ‘‘or fiscal year 2016’’ and in12 serting ‘‘fiscal year 2016, or any succeeding 

13 even-numbered fiscal year’’; 

14 (4) in paragraph (9), by striking ‘‘, 2017, or 

15 2018’’ and inserting ‘‘or 2017’’; and 

16 (5) by striking paragraph (10). 

17 (c) EXTENSION OF THE CHILD ENROLLMENT CON18 TINGENCY FUND.—Section 2104(n) of the Social Security 

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

20 (1) in paragraph (2)— 

21 (A) in subparagraph (A)(ii), by striking 

22 ‘‘2010, 2011, 2012, 2013, 2014, and 2016’’ 

23 and inserting ‘‘2010 through 2014, 2016, 2018, 

24 and each subsequent fiscal year’’; and 


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1 (B) in subparagraph (B), by striking 

2 ‘‘2010, 2011, 2012, 2013, 2014, and 2016’’ 

3 and inserting ‘‘2010 through 2014, 2016, 2018, 

4 and each subsequent fiscal year’’; and 

5 (2) in paragraph (3)(A), in the matter pre6 ceding clause (i), by striking ‘‘or a semi-annual allot7 ment period for fiscal year 2015 or 2017’’ and in8 serting ‘‘or in fiscal year 2018 or any subsequent 

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

10 fiscal year 2015, or 2017)’’. 

11 (d) EXTENSION OF QUALIFYING STATES OPTION.— 

12 (1) IN GENERAL.—Section 2105(g)(4) of the 

13 Social Security Act (42 U.S.C. 1397ee(g)(4)) is 

14 amended— 

15 (A) in the heading, by striking ‘‘THROUGH

16 2017’’ and inserting ‘‘AND SUBSEQUENT FISCAL

17 YEARS’’; and 

18 (B) in subparagraph (A), by striking ‘‘for 

19 any of fiscal years 2009 through 2017’’ and in20 serting ‘‘for fiscal year 2009 or any subsequent 

21 fiscal year’’. 

22 (2) TECHNICAL AMENDMENTS.—Section 

23 2104(f)(2)(B)(ii) of the Social Security Act (42 

24 U.S.C. 1397dd(f)(2)(B)(ii)), as amended by section 

25 3201(c) of the CHIP and Public Health Funding 


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1 Extension Act (division C of Public Law 115–96), is 

2 amended— 

3 (A) in subclause (I), by striking ‘‘for the 

4 month (as defined in subclause (II))’’ and in5 serting ‘‘(as defined in subclause (II)) for the 

6 month’’; 

7 (B) in subclause (II), by inserting ‘‘, as in 

8 effect on the day before the date of the enact9 ment of the KIDS Act,’’ after ‘‘section 

10 2105(g)(4)(A)’’; and 

11 (C) in subclause (VI)— 

12 (i) by inserting ‘‘, as in effect on the 

13 day before the date of the enactment of the 

14 KIDS Act’’ after ‘‘, section 2105(g)(4)’’; 

15 and 

16 (ii) by inserting ‘‘, as so in effect’’ 

17 after ‘‘under section 2105(g)(4)’’. 

18 (e) EXTENSION OF EXPRESS LANE ELIGIBILITY OP19 TION.—Section 1902(e)(13) of the Social Security Act (42 

20 U.S.C. 1396a(e)(13)) is amended by striking subpara21 graph (I). 

22 (f) ASSURANCE OF AFFORDABILITY STANDARD FOR

23 CHILDREN AND FAMILIES.— 


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

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

3 amended— 

4 (A) in the paragraph heading, by striking 

5 ‘‘UNTIL OCTOBER 1, 2019’’; and 

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

7 preceding clause (i)— 

8 (i) by striking ‘‘During the period 

9 that begins on’’ and inserting ‘‘Beginning 

10 on’’; 

11 (ii) by striking ‘‘and ends on Sep12 tember 30, 2019’’; and 

13 (iii) by striking ‘‘The preceding sen14 tence shall not be construed as preventing 

15 a State during such period’’ and inserting 

16 ‘‘Beginning on October 1, 2019, the pre17 ceding sentence shall only apply with re18 spect to children in families whose income 

19 does not exceed 300 percent of the poverty 

20 line (as defined in section 2110(c)(5)) ap21 plicable to a family of the size involved. 

22 The preceding sentences shall not be con23 strued as preventing a State during any 

24 such periods’’. 


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1 (2) CONFORMING AMENDMENTS.—Section 

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

3 1396a(gg)(2)) is amended— 

4 (A) in the paragraph heading, by striking 

5 ‘‘UNTIL OCTOBER 1, 2019’’; and 

6 (B) by striking ‘‘through September 30, 

7 2019,’’ and inserting ‘‘(but beginning on Octo8 ber 1, 2019, only with respect to children in 

9 families whose income does not exceed 300 per10 cent of the poverty line (as defined in section 

11 2110(c)(5)) applicable to a family of the size in12 volved)’’. 

13 (g) CHIP LOOK-ALIKE PLANS.— 

14 (1) BLENDING RISK POOLS.—Section 2107 of 

15 the Social Security Act (42 U.S.C. 1397gg) is 

16 amended by adding at the end the following: 

17 ‘‘(g) USE OF BLENDED RISK POOLS.— 

18 ‘‘(1) IN GENERAL.—Nothing in this title (or 

19 any other provision of Federal law) shall be con20 strued as preventing a State from considering chil21 dren enrolled in a qualified CHIP look-alike pro22 gram and children enrolled in a State child health 

23 plan under this title (or a waiver of such plan) as 

24 members of a single risk pool. 


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1 ‘‘(2) QUALIFIED CHIP LOOK-ALIKE PROGRAM.— 

2 In this subsection, the term ‘qualified CHIP look3 alike program’ means a State program— 

4 ‘‘(A) under which children who are under 

5 the age of 19 and are not eligible to receive 

6 medical assistance under title XIX or child 

7 health assistance under this title may purchase 

8 coverage through the State that provides bene9 fits that are at least identical to the benefits 

10 provided under the State child health plan 

11 under this title (or a waiver of such plan); and 

12 ‘‘(B) that is funded exclusively through 

13 non-Federal funds, including funds received by 

14 the State in the form of premiums for the pur15 chase of such coverage.’’. 

16 (2) COVERAGE RULE.— 

17 (A) IN GENERAL.—Section 5000A(f)(1) of 

18 the Internal Revenue Code of 1986 is amended 

19 in subparagraph (A)(iii), by inserting ‘‘or under 

20 a qualified CHIP look-alike program (as de21 fined in section 2107(g) of the Social Security 

22 Act)’’ before the comma at the end. 

23 (B) EFFECTIVE DATE.—The amendment 

24 made by subparagraph (A) shall apply with reVerDate Sep 11 2014 03:15 Jan 20, 2018 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4820.IH H4820

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1 spect to taxable years beginning after December 

2 31, 2017. 

3 (h) AVAILABILITY OF UNUSED FISCAL YEAR 2018 

4 REDISTRIBUTION AMOUNTS.—Any amounts that have 

5 been redistributed to States under subsection (f) of section 

6 2104 of the Social Security Act (42 U.S.C. 1397dd) for 

7 fiscal year 2018 that are not, or will not be, expended by 

8 the end of that fiscal year shall be— 

9 (1) adjusted by the Secretary before the end of 

10 fiscal year 2018 to reflect an updated estimate of 

11 shortfalls under subsection (f)(2)(A) of such section; 

12 and 

13 (2) available for redistribution under subsection 

14 (f) of such section for subsequent fiscal years. 

15 SEC. 102. EXTENSION OF CERTAIN PROGRAMS AND DEM16 ONSTRATION PROJECTS. 

17 (a) CHILDHOOD OBESITY DEMONSTRATION

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

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

20 (1) by striking ‘‘and $10,000,000’’ and insert21 ing ‘‘, $10,000,000’’; and 

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

23 and $5,000,000 for fiscal year 2018 and each subse24 quent fiscal year’’. 


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1 (b) PEDIATRIC QUALITY MEASURES PROGRAM.— 

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

3 1320b–9a(i)) is amended— 

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

5 following: 

6 ‘‘(1) IN GENERAL.—Out of any’’; 

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

8 and inserting ‘‘there is appropriated— 

9 ‘‘(A) for each’’; 

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

11 the period’’ and inserting ‘‘; 

12 ‘‘(B) for the period’’; 

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

14 this subsection shall remain available until ex15 pended.’’ and inserting ‘‘; and’’; and 

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

17 ‘‘(C) for fiscal year 2018 and each subse18 quent fiscal year, $15,000,000 for the purpose 

19 of carrying out this section (other than sub20 sections (e), (f), and (g)). 

21 ‘‘(2) AVAILABILITY.—Funds appropriated 

22 under this subsection shall remain available until ex23 pended.’’. 


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1 SEC. 103. EXTENSION OF OUTREACH AND ENROLLMENT 

2 PROGRAM. 

3 (a) IN GENERAL.—Section 2113 of the Social Secu4 rity Act (42 U.S.C. 1397mm) is amended— 

5 (1) in subsection (a)(1), by striking ‘‘during the 

6 period of fiscal years 2009 through 2017’’; and 

7 (2) in subsection (g)— 

8 (A) by striking ‘‘and $40,000,000’’ and in9 serting ‘‘, $40,000,000’’; and 

10 (B) by inserting after ‘‘2017’’ the fol11 lowing: ‘‘, and $20,000,000 for fiscal year 2018 

12 and each subsequent fiscal year’’. 

13 (b) MAKING ORGANIZATIONS THAT USE PARENT

14 MENTORS ELIGIBLE TO RECEIVE GRANTS.—Section 

15 2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) 

16 is amended— 

17 (1) in paragraph (1)(E), by striking ‘‘or com18 munity-based doula programs’’ and inserting ‘‘, com19 munity-based doula programs, or parent mentors’’; 

20 and 

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

22 paragraph: 

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

24 mentor’ means an individual who— 


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

2 one child who is an eligible child under this title 

3 or title XIX; and 

4 ‘‘(B) is trained to assist families with chil5 dren who have no health insurance coverage 

6 with respect to improving the social deter7 minants of the health of such children, includ8 ing by providing— 

9 ‘‘(i) education about health insurance 

10 coverage, including, with respect to obtain11 ing such coverage, eligibility criteria and 

12 application and renewal processes; 

13 ‘‘(ii) assistance with completing and 

14 submitting applications for health insur15 ance coverage; 

16 ‘‘(iii) a liaison between families and 

17 representatives of State plans under title 

18 XIX or State child health plans under this 

19 title; 

20 ‘‘(iv) guidance on identifying medical 

21 and dental homes and community phar22 macies for children; and 

23 ‘‘(v) assistance and referrals to suc24 cessfully address social determinants of 


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1 children’s health, including poverty, food 

2 insufficiency, and housing.’’. 

3 (c) EXCLUSION FROM MODIFIED ADJUSTED GROSS

4 INCOME.—Section 1902(e) of the Social Security Act (42 

5 U.S.C. 1396a(e)) is amended— 

6 (1) in the first paragraph (14), relating to in7 come determined using modified adjusted gross in8 come, by adding at the end the following new sub9 paragraph: 

10 ‘‘(J) EXCLUSION OF PARENT MENTOR

11 COMPENSATION FROM INCOME DETERMINA12 TION.—Any nominal amount received by an in13 dividual as compensation, including a stipend, 

14 for participation as a parent mentor (as defined 

15 in paragraph (5) of section 2113(f)) in an activ16 ity or program funded through a grant under 

17 such section shall be disregarded for purposes 

18 of determining the income eligibility of such in19 dividual for medical assistance under the State 

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

21 (2) by striking ‘‘(14) EXCLUSION’’ and insert22 ing ‘‘(15) EXCLUSION’’. 


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1 SEC. 104. EXTENSION AND REDUCTION OF ADDITIONAL 

2 FEDERAL FINANCIAL PARTICIPATION FOR 

3 CHIP. 

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

5 1397ee(b)) is amended in the second sentence by inserting 

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

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

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

9 of a fiscal year occurring during such period) shall be in10 creased by 11.5 percentage points’’ after ‘‘23 percentage 

11 points,’’. 

12 TITLE II—MEDICARE AND 

13 OTHER HEALTH EXTENDERS 

14 Subtitle A—Medicare Extenders 

15 and Related Policies 

16 SEC. 201. EXTENSION OF WORK GPCI FLOOR. 

17 Section 1848(e)(1)(E) of the Social Security Act (42 

18 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu19 ary 1, 2018’’ and inserting ‘‘January 1, 2020’’. 

20 SEC. 202. PERMANENT REPEAL OF THE THERAPY CAPS. 

21 Section 1833(g) of the Social Security Act (42 U.S.C. 

22 1395l(g)) is amended— 

23 (1) in paragraph (1)— 

24 (A) by striking ‘‘Subject to paragraphs (4) 

25 and (5)’’ and inserting ‘‘(A) Subject to para26 graphs (4) and (5)’’; 


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1 (B) in the subparagraph (A), as inserted 

2 and designated by subparagraph (A) of this 

3 paragraph, by adding at the end the following 

4 new sentence: ‘‘The preceding sentence shall 

5 not apply to expenses incurred with respect to 

6 services furnished after December 31, 2017.’’; 

7 and 

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

9 subparagraph: 

10 ‘‘(B) With respect to services furnished during 2018 

11 or a subsequent year, in the case of physical therapy serv12 ices of the type described in section 1861(p), speech-lan13 guage pathology services of the type described in such sec14 tion through the application of section 1861(ll)(2), and 

15 physical therapy services and speech-language pathology 

16 services of such type which are furnished by a physician 

17 or as incident to physicians’ services, with respect to ex18 penses incurred in any calendar year, any amount that 

19 is more than the amount specified in paragraph (2) for 

20 the year shall not be considered as incurred expenses for 

21 purposes of subsections (a) and (b) unless the applicable 

22 requirements of paragraph (7) are met.’’; 

23 (2) in paragraph (3)— 


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1 (A) by striking ‘‘Subject to paragraphs (4) 

2 and (5)’’ and inserting ‘‘(A) Subject to para3 graphs (4) and (5)’’; 

4 (B) in the subparagraph (A), as inserted 

5 and designated by subparagraph (A) of this 

6 paragraph, by adding at the end the following 

7 new sentence: ‘‘The preceding sentence shall 

8 not apply to expenses incurred with respect to 

9 services furnished after December 31, 2017.’’; 

10 and 

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

12 subparagraph: 

13 ‘‘(B) With respect to services furnished during 2018 

14 or a subsequent year, in the case of occupational therapy 

15 services (of the type that are described in section 1861(p) 

16 through the operation of section 1861(g) and of such type 

17 which are furnished by a physician or as incident to physi18 cians’ services), with respect to expenses incurred in any 

19 calendar year, any amount that is more than the amount 

20 specified in paragraph (2) for the year shall not be consid21 ered as incurred expenses for purposes of subsections (a) 

22 and (b) unless the applicable requirements of paragraph 

23 (7) are met.’’; 

24 (3) in paragraph (5)— 


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1 (A) by redesignating subparagraph (D) as 

2 paragraph (8) and moving such paragraph to 

3 immediately follow paragraph (7), as added by 

4 paragraph (4) of this section; and 

5 (B) in subparagraph (E)(iv), by inserting 

6 ‘‘, except as such process is applied under para7 graph (7)(B)’’ before the period at the end; and 

8 (4) by adding at the end the following new 

9 paragraph: 

10 ‘‘(7) For purposes of paragraphs (1)(B) and (3)(B), 

11 with respect to services described in such paragraphs, the 

12 requirements described in this paragraph are as follows: 

13 ‘‘(A) INCLUSION OF APPROPRIATE MODIFIER.— 

14 The claim for such services contains an appropriate 

15 modifier (such as the KX modifier described in para16 graph (5)(B)) indicating that such services are medi17 cally necessary as justified by appropriate docu18 mentation in the medical record involved. 

19 ‘‘(B) TARGETED MEDICAL REVIEW FOR CER20 TAIN SERVICES ABOVE THRESHOLD.— 

21 ‘‘(i) IN GENERAL.—In the case where ex22 penses that would be incurred for such services 

23 would exceed the threshold described in clause 

24 (ii) for the year, such services shall be subject 


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1 to the process for medical review implemented 

2 under paragraph (5)(E). 

3 ‘‘(ii) THRESHOLD.—The threshold under 

4 this clause for— 

5 ‘‘(I) a year before 2028, is $3,000; 

6 ‘‘(II) 2028, is the amount specified in 

7 subclause (I) increased by the percentage 

8 increase in the MEI (as defined in section 

9 1842(i)(3)) for 2028; and 

10 ‘‘(III) a subsequent year, is the 

11 amount specified in this clause for the pre12 ceding year increased by the percentage in13 crease in the MEI (as defined in section 

14 1842(i)(3)) for such subsequent year, 

15 except that if an increase under subclause (II) 

16 or (III) for a year is not a multiple of $10, it 

17 shall be rounded to the nearest multiple of $10. 

18 ‘‘(iii) APPLICATION.—The threshold under 

19 clause (ii) shall be applied separately— 

20 ‘‘(I) for physical therapy services and 

21 speech-language pathology services; and 

22 ‘‘(II) for occupational therapy serv23 ices. 

24 ‘‘(iv) FUNDING.—For purposes of carrying 

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1 vide for the transfer, from the Federal Supple2 mentary Medical Insurance Trust Fund under 

3 section 1841 to the Centers for Medicare & 

4 Medicaid Services Program Management Ac5 count, of $5,000,000 for each fiscal year begin6 ning with fiscal year 2018, to remain available 

7 until expended. Such funds may not be used by 

8 a contractor under section 1893(h) for medical 

9 reviews under this subparagraph.’’. 

10 SEC. 203. GROUND AMBULANCE SERVICES COST REPORT11 ING REQUIREMENT. 

12 (a) IN GENERAL.—Section 1121 of the Social Secu13 rity Act (42 U.S.C. 1320a) is amended— 

14 (1) in subsection (a)— 

15 (A) by striking ‘‘For the purposes of’’ and 

16 inserting ‘‘Subject to subsection (d), for the 

17 purposes of’’; 

18 (B) by inserting ‘‘suppliers of ground am19 bulance services,’’ after ‘‘health maintenance or20 ganizations,’’; and 

21 (C) in the matter following paragraph (5), 

22 by adding the following new sentence: ‘‘Not 

23 later than December 31, 2019, the Secretary 

24 shall modify the uniform reporting system for 

25 providers of services with respect to ambulance 


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1 services to ensure that such system contains in2 formation similar (as determined by the Sec3 retary) to information required under the uni4 form reporting system for suppliers of ground 

5 ambulance services.’’; and 

6 (2) by adding at the end the following new sub7 section: 

8 ‘‘(d) In the case of a supplier of ground ambulance 

9 services that furnishes such services for fewer than 20 in10 dividuals entitled to benefits under part A of title XVIII 

11 and enrolled under part B of such title in a cost reporting 

12 period (as defined by the Secretary), the Secretary may 

13 modify the requirements for inclusion of any information 

14 specified in subsection (a) in reports made in accordance 

15 with the uniform reporting systems established under this 

16 section with respect to such services.’’. 

17 (b) SUSPENSION OF PAYMENT FOR GROUND AMBU18 LANCE SERVICES; DEEMING CERTAIN PAYMENTS OVER19 PAYMENTS.—Section 1834(l) of the Social Security Act 

20 (42 U.S.C. 1395m(l)) is amended by adding at the end 

21 the following new paragraph: 

22 ‘‘(17) REQUIREMENT TO SUBMIT COST REPORT

23 AND AUTHORITY TO SUSPEND PAYMENTS AND DEEM

24 CERTAIN PAYMENTS OVERPAYMENTS FOR GROUND

25 AMBULANCE SERVICES.— 


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1 ‘‘(A) IN GENERAL.—With respect to 

2 ground ambulance services furnished by a sup3 plier of such services during cost reporting peri4 ods (as defined in subparagraph (I)) beginning 

5 on or after January 1, 2020, such supplier shall 

6 make reports to the Secretary of information 

7 described in section 1121(a) in accordance with 

8 the uniform reporting system established under 

9 such section for such suppliers and, as may be 

10 required by the Secretary, of any of the infor11 mation described in subparagraph (B). 

12 ‘‘(B) ADDITIONAL INFORMATION.—The 

13 Secretary may, with respect to a supplier of 

14 ground ambulance services, require the fol15 lowing information (to be reported to the extent 

16 practicable under the uniform reporting system 

17 established under section 1121(a) for such sup18 pliers): 

19 ‘‘(i) Whether the supplier is part of 

20 an emergency services department, a gov21 ernmental organization, or another type of 

22 entity (as described by the Secretary). 

23 ‘‘(ii) The number of hours in a week 

24 during which the supplier is available for 

25 furnishing ground ambulance services. 


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1 ‘‘(iii) The average number of volun2 teer hours a week used by the supplier. 

3 ‘‘(C) SUSPENSION OF PAYMENT.—Subject 

4 to subparagraph (E), in the case that the Sec5 retary determines that a supplier of ground am6 bulance services has not made to the Secretary 

7 a timely report described in subparagraph (A) 

8 with respect to a cost reporting period begin9 ning on or after January 1, 2020, and before 

10 January 1, 2022, the Secretary may suspend 

11 payments made under this subsection, in whole 

12 or in part, to such supplier until the Secretary 

13 finds that such supplier has made such a re14 port. 

15 ‘‘(D) DEEMING CERTAIN PAYMENTS OVER16 PAYMENTS.—Subject to subparagraphs (E) and 

17 (F), in the case that the Secretary determines 

18 that a supplier of ground ambulance services 

19 has not made to the Secretary a complete, accu20 rate, and timely report described in subpara21 graph (A) with respect to a cost reporting pe22 riod beginning on or after January 1, 2022, the 

23 Secretary may deem payments made under this 

24 subsection to such supplier for such period to 


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1 be overpayments and recoup such overpay2 ments. 

3 ‘‘(E) HARDSHIP DELAY.—The Secretary 

4 shall establish a process whereby a supplier of 

5 ground ambulance services may request a delay 

6 in making a report described in subparagraph 

7 (A) with respect to a cost reporting period for 

8 reason of significant hardship (as determined 

9 by the Secretary). 

10 ‘‘(F) AUTHORITY TO MODIFY COST RE11 PORTING ELEMENTS AND ENFORCEMENT.—Not 

12 earlier than January 1, 2024, the Secretary 

13 may provide that subparagraph (D) no longer 

14 applies to ground ambulance services suppliers 

15 or a category of such suppliers after— 

16 ‘‘(i) taking into account the rec17 ommendation of the Medicare Payment 

18 Advisory Commission in the most recent 

19 report available to the Secretary submitted 

20 under section 204 of the Advancing Sen21 iors and Kids Act regarding whether cost 

22 reports made by suppliers or a category of 

23 suppliers (as specified for purposes of the 

24 report submitted under such section) 

25 should be required or modified; and 


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1 ‘‘(ii) undertaking notice and comment 

2 rulemaking. 

3 ‘‘(G) AUDIT OF COST REPORTS.—The Sec4 retary shall audit reports described in subpara5 graph (A) made with respect to cost reporting 

6 periods beginning on or after January 1, 2021. 

7 ‘‘(H) APPEALS.—The Secretary shall es8 tablish a process whereby a supplier of ground 

9 ambulance services may appeal a determination 

10 described in subparagraph (C) or (D) made 

11 with respect to a cost report required to be 

12 made by such supplier under subparagraph (A). 

13 ‘‘(I) DEFINITION.—In this paragraph, the 

14 term ‘cost reporting period’ means, with respect 

15 to a year, the 12-month period beginning on 

16 January 1 of such year.’’. 

17 (c) STAKEHOLDER FEEDBACK.— 

18 (1) IN GENERAL.—The Secretary of Health and 

19 Human Services shall implement the provisions of 

20 this section, including the amendments made by this 

21 section, through notice and comment rulemaking 

22 and seek input from stakeholders. 

23 (2) NONAPPLICATION OF PAPERWORK REDUC24 TION ACT.—Chapter 35 of title 44, United States 

25 Code, shall not apply with respect to— 


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1 (A) the development and implementation of 

2 the uniform reporting system required under 

3 section 1121(a) of the Social Security Act (42 

4 U.S.C. 1320a(a)) for suppliers of ground ambu5 lance services and reports required to be made 

6 under section 1834(l)(17) of such Act (42 

7 U.S.C. 1395m(l)(17)), as added by subsection 

8 (b) of this section; and 

9 (B) the modification of the uniform report10 ing systems under such section 1121(a) of such 

11 Act for providers of such services and reports 

12 required to be made under section 

13 1861(v)(1)(F) of such Act (42 U.S.C. 

14 1395x(v)(1)(F)). 

15 (d) IMPLEMENTATION RESOURCES.— 

16 (1) IN GENERAL.—There are hereby appro17 priated to the Secretary from the Federal Hospital 

18 Insurance Trust Fund under section 1817 of the So19 cial Security Act (42 U.S.C. 1395i) $8,000,000 and 

20 from the Federal Supplementary Medical Insurance 

21 Trust Fund under section 1841 of such Act (42 

22 U.S.C. 1395t) $92,000,000 (of which not less than 

23 $10,000,000 shall be used to fulfill the auditing re24 quirement under section 1834(l)(17)(G) of such Act, 

25 as added by subsection (b) of this section) to carry 


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1 out the provisions of this section, including the 

2 amendments made by this section, to remain avail3 able through December 31, 2022. 

4 (2) FUNDING FOR EMPLOYEES.—The Secretary 

5 of Health and Human Services shall provide for the 

6 transfer to the Centers for Medicare & Medicaid 

7 Services Program Management Account, from the 

8 Federal Supplementary Medical Insurance Trust 

9 Fund under section 1841 of the Social Security Act 

10 (42 U.S.C. 1395t), of such sums as may be nec11 essary in order to directly hire no more than 2 full12 time employees to carry out the provisions of this 

13 section, including the amendments made by this sec14 tion. 

15 (e) SENSE OF CONGRESS.—It is the sense of Con16 gress that— 

17 (1) a cost report made by a supplier of ground 

18 ambulance services with respect to a cost reporting 

19 period beginning before January 1, 2022, may not 

20 contain complete and accurate information on 

21 ground ambulance services furnished during such a 

22 period by the supplier; and 

23 (2) the Secretary should take into account only 

24 the timeliness of such a report made with respect to 

25 such a period when determining whether to suspend 


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1 payments to a supplier under section 1834(l) of the 

2 Social Security Act (42 U.S.C. 1395m(l)). 

3 SEC. 204. GROUND AMBULANCE SERVICES COST REPORT4 ING STUDY. 

5 (a) IN GENERAL.—Not later than March 15, 2023, 

6 and as determined necessary by the Medicare Payment 

7 Advisory Commission thereafter, such Commission shall 

8 assess and submit to Congress a report on cost reports 

9 carried out in accordance with sections 1121(a) and 

10 1834(l) of the Social Security Act (42 U.S.C. 1320a(a), 

11 1395m(l)), the adequacy of payments for such services 

12 made under section 1834(l) of such Act, and geographic 

13 variations in the cost of providing such services. 

14 (b) CONTENTS.—The report described in subsection 

15 (a) shall contain the following: 

16 (1) An analysis of cost report data submitted in 

17 accordance with such sections. 

18 (2) An analysis of any burden on providers and 

19 suppliers of such services associated with reporting 

20 such data. 

21 (3) A recommendation on whether or not cost 

22 reports of ambulance services made by suppliers or 

23 a category of suppliers (as specified by the Sec24 retary) of such services, or the ground ambulance 

25 portion of cost reports made by providers of such 


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1 services, should be required or modified, taking into 

2 account the analyses described in paragraphs (1) 

3 and (2). 

4 SEC. 205. EXTENSION OF GROUND AMBULANCE SERVICES 

5 EXTENDERS. 

6 Section 1834(l) of the Social Security Act (42 U.S.C. 

7 1395m(l)) is amended— 

8 (1) in paragraph (12)(A), by striking ‘‘2018’’ 

9 and inserting ‘‘2023’’; and 

10 (2) in paragraph (13)(A), by striking ‘‘2018’’ 

11 each place it appears and inserting ‘‘2023’’. 

12 SEC. 206. EXTENSION OF INCREASED INPATIENT HOSPITAL 

13 PAYMENT ADJUSTMENT FOR CERTAIN LOW14 VOLUME HOSPITALS. 

15 Section 1886(d)(12) of the Social Security Act (42 

16 U.S.C. 1395ww(d)(12)) is amended— 

17 (1) in subparagraph (B), in the matter pre18 ceding clause (i), by striking ‘‘and for discharges oc19 curring in fiscal year 2020 and subsequent fiscal 

20 years’’; 

21 (2) in subparagraph (C)(i)— 

22 (A) by striking ‘‘fiscal years 2011 through 

23 2017’’ each place it appears and inserting ‘‘fis24 cal years 2011 through 2019’’; and 


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1 (B) by striking ‘‘or portion of fiscal year’’; 

2 and 

3 (3) in subparagraph (D)— 

4 (A) in the heading, by striking ‘‘TEM5 PORARY APPLICABLE PERCENTAGE INCREASE’’ 

6 and inserting ‘‘APPLICABLE PERCENTAGE IN7 CREASE BEGINNING WITH FISCAL YEAR 2011’’; 

8 (B) by striking ‘‘fiscal years 2011 through 

9 2017,’’ and inserting ‘‘fiscal years 2011 

10 through 2019’’; and 

11 (C) by striking ‘‘or the portion of fiscal 

12 year’’ each place it appears. 

13 SEC. 207. EXTENSION OF THE MEDICARE-DEPENDENT HOS14 PITAL (MDH) PROGRAM. 

15 (a) IN GENERAL.—Section 1886(d)(5)(G) of the So16 cial Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amend17 ed— 

18 (1) in clause (i), by striking ‘‘October 1, 2017’’ 

19 and inserting ‘‘October 1, 2019’’; and 

20 (2) in clause (ii)(II), by striking ‘‘October 1, 

21 2017’’ and inserting ‘‘October 1, 2019’’. 

22 (b) CONFORMING AMENDMENTS.— 

23 (1) EXTENSION OF TARGET AMOUNT.—Section 

24 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 

25 1395ww(b)(3)(D)) is amended— 


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1 (A) in the matter preceding clause (i), by 

2 striking ‘‘October 1, 2017’’ and inserting ‘‘Oc3 tober 1, 2019’’; and 

4 (B) in clause (iv), by striking ‘‘through fis5 cal year 2017’’ and inserting ‘‘through fiscal 

6 year 2019’’. 

7 (2) PERMITTING HOSPITALS TO DECLINE RE8 CLASSIFICATION.—Section 13501(e)(2) of the Omni9 bus Budget Reconciliation Act of 1993 (42 U.S.C. 

10 1395ww note) is amended by striking ‘‘through fis11 cal year 2017’’ and inserting ‘‘through fiscal year 

12 2019’’. 

13 SEC. 208. SPECIALIZED MEDICARE ADVANTAGE PLANS FOR 

14 SPECIAL NEEDS INDIVIDUALS. 

15 (a) PERMANENT EXTENSION.—Section 1859(f)(1) of 

16 the Social Security Act (42 U.S.C. 1395w–28(f)(1)) is 

17 amended by striking ‘‘and for periods before January 1, 

18 2019’’. 

19 (b) INCREASED INTEGRATION OF DUAL SNPS.— 

20 (1) IN GENERAL.—Section 1859(f) of the Social 

21 Security Act (42 U.S.C. 1395w–28(f)) is amended— 

22 (A) in paragraph (3), by adding at the end 

23 the following new subparagraph: 

24 ‘‘(F) The plan meets the requirements ap25 plicable under paragraph (8).’’; and 


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1 (B) by adding at the end the following new 

2 paragraph: 

3 ‘‘(8) INCREASED INTEGRATION OF DUAL

4 SNPS.— 

5 ‘‘(A) DESIGNATED CONTACT.—The Sec6 retary, acting through the Federal Coordinated 

7 Health Care Office established under section 

8 2602 of Public Law 111–148, shall serve as a 

9 dedicated point of contact for States to address 

10 misalignments that arise with the integration of 

11 specialized MA plans for special needs individ12 uals described in subsection (b)(6)(B)(ii) under 

13 this paragraph and, consistent with such role, 

14 shall— 

15 ‘‘(i) establish a uniform process for 

16 disseminating to State Medicaid agencies 

17 information under this title impacting con18 tracts between such agencies and such 

19 plans under this subsection; and 

20 ‘‘(ii) establish basic resources for 

21 States interested in exploring such plans 

22 as a platform for integration, such as a 

23 model contract or other tools to achieve 

24 those goals. 


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1 ‘‘(B) UNIFIED GRIEVANCES AND APPEALS

2 PROCESS.— 

3 ‘‘(i) IN GENERAL.—Not later than 

4 April 1, 2020, the Secretary shall establish 

5 procedures, to the extent feasible as deter6 mined by the Secretary, unifying griev7 ances and appeals procedures under sec8 tions 1852(f), 1852(g), 1902(a)(3), 

9 1902(a)(5), and 1932(b)(4) for items and 

10 services provided by specialized MA plans 

11 for special needs individuals described in 

12 subsection (b)(6)(B)(ii) under this title 

13 and title XIX. The Secretary shall solicit 

14 comment in developing such procedures 

15 from States, plans, beneficiaries and their 

16 representatives, and other relevant stake17 holders. With respect to items and services 

18 described in the previous sentence, appeals 

19 procedures established under this clause 

20 shall apply in place of otherwise applicable 

21 appeals procedures. 

22 ‘‘(ii) PROCEDURES.—The procedures 

23 established under clause (i) shall be in24 cluded in the plan contract under para25 graph (3)(D) and shall— 


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1 ‘‘(I) adopt the provisions for the 

2 enrollee that are most protective for 

3 the enrollee and, to the extent feasible 

4 as determined by the Secretary, are 

5 compatible with unified timeframes 

6 and consolidated access to external re7 view under an integrated process; 

8 ‘‘(II) take into account dif9 ferences in State plans under title 

10 XIX to the extent necessary; 

11 ‘‘(III) be easily navigable by an 

12 enrollee; and 

13 ‘‘(IV) include the elements de14 scribed in clause (iii), as applicable. 

15 ‘‘(iii) ELEMENTS DESCRIBED.—Both 

16 unified appeals and unified grievance pro17 cedures shall include, as applicable, the fol18 lowing elements described in this clause: 

19 ‘‘(I) Single written notification of 

20 all applicable grievances and appeal 

21 rights under this title and title XIX. 

22 For purposes of this subparagraph, 

23 the Secretary may waive the require24 ments under section 1852(g)(1)(B) 

25 when the specialized MA plan covers 


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1 items or services under this part or 

2 under title XIX. 

3 ‘‘(II) Single pathways for resolu4 tion of any grievance or appeal related 

5 to a particular item or service pro6 vided by specialized MA plans for spe7 cial needs individuals described in 

8 subsection (b)(6)(B)(ii) under this 

9 title and title XIX. 

10 ‘‘(III) Notices written in plain 

11 language and available in a language 

12 and format that is accessible to the 

13 enrollee, including in non-English lan14 guages that are prevalent in the serv15 ice area of the specialized MA plan. 

16 ‘‘(IV) Unified timeframes for 

17 grievances and appeals processes, 

18 such as an individual’s filing of a 

19 grievance or appeal, a plan’s acknowl20 edgment and resolution of a grievance 

21 or appeal, and notification of decisions 

22 with respect to a grievance or appeal. 

23 ‘‘(V) Requirements for how the 

24 plan must process, track, and resolve 

25 grievances and appeals, to ensure 


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1 beneficiaries are notified on a timely 

2 basis of decisions that are made 

3 throughout the grievance or appeals 

4 process and are able to easily deter5 mine the status of a grievance or ap6 peal. 

7 ‘‘(iv) CONTINUATION OF BENEFITS

8 PENDING APPEAL.—The unified procedures 

9 under clause (i) shall, with respect to all 

10 benefits under parts A and B and title 

11 XIX subject to appeal under such proce12 dures, incorporate provisions under current 

13 law and implementing regulations that pro14 vide continuation of benefits pending ap15 peal under this title and title XIX. 

16 ‘‘(C) REQUIREMENT FOR UNIFIED GRIEV17 ANCES AND APPEALS.—For 2022 and subse18 quent years, the contract of a specialized MA 

19 plan for special needs individuals described in 

20 subsection (b)(6)(B)(ii) with a State Medicaid 

21 agency under paragraph (3)(D) shall require 

22 the use of unified grievances and appeals proce23 dures as described in subparagraph (B). 

24 ‘‘(D) REQUIREMENTS FOR FULL INTEGRA25 TION FOR CERTAIN DUAL SNPS.— 


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1 ‘‘(i) REQUIREMENT.—For 2021 and 

2 subsequent years, a specialized MA plan 

3 for special needs individuals described in 

4 subsection (b)(6)(B)(ii) shall meet one or 

5 more of the following requirements for in6 tegration of benefits under this title and 

7 title XIX: 

8 ‘‘(I) Meet the requirements of a 

9 fully integrated plan described in sec10 tion 1853(a)(1)(B)(iv)(II) (other than 

11 the requirement that the plan have 

12 similar average levels of frailty, as de13 termined by the Secretary, as the 

14 PACE program). 

15 ‘‘(II) Enter into a capitated con16 tract with the State Medicaid agency 

17 to provide long-term services and sup18 ports or behavioral health services, or 

19 both. 

20 ‘‘(III) To the extent the State 

21 does not allow for or require such a 

22 specialized MA plan to enter into a 

23 capitated contract described in sub24 clause (II), enter into another type of 

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1 mined appropriate by the Secretary 

2 after consultation with stakeholders, 

3 such as by— 

4 ‘‘(aa) entering into a con5 tract with the State that requires 

6 notifying the State in a timely 

7 manner of hospitalizations, emer8 gency room visits, and hospital or 

9 nursing home discharges of en10 rollees or otherwise requires shar11 ing data that would benefit the 

12 coordination of items and serv13 ices under this title and the State 

14 plan under title XIX; or 

15 ‘‘(bb) being offered by a 

16 parent organization that also of17 fers a Medicaid managed care 

18 plan that provides long-term 

19 services and supports or behav20 ioral health services to the same 

21 enrollees as under such special22 ized MA plan. 

23 ‘‘(ii) SANCTIONS.—For 2021 and sub24 sequent years, if the Secretary determines 

25 that a specialized MA plan fails to comply 


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1 with clause (i), the Secretary may provide 

2 for the application against the Medicare 

3 Advantage organization offering the plan 

4 any of the remedies described in section 

5 1857(g)(2).’’. 

6 (2) CONFORMING AMENDMENT TO RESPON7 SIBILITIES OF FEDERAL COORDINATED HEALTH

8 CARE OFFICE.—Section 2602(d) of Public Law 111– 

9 148 (42 U.S.C. 1315b(d)) is amended by adding at 

10 the end the following new paragraphs: 

11 ‘‘(6) To act as a designated contact for States 

12 under subsection (f)(8)(A) of section 1859 of the So13 cial Security Act (42 U.S.C. 1395w–28) with respect 

14 to the integration of specialized MA plans for special 

15 needs individuals described in subsection 

16 (b)(6)(B)(ii) of such section. 

17 ‘‘(7) To be responsible for developing regula18 tions and guidance related to the implementation of 

19 a unified grievance and appeals process as described 

20 in subparagraphs (B) and (C) of section 1859(f)(8) 

21 of the Social Security Act (42 U.S.C. 1395w– 

22 28(f)(8)). 

23 ‘‘(8) To be responsible for developing regula24 tions and guidance related to the integration or 

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1 care program under title XVIII of such Act and 

2 Medicaid program under title XIX of such Act re3 garding specialized MA plans for special needs indi4 viduals described in subsection (b)(6)(B)(ii) of such 

5 section 1859.’’. 

6 (c) IMPROVEMENTS TO SEVERE OR DISABLING

7 CHRONIC CONDITION SNPS.— 

8 (1) CARE MANAGEMENT REQUIREMENTS.—Sec9 tion 1859(f)(5) of the Social Security Act (42 

10 U.S.C. 1395w–28(f)(5)) is amended— 

11 (A) by redesignating subparagraphs (A) 

12 and (B) as clauses (i) and (ii), respectively, and 

13 indenting appropriately; 

14 (B) in clause (ii), as redesignated by sub15 paragraph (B), by redesignating clauses (i) 

16 through (iii) as subclauses (I) through (III), re17 spectively, and indenting appropriately; 

18 (C) by striking ‘‘ALL SNPS.—The require19 ments’’ and inserting ‘‘ALL SNPS.— 

20 ‘‘(A) IN GENERAL.—Subject to subpara21 graph (B), the requirements’’; and 

22 (D) by adding at the end the following new 

23 subparagraph: 

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1 ABLING CHRONIC CONDITION SNPS.—For 2020 

2 and subsequent years, in the case of a special3 ized MA plan for special needs individuals de4 scribed in subsection (b)(6)(B)(iii), the require5 ments described in this paragraph include the 

6 following: 

7 ‘‘(i) The interdisciplinary team under 

8 subparagraph (A)(ii)(III) includes a team 

9 of providers with demonstrated expertise, 

10 including training in an applicable spe11 cialty, in treating individuals similar to the 

12 targeted population of the plan. 

13 ‘‘(ii) Requirements developed by the 

14 Secretary to provide face-to-face encoun15 ters with individuals enrolled in the plan 

16 not less frequently than on an annual 

17 basis. 

18 ‘‘(iii) As part of the model of care 

19 under clause (i) of subparagraph (A), the 

20 results of the initial assessment and an21 nual reassessment under clause (ii)(I) of 

22 such subparagraph of each individual en23 rolled in the plan are addressed in the indi24 vidual’s individualized care plan under 

25 clause (ii)(II) of such subparagraph. 


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1 ‘‘(iv) As part of the annual evaluation 

2 and approval of such model of care, the 

3 Secretary shall take into account whether 

4 the plan fulfilled the previous year’s goals 

5 (as required under the model of care). 

6 ‘‘(v) The Secretary shall establish a 

7 minimum benchmark for each element of 

8 the model of care of a plan. The Secretary 

9 shall only approve a plan’s model of care 

10 under this paragraph if each element of 

11 the model of care meets the minimum 

12 benchmark applicable under the preceding 

13 sentence.’’. 

14 (2) REVISIONS TO THE DEFINITION OF A SE15 VERE OR DISABLING CHRONIC CONDITIONS SPECIAL16 IZED NEEDS INDIVIDUAL.— 

17 (A) IN GENERAL.—Section 

18 1859(b)(6)(B)(iii) of the Social Security Act 

19 (42 U.S.C. 1395w–28(b)(6)(B)(iii)) is amend20 ed— 

21 (i) by striking ‘‘who have’’ and insert22 ing ‘‘who— 

23 ‘‘(I) before January 1, 2022, 

24 have’’; 


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1 (ii) in subclause (I), as added by 

2 clause (i), by striking the period at the end 

3 and inserting ‘‘; and’’; and 

4 (iii) by adding at the end the fol5 lowing new subclause: 

6 ‘‘(II) on or after January 1, 

7 2022, have one or more capitated and 

8 medically complex chronic conditions 

9 that is life threatening or significantly 

10 limits overall health or function, have 

11 a high risk of hospitalization or other 

12 adverse health outcomes, and require 

13 intensive care coordination and that is 

14 listed under subsection (f)(9)(A).’’. 

15 (B) PANEL OF CLINICAL ADVISORS.—Sec16 tion 1859(f) of the Social Security Act (42 

17 U.S.C. 1395w–28(f)), as amended by subsection 

18 (b), is amended by adding at the end the fol19 lowing new paragraph: 

20 ‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION

21 OF THE DEFINITION OF A SEVERE OR DISABLING

22 CHRONIC CONDITIONS SPECIALIZED NEEDS INDI23 VIDUAL.— 

24 ‘‘(A) IN GENERAL.—Not later than De25 cember 31, 2020, and every 5 years thereafter, 


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1 the Secretary shall convene a panel of clinical 

2 advisors to establish and update a list of condi3 tions that meet each of the following criteria: 

4 ‘‘(i) Conditions that meet the defini5 tion of a severe or disabling chronic condi6 tion under subsection (b)(6)(B)(iii) on or 

7 after January 1, 2022. 

8 ‘‘(ii) Conditions that require prescrip9 tion drugs, providers, and models of care 

10 that are unique to the specific population 

11 of enrollees in a specialized MA plan for 

12 special needs individuals described in such 

13 subsection on or after such date and— 

14 ‘‘(I) as a result of such special 

15 needs individuals with such a condi16 tion having access to and being en17 rolled in such a plan, as compared to 

18 access to and enrollment in other 

19 Medicare Advantage plans under this 

20 part, it is projected that such individ21 uals would improve health outcomes 

22 with respect to such condition, that 

23 such individuals would have reduced 

24 overall costs under this title, and that 

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1 penditures under this title for such in2 dividuals; or 

3 ‘‘(II) have a low prevalence in the 

4 general population of beneficiaries 

5 under this title or a disproportionally 

6 high per-beneficiary cost under this 

7 title. 

8 ‘‘(B) GAO STUDY ON HEALTH OUTCOMES

9 OF INDIVIDUALS ENROLLED IN SPECIALIZED

10 MA PLANS.—Not later than the date that is 3 

11 years after the date of the enactment of this 

12 paragraph, the Comptroller General of the 

13 United States shall conduct a study and submit 

14 to Congress a report on the extent to which 

15 health outcomes can be compared across spe16 cialized MA plans for special needs individuals 

17 (as defined in section 1859(b)(6)) and other 

18 Medicare Advantage plans under this part 

19 across similar populations, using existing meas20 ures and that identifies any potential limita21 tions where new measures may need to be de22 veloped for such population.’’. 

23 (d) QUALITY MEASUREMENT AT THE PLAN LEVEL

24 FOR SNPS AND DETERMINATION OF FEASIBILITY OF

25 QUALITY MEASUREMENT AT THE PLAN LEVEL FOR ALL


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1 MA PLANS.—Section 1853(o) of the Social Security Act 

2 (42 U.S.C. 1395w–23(o)) is amended by adding at the end 

3 the following new paragraphs: 

4 ‘‘(6) QUALITY MEASUREMENT AT THE PLAN

5 LEVEL FOR SNPS.— 

6 ‘‘(A) IN GENERAL.—Subject to subpara7 graph (B), the Secretary may require reporting 

8 of data under section 1852(e) for, and apply 

9 under this subsection, quality measures at the 

10 plan level for specialized MA plans for special 

11 needs individuals instead of at the contract 

12 level. 

13 ‘‘(B) CONSIDERATIONS.—Prior to applying 

14 quality measurement at the plan level under 

15 this paragraph, the Secretary shall— 

16 ‘‘(i) take into consideration the min17 imum number of enrollees in a specialized 

18 MA plan for special needs individuals in 

19 order to determine if a statistically signifi20 cant or valid measurement of quality at 

21 the plan level is possible under this para22 graph; 

23 ‘‘(ii) if quality measures are reported 

24 at the plan level, ensure that MA plans are 


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1 not required to provide duplicative infor2 mation; and 

3 ‘‘(iii) ensure that such reporting does 

4 not interfere with the collection of encoun5 ter data submitted by MA organizations or 

6 the administration of any changes to the 

7 program under this part as a result of the 

8 collection of such data. 

9 ‘‘(C) APPLICATION.—If the Secretary ap10 plies quality measurement at the plan level 

11 under this paragraph— 

12 ‘‘(i) such quality measurement may 

13 include Medicare Health Outcomes Survey 

14 (HOS), Healthcare Effectiveness Data and 

15 Information Set (HEDIS), Consumer As16 sessment of Healthcare Providers and Sys17 tems (CAHPS) measures and quality 

18 measures under part D; and 

19 ‘‘(ii) the Secretary shall consider ap20 plying administrative actions, such as rem21 edies described in section 1857(g)(2), to 

22 the plan level. 

23 ‘‘(7) DETERMINATION OF FEASIBILITY OF

24 QUALITY MEASUREMENT AT THE PLAN LEVEL FOR

25 ALL MA PLANS.— 


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1 ‘‘(A) DETERMINATION OF FEASIBILITY.— 

2 The Secretary shall determine the feasibility of 

3 requiring reporting of data under section 

4 1852(e) for, and applying under this subsection, 

5 quality measures at the plan level for all MA 

6 plans under this part. 

7 ‘‘(B) CONSIDERATION OF CHANGE.—After 

8 making a determination under subparagraph 

9 (A), the Secretary shall consider requiring such 

10 reporting and applying such quality measures 

11 at the plan level as described in such subpara12 graph.’’. 

13 (e) GAO STUDY AND REPORT ON STATE-LEVEL IN14 TEGRATION BETWEEN DUAL SNPS AND MEDICAID.— 

15 (1) STUDY.—The Comptroller General of the 

16 United States (in this paragraph referred to as the 

17 ‘‘Comptroller General’’) shall conduct a study on 

18 State-level integration between specialized MA plans 

19 for special needs individuals described in subsection 

20 (b)(6)(B)(ii) of section 1859 of the Social Security 

21 Act (42 U.S.C. 1395w–28) and the Medicaid pro22 gram under title XIX of such Act (42 U.S.C. 1396 

23 et seq.). Such study shall include an analysis of the 

24 following: 


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1 (A) The characteristics of States in which 

2 the State agency responsible for administering 

3 the State plan under such title XIX has a con4 tract with such a specialized MA plan and that 

5 delivers long-term services and supports under 

6 the State plan under such title XIX through a 

7 managed care program, including the require8 ments under such State plan with respect to 

9 long-term services and supports. 

10 (B) The types of such specialized MA 

11 plans, which may include the following: 

12 (i) A plan described in section 

13 1853(a)(1)(B)(iv)(II) of such Act (42 

14 U.S.C. 1395w–23(a)(1)(B)(iv)(II)). 

15 (ii) A plan that meets the require16 ments described in subsection (f)(3)(D) of 

17 such section 1859. 

18 (iii) A plan described in clause (ii) 

19 that also meets additional requirements es20 tablished by the State. 

21 (C) The characteristics of individuals en22 rolled in such specialized MA plans. 

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1 term services and supports under such title 

2 XIX through a managed care program: 

3 (i) Which populations of individuals 

4 are eligible to receive such services and 

5 supports. 

6 (ii) Whether all such services and sup7 ports are provided on a capitated basis or 

8 if any of such services and supports are 

9 carved out and provided through fee-for10 service. 

11 (E) As, practicable, how the availability 

12 and variation of integration arrangements of 

13 such specialized MA plans offered in States af14 fects spending, service delivery options, access 

15 to community-based care, and utilization of 

16 care. 

17 (F) Barriers and opportunities for making 

18 further progress on dual integration, as well as 

19 recommend legislation to expedite or refine 

20 pathways toward fully integrated care. 

21 (2) REPORT.—Not later than 2 years after the 

22 date of the enactment of this Act, the Comptroller 

23 General shall submit to Congress a report containing 

24 the results of the study conducted under paragraph 

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1 tion and administrative action as the Comptroller 

2 General determines appropriate. 

3 SEC. 209. EXPANDING SUPPLEMENTAL BENEFITS TO MEET 

4 THE NEEDS OF CHRONICALLY ILL MEDICARE 

5 ADVANTAGE ENROLLEES. 

6 (a) IN GENERAL.—Section 1852(a)(3) of the Social 

7 Security Act (42 U.S.C. 1395w–22(a)(3)) is amended— 

8 (1) in subparagraph (A), by striking ‘‘Each’’ 

9 and inserting ‘‘Subject to subparagraph (D), each’’; 

10 and 

11 (2) by adding at the end the following new sub12 paragraph: 

13 ‘‘(D) EXPANDING SUPPLEMENTAL BENE14 FITS TO MEET THE NEEDS OF CHRONICALLY

15 ILL ENROLLEES.— 

16 ‘‘(i) IN GENERAL.—For plan year 

17 2020 and subsequent plan years, in addi18 tion to any supplemental health care bene19 fits otherwise provided under this para20 graph, an MA plan, including a specialized 

21 MA plan for special needs individuals de22 scribed in subsection (b)(6) of section 

23 1859, may provide supplemental benefits 

24 described in clause (ii) to a chronically ill 

25 enrollee (as defined in clause (iii)). 


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1 ‘‘(ii) SUPPLEMENTAL BENEFITS DE2 SCRIBED.— 

3 ‘‘(I) IN GENERAL.—Supplemental 

4 benefits described in this clause are 

5 supplemental benefits that, with re6 spect to a chronically ill enrollee, have 

7 a reasonable expectation of improving 

8 or maintaining the health or overall 

9 function of the chronically ill enrollee 

10 and may not be limited to being pri11 marily health related benefits. 

12 ‘‘(II) AUTHORITY TO WAIVE UNI13 FORMITY REQUIREMENTS.—The Sec14 retary may, with respect to supple15 mental benefits provided to a chron16 ically ill enrollee under this subpara17 graph, waive the uniformity require18 ment, as determined appropriate by 

19 the Secretary. 

20 ‘‘(iii) CHRONICALLY ILL ENROLLEE

21 DEFINED.—In this subparagraph, the term 

22 ‘chronically ill enrollee’ means an enrollee 

23 in an MA plan that the Secretary deter24 mines— 


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1 ‘‘(I) has one or more comorbid 

2 and medically complex chronic condi3 tions that is life threatening or signifi4 cantly limits the overall health or 

5 function of the enrollee; 

6 ‘‘(II) has a high risk of hos7 pitalization or other adverse health 

8 outcomes; or 

9 ‘‘(III) requires intensive care co10 ordination.’’. 

11 (b) GAO STUDY AND REPORT.— 

12 (1) STUDY.—The Comptroller General of the 

13 United States (in this subsection referred to as the 

14 ‘‘Comptroller General’’) shall conduct a study on 

15 supplemental benefits provided to enrollees in Medi16 care Advantage plans under part C of title XVIII of 

17 the Social Security Act, including specialized MA 

18 plans for special needs individuals described in sec19 tion 1859(b)(6) of such Act (42 U.S.C. 1395w– 

20 28(b)(6)). Such study shall be conducted in con21 sultation with the Centers for Medicare & Medicaid 

22 Services and Medicare Advantage plans as necessary 

23 and, to the extent data is available, shall include an 

24 analysis of the following: 


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1 (A) The type of supplemental benefits pro2 vided to such enrollees, the total number of en3 rollees receiving each supplemental benefit, and 

4 whether the supplemental benefit is covered by 

5 the standard benchmark cost of the benefit or 

6 with an additional premium. 

7 (B) The frequency in which supplemental 

8 benefits are utilized by such enrollees. 

9 (C) The impact supplemental benefits have 

10 on— 

11 (i) indicators of the quality of care re12 ceived by such enrollees, including overall 

13 health and function of the enrollees; 

14 (ii) the utilization of items and serv15 ices for which benefits are available under 

16 the original Medicare fee-for-service pro17 gram option under parts A and B of such 

18 title XVIII by such enrollees; and 

19 (iii) the amount of the bids submitted 

20 by Medicare Advantage Organizations for 

21 Medicare Advantage plans under such part 

22 C. 

23 (2) REPORT.—Not later than 5 years after the 

24 date of the enactment of this Act, the Comptroller 

25 General shall submit to Congress a report containing 


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1 the results of the study conducted under paragraph 

2 (1), together with recommendations for such legisla3 tion and administrative action as the Comptroller 

4 General determines appropriate. 

5 SEC. 210. EXTENSION OF CONSENSUS-BASED ENTITY FUND6 ING. 

7 Section 1890(d)(2) of the Social Security Act (42 

8 U.S.C. 1395aaa(d)(2)) is amended by striking ‘‘2017’’ 

9 and inserting ‘‘2019’’. 

10 SEC. 211. EXTENSION OF CERTAIN MIPPA FUNDING PROVI11 SIONS. 

12 Section 119 of the Medicare Improvements for Pa13 tients and Providers Act of 2008 (42 U.S.C. 1395b–3 

14 note) is amended— 

15 (1) in subsection (a)(1)(B)— 

16 (A) in clause (vi), by striking ‘‘and’’ at the 

17 end; 

18 (B) in clause (vii), by striking the period 

19 at the end and inserting ‘‘; and’’; and 

20 (C) by inserting after clause (vii) the fol21 lowing new clause: 

22 ‘‘(viii) for each of fiscal years 2018 

23 through 2019, of $13,000,000.’’; 

24 (2) in subsection (b)(1)(B)— 


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1 (A) in clause (vi), by striking ‘‘and’’ at the 

2 end; 

3 (B) in clause (vii), by striking the period 

4 at the end and inserting ‘‘; and’’; and 

5 (C) by inserting after clause (vii) the fol6 lowing new clause: 

7 ‘‘(viii) for each of fiscal years 2018 

8 through 2019, of $7,500,000.’’; 

9 (3) in subsection (c)(1)(B)— 

10 (A) in clause (vi), by striking ‘‘and’’ at the 

11 end; 

12 (B) in clause (vii), by striking the period 

13 at the end and inserting ‘‘; and’’; and 

14 (C) by inserting after clause (vii) the fol15 lowing new clause: 

16 ‘‘(viii) for each of fiscal years 2018 

17 through 2019, of $5,000,000.’’; and 

18 (4) in subsection (d)(2)— 

19 (A) in clause (vi), by striking ‘‘and’’ at the 

20 end; 

21 (B) in clause (vii), by striking the period 

22 at the end and inserting ‘‘; and’’; and 

23 (C) by inserting after clause (vii) the fol24 lowing new clause: 


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1 ‘‘(viii) for each of fiscal years 2018 

2 through 2019, of $12,000,000.’’. 

3 SEC. 212. EXTENSION OF HOME HEALTH RURAL ADD-ON. 

4 Section 421(a) of the Medicare Prescription Drug, 

5 Improvement, and Modernization Act of 2003 (Public Law 

6 108–173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as 

7 amended by section 5201(b) of the Deficit Reduction Act 

8 of 2005 (Public Law 109–171; 120 Stat. 46), section 

9 3131(c) of the Patient Protection and Affordable Care Act 

10 (Public Law 111–148; 124 Stat. 428), and section 210 

11 of the Medicare Access and CHIP Reauthorization Act of 

12 2015 (Public Law 114–10), is further amended by strik13 ing ‘‘January 1, 2018’’ and inserting ‘‘January 1, 2020’’ 

14 each place it appears. 

15 Subtitle B—Medicaid and Public 

16 Health Extenders 

17 SEC. 221. EXTENSION FOR COMMUNITY HEALTH CENTERS 

18 AND THE NATIONAL HEALTH SERVICE 

19 CORPS. 

20 (a) COMMUNITY HEALTH CENTERS FUNDING.—Sec21 tion 10503(b)(1) of the Patient Protection and Affordable 

22 Care Act (42 U.S.C. 254b–2(b)(1)), as amended by sec23 tion 3101 of Public Law 115–96, is amended by amending 

24 subparagraph (F) to read as follows: 


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1 ‘‘(F) $3,600,000,000 for each of fiscal 

2 years 2018 and 2019.’’. 

3 (b) OTHER COMMUNITY HEALTH CENTERS PROVI4 SIONS.—Section 330 of the Public Health Service Act (42 

5 U.S.C. 254b) is amended— 

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

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

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

9 and inserting ‘‘use disorder’’; 

10 (3) in subsection (c)— 

11 (A) in paragraph (1), by striking subpara12 graphs (B) through (D); 

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

14 that follows through ‘‘The Secretary’’ and in15 serting the following: 

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

17 (C) in paragraph (1), as amended, by re18 designating clauses (i) through (v) as subpara19 graphs (A) through (E) and moving the margin 

20 of each of such redesignated subparagraph 2 

21 ems to the left; 

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

23 following: 

24 ‘‘(d) IMPROVING QUALITY OF CARE.— 


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

2 may award supplemental grant funds to health cen3 ters funded under this section to implement evi4 dence-based models for increasing access to high5 quality primary care services, which may include 

6 models related to— 

7 ‘‘(A) improving the delivery of care for in8 dividuals with multiple chronic conditions; 

9 ‘‘(B) workforce configuration; 

10 ‘‘(C) reducing the cost of care; 

11 ‘‘(D) enhancing care coordination; 

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

13 technology-enabled collaborative learning and 

14 capacity building models; 

15 ‘‘(F) care integration, including integration 

16 of behavioral health, mental health, or sub17 stance use disorder services; and 

18 ‘‘(G) addressing emerging public health or 

19 substance use disorder issues to meet the health 

20 needs of the population served by the health 

21 center. 

22 ‘‘(2) SUSTAINABILITY.—In making supple23 mental awards under this subsection, the Secretary 

24 may consider whether the health center involved has 

25 submitted a plan for continuing the activities funded 


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1 under this subsection after supplemental funding is 

2 expended. 

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

4 may give special consideration to applications for 

5 supplemental funding under this subsection that 

6 seek to address significant barriers to access to care 

7 in areas with a greater shortage of health care pro8 viders and health services relative to the national av9 erage.’’; 

10 (5) in subsection (e)(1)— 

11 (A) in subparagraph (B)— 

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

13 ‘‘1 year’’; and 

14 (ii) by adding at the end the fol15 lowing: ‘‘The Secretary shall not make a 

16 grant under this paragraph unless the ap17 plicant provides assurances to the Sec18 retary that within 120 days of receiving 

19 grant funding for the operation of the 

20 health center, the applicant will submit, for 

21 approval by the Secretary, an implementa22 tion plan to meet the requirements of sub23 section (l)(3). The Secretary may extend 

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1 ance upon a demonstration of good cause 

2 by the health center.’’; and 

3 (B) in subparagraph (C)— 

4 (i) in the subparagraph heading, by 

5 striking ‘‘AND PLANS’’; 

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

7 in subparagraphs (B) and (C) of sub8 section (c)(1))’’; 

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

10 the purchase’’ and inserting the following: 

11 ‘‘including— 

12 ‘‘(i) the purchase’’; 

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

14 data and information systems’’ after ‘‘of 

15 equipment’’; 

16 (v) by striking the period at the end 

17 and inserting a semicolon; and 

18 (vi) by adding at the end the fol19 lowing: 

20 ‘‘(ii) the provision of training and 

21 technical assistance; and 

22 ‘‘(iii) other activities that— 

23 ‘‘(I) reduce costs associated with 

24 the provision of health services; 


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1 ‘‘(II) improve access to, and 

2 availability of, health services provided 

3 to individuals served by the centers; 

4 ‘‘(III) enhance the quality and 

5 coordination of health services; or 

6 ‘‘(IV) improve the health status 

7 of communities.’’; 

8 (6) in subsection (e)(5)(B)— 

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

10 striking ‘‘AND PLANS’’; and 

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

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

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

14 health center or to a network’’; 

15 (7) by striking subsection (s); 

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

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

18 (9) by inserting after subsection (f), the fol19 lowing: 

20 ‘‘(g) NEW ACCESS POINTS AND EXPANDED SERV21 ICES.— 

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

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

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1 graph (A) or (B) of subsection (e)(1) to estab2 lish new delivery sites. 

3 ‘‘(B) SPECIAL CONSIDERATION.—In car4 rying out subparagraph (A), the Secretary may 

5 give special consideration to applicants that 

6 have demonstrated the new delivery site will be 

7 located within a sparsely populated area, or an 

8 area which has a level of unmet need that is 

9 higher relative to other applicants. 

10 ‘‘(C) CONSIDERATION OF APPLICATIONS.— 

11 In carrying out subparagraph (A), the Sec12 retary shall approve applications for grants 

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

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

15 medically underserved populations in rural 

16 areas which may be expected to use the services 

17 provided by the applicants involved to the medi18 cally underserved populations in urban areas 

19 which may be expected to use the services pro20 vided by the applicants is not less than two to 

21 three or greater than three to two. 

22 ‘‘(D) SERVICE AREA OVERLAP.—If in car23 rying out subparagraph (A) the applicant pro24 poses to serve an area that is currently served 

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1 tion, the Secretary may consider whether the 

2 award of funding to an additional health center 

3 in the area can be justified based on the unmet 

4 need for additional services within the 

5 catchment area. 

6 ‘‘(2) APPROVAL OF EXPANDED SERVICE APPLI7 CATIONS.— 

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

9 approve applications for grants under subpara10 graph (A) or (B) of subsection (e)(1) to expand 

11 the capacity of the applicant to provide required 

12 primary health services described in subsection 

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

14 subsection (b)(2). 

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

16 carrying out subparagraph (A), the Secretary 

17 may give special consideration to expanded 

18 service applications that seek to address emerg19 ing public health or behavioral health, mental 

20 health, or substance abuse issues through in21 creasing the availability of additional health 

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

23 area in which there are significant barriers to 

24 accessing care. 


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1 ‘‘(C) CONSIDERATION OF APPLICATIONS.— 

2 In carrying out subparagraph (A), the Sec3 retary shall approve applications for applicants 

4 in such a manner that the ratio of the medically 

5 underserved populations in rural areas which 

6 may be expected to use the services provided by 

7 the applicants involved to the medically under8 served populations in urban areas which may be 

9 expected to use the services provided by such 

10 applicants is not less than two to three or 

11 greater than three to two.’’; 

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

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

14 children and youth at risk of homelessness’’ and 

15 inserting ‘‘, children and youth at risk of home16 lessness, homeless veterans, and veterans at 

17 risk of homelessness’’; and 

18 (B) in paragraph (5)— 

19 (i) by striking subparagraph (B); 

20 (ii) by redesignating subparagraph 

21 (C) as subparagraph (B); and 

22 (iii) in subparagraph (B) (as so redes23 ignated)— 


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1 (I) in the subparagraph heading, 

2 by striking ‘‘ABUSE’’ and inserting 

3 ‘‘USE DISORDER’’; and 

4 (II) by striking ‘‘abuse’’ and in5 serting ‘‘use disorder’’; 

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

7 (A) in paragraph (2)— 

8 (i) in the paragraph heading, by in9 serting ‘‘UNMET’’ before ‘‘NEED’’; 

10 (ii) in the matter preceding subpara11 graph (A), by inserting ‘‘and an applica12 tion for a grant under subsection (g)’’ 

13 after ‘‘subsection (e)(1)’’; 

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

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

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

17 ‘‘and’’ at the end; 

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

19 the period at the end and inserting ‘‘; 

20 and’’; and 

21 (vi) by adding after subparagraph (C) 

22 the following: 

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

24 grant pursuant to subsection (g)(1), a dem25 onstration that the applicant has consulted with 


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1 appropriate State and local government agen2 cies, and health care providers regarding the 

3 need for the health services to be provided at 

4 the proposed delivery site.’’; 

5 (B) in paragraph (3)— 

6 (i) in the matter preceding subpara7 graph (A), by inserting ‘‘or subsection (g)’’ 

8 after ‘‘subsection (e)(1)(B)’’; 

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

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

11 inserting ‘‘, including other health care 

12 providers that provide care within the 

13 catchment area, local hospitals, and spe14 cialty providers in the catchment area of 

15 the center, to provide access to services not 

16 available through the health center and to 

17 reduce the non-urgent use of hospital 

18 emergency departments’’; 

19 (iii) in subparagraph (H)(ii), by in20 serting ‘‘who shall be directly employed by 

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

22 a director for the center’’; 

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

24 ‘‘and’’ at the end; 


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

2 the period and inserting ‘‘; and’’; and 

3 (vi) by inserting after subparagraph 

4 (M), the following: 

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

6 procedures in place to ensure the appropriate 

7 use of Federal funds in compliance with appli8 cable Federal statutes, regulations, and the 

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

10 and 

11 (C) by striking paragraph (4); 

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

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

14 carry out activities under this subsection and oper15 ational support activities under subsection (n) shall 

16 not exceed 3 percent of the amount appropriated for 

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

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

19 striking ‘‘grants for new health centers under sub20 sections (c) and (e)’’ and inserting ‘‘operating grants 

21 under subsection (e), applications for new access 

22 points and expanded service pursuant to subsection 

23 (g)’’; 

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

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1 vided by the Secretary under this paragraph may 

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

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

4 receive more than one waiver under this paragraph 

5 in consecutive years.’’; 

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

7 (A) by striking ‘‘appropriate committees of 

8 Congress a report concerning the distribution of 

9 funds under this section’’ and inserting the fol10 lowing: ‘‘Committee on Health, Education, 

11 Labor, and Pensions of the Senate, and the 

12 Committee on Energy and Commerce of the 

13 House of Representatives, a report including, at 

14 a minimum— 

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

16 out this section’’; 

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

18 shall include an assessment’’ and inserting the 

19 following: ‘‘populations; 

20 ‘‘(B) an assessment’’; 

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

22 substantial changes in the distribution of 

23 funds.’’ and inserting a semicolon; and 

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


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1 ‘‘(C) the distribution of awards and fund2 ing for new or expanded services in each of 

3 rural areas and urban areas; 

4 ‘‘(D) the distribution of awards and fund5 ing for establishing new access points, and the 

6 number of new access points created; 

7 ‘‘(E) the amount of unexpended funding 

8 for loan guarantees and loan guarantee author9 ity under title XVI; 

10 ‘‘(F) the rationale for any substantial 

11 changes in the distribution of funds; 

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

13 and access points; 

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

15 grants awarded pursuant to subsection 

16 (e)(1)(B); and 

17 ‘‘(I) the number and reason for any waiv18 ers provided pursuant to subsection (r)(4).’’; 

19 and 

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

21 adding at the end the following new paragraph: 

22 ‘‘(5) FUNDING FOR PARTICIPATION OF HEALTH

23 CENTERS IN ALL OF US RESEARCH PROGRAM.—In 

24 addition to any amounts made available pursuant to 

25 subsection (d) of this section, paragraph (1) of this 


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1 subsection, section 402A of this Act, or section 

2 10503 of the Patient Protection and Affordable Care 

3 Act, there is authorized to be appropriated, and 

4 there is appropriated, out of any monies in the 

5 Treasury not otherwise appropriated, to the Sec6 retary $25,000,000 for fiscal year 2018 to support 

7 the participation of health centers in the All of Us 

8 Research Program under the Precision Medicine Ini9 tiative under section 498E of this Act.’’. 

10 (c) NATIONAL HEALTH SERVICE CORPS.—Section 

11 10503(b)(2) of the Patient Protection and Affordable 

12 Care Act (42 U.S.C. 254b–2(b)(2)), as amended by sec13 tion 3101 of Public Law 115–96, is amended by amending 

14 subparagraph (F) to read as follows: 

15 ‘‘(F) $310,000,000 for each of fiscal years 

16 2018 and 2019.’’. 

17 SEC. 222. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 

18 (a) SPECIAL DIABETES PROGRAM FOR TYPE I DIA19 BETES.—Subparagraph (D) of section 330B(b)(2) of the 

20 Public Health Service Act (42 U.S.C. 254c–2(b)(2)), as 

21 amended by section 3102 of Public Law 115–96, is 

22 amended to read as follows: 

23 ‘‘(D) $150,000,000 for each of fiscal years 

24 2018 and 2019.’’. 


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1 (b) SPECIAL DIABETES PROGRAM FOR INDIANS.— 

2 Subparagraph (D) of section 330C(c)(2) of the Public 

3 Health Service Act (42 U.S.C. 254c–3(c)(2)), as amended 

4 by section 3102 of Public Law 115–96, is amended to read 

5 as follows: 

6 ‘‘(D) $150,000,000 for each of fiscal years 

7 2018 and 2019.’’. 

8 SEC. 223. REAUTHORIZATION OF PROGRAM OF PAYMENTS 

9 TO TEACHING HEALTH CENTERS THAT OPER10 ATE GRADUATE MEDICAL EDUCATION PRO11 GRAMS. 

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

13 the Public Health Service Act (42 U.S.C. 256h) is amend14 ed to read as follows: 

15 ‘‘(a) PAYMENTS.— 

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

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

18 this section for direct expenses and indirect expenses 

19 to qualified teaching health centers that are listed as 

20 sponsoring institutions by the relevant accrediting 

21 body for, as appropriate— 

22 ‘‘(A) maintenance of filled positions at ex23 isting approved graduate medical residency 

24 training programs; 


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1 ‘‘(B) expansion of existing approved grad2 uate medical residency training programs; and 

3 ‘‘(C) establishment of new approved grad4 uate medical residency training programs. 

5 ‘‘(2) PER RESIDENT AMOUNT.—In making pay6 ments under paragraph (1), the Secretary shall con7 sider the cost of training residents at teaching 

8 health centers and the implications of the per resi9 dent amount on approved graduate medical resi10 dency training programs at teaching health centers. 

11 ‘‘(3) PRIORITY.—In making payments under 

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

13 qualified teaching health centers that— 

14 ‘‘(A) serve a health professional shortage 

15 area with a designation in effect under section 

16 332 or a medically underserved community (as 

17 defined in section 799B); or 

18 ‘‘(B) are located in a rural area (as de19 fined in section 1886(d)(2)(D) of the Social Se20 curity Act).’’. 

21 (b) FUNDING.—Paragraph (1) of section 340H(g) of 

22 the Public Health Service Act (42 U.S.C. 256h(g)), as 

23 amended by section 3101 of Public Law 115–96, is 

24 amended by striking ‘‘and $30,000,000 for the period of 

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1 serting ‘‘and $126,500,000 for each of fiscal years 2018 

2 and 2019’’. 

3 (c) ANNUAL REPORTING.—Subsection (h)(1) of sec4 tion 340H of the Public Health Service Act (42 U.S.C. 

5 256h) is amended— 

6 (1) by redesignating subparagraph (D) as sub7 paragraph (H); and 

8 (2) by inserting after subparagraph (C) the fol9 lowing: 

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

11 residents described in paragraph (4). 

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

13 treated by residents described in paragraph (4). 

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

15 in paragraph (4) who completed their residency 

16 training at the end of such residency academic 

17 year, the number and percentage of such resi18 dents entering primary care practice (meaning 

19 any of the areas of practice listed in the defini20 tion of a primary care residency program in 

21 section 749A). 

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

23 in paragraph (4) who completed their residency 

24 training at the end of such residency academic 

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1 dents who entered practice at a health care fa2 cility— 

3 ‘‘(i) primarily serving a health profes4 sional shortage area with a designation in 

5 effect under section 332 or a medically un6 derserved community (as defined in section 

7 799B); or 

8 ‘‘(ii) located in a rural area (as de9 fined in section 1886(d)(2)(D) of the So10 cial Security Act).’’. 

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

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

13 Services shall submit to the Congress a report on the di14 rect graduate expenses of approved graduate medical resi15 dency training programs, and the indirect expenses associ16 ated with the additional costs of teaching residents, of 

17 qualified teaching health centers (as such terms are used 

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

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

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

21 the Public Health Service Act (42 U.S.C. 256h) is amend22 ed— 

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

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


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1 (2) by inserting after paragraph (1) the fol2 lowing: 

3 ‘‘(2) NEW APPROVED GRADUATE MEDICAL

4 RESIDENCY TRAINING PROGRAM.—The term ‘new 

5 approved graduate medical residency training pro6 gram’ means an approved graduate medical resi7 dency training program for which the sponsoring 

8 qualified teaching health center has not received a 

9 payment under this section for a previous fiscal year 

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

11 (f) TECHNICAL CORRECTION.—Subsection (f) of sec12 tion 340H (42 U.S.C. 256h) is amended by striking ‘‘hos13 pital’’ each place it appears and inserting ‘‘teaching health 

14 center’’. 

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

16 provisions of section 340H of the Public Health Service 

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

18 date of enactment of Public Law 115–96, shall continue 

19 to apply with respect to payments under such section for 

20 fiscal years before fiscal year 2018. 

21 SEC. 224. EXTENSION FOR FAMILY-TO-FAMILY HEALTH IN22 FORMATION CENTERS. 

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

24 701(c)) is amended— 

25 (1) in paragraph (1)(A)— 


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

2 end; 

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

4 the end and inserting ‘‘; and’’; and 

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

6 clause: 

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

8 and 2019.’’; 

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

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

11 years 2018 and 2019, such centers shall also be de12 veloped in all territories and at least one such center 

13 shall be developed for Indian tribes’’; and 

14 (3) by amending paragraph (5) to read as fol15 lows: 

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

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

18 given such term in section 4 of the Indian Health 

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

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

21 States and the District of Columbia; and 

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

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

24 Northern Mariana Islands.’’. 


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1 SEC. 225. EXTENSION OF ABSTINENCE EDUCATION; EXTEN2 SION OF PERSONAL RESPONSIBILITY EDU3 CATION PROGRAM. 

4 (a) ABSTINENCE EDUCATION.—Section 510 of the 

5 Social Security Act (42 U.S.C. 710) is amended— 

6 (1) in subsection (a), in the matter preceding 

7 paragraph (1), by striking ‘‘2017’’ and inserting 

8 ‘‘2019’’; and 

9 (2) in subsection (d)— 

10 (A) by striking ‘‘2015 and’’ and inserting 

11 ‘‘2015,’’; and 

12 (B) by inserting after ‘‘2017’’ the fol13 lowing: ‘‘, and an additional $75,000,000 for 

14 each of fiscal years 2018 through 2019’’. 

15 (b) PERSONAL RESPONSIBILITY EDUCATION.— 

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

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

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

19 ‘‘2017’’ and inserting ‘‘2019’’; 

20 (B) in subsection (a)(4)— 

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

22 ‘‘2017’’ each place it appears and inserting 

23 ‘‘2019’’; and 

24 (ii) in subparagraph (B)— 

25 (I) in the subparagraph heading, 

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1 serting ‘‘COMPETITIVE PREP

2 GRANTS’’; and 

3 (II) in clause (i), by striking ‘‘so4 licit applications to award 3-year 

5 grants in each of fiscal years 2012 

6 through 2017’’ and inserting ‘‘con7 tinue through fiscal year 2019 grants 

8 awarded for any of fiscal years 2015 

9 through 2017’’; 

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

11 ‘‘youth with HIV/AIDS,’’ the following: ‘‘vic12 tims of human trafficking,’’; and 

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

14 and inserting ‘‘2019’’. 

15 (2) EFFECTIVE DATE.—The amendments made 

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

17 SEC. 226. EXTENSION OF HEALTH WORKFORCE DEM18 ONSTRATION PROJECTS FOR LOW-INCOME 

19 INDIVIDUALS. 

20 Section 2008(c)(1) of the Social Security Act (42 

21 U.S.C. 1397g(c)(1)) is amended by striking ‘‘2017’’ and 

22 inserting ‘‘2019’’. 


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1 SEC. 227. DELAY OF REDUCTION TO MEDICAID DSH ALLOT2 MENTS. 

3 Section 1923(f) of the Social Security Act (42 U.S.C. 

4 1396r–4(f)(7)) is amended— 

5 (1) in paragraph (7)(A)— 

6 (A) in clause (i), in the matter preceding 

7 subclause (I), by striking ‘‘2018 through 2025’’ 

8 and inserting ‘‘2020 through 2027’’; and 

9 (B) by amending clause (ii) to read as fol10 lows: 

11 ‘‘(I) $2,000,000,000 for fiscal 

12 year 2020; 

13 ‘‘(II) $3,000,000,000 for fiscal 

14 year 2021; 

15 ‘‘(III) $4,000,000,000 for fiscal 

16 year 2022; 

17 ‘‘(IV) $5,000,000,000 for fiscal 

18 year 2023; 

19 ‘‘(V) $6,000,000,000 for fiscal 

20 year 2024; 

21 ‘‘(VI) $7,000,000,000 for fiscal 

22 year 2025; 

23 ‘‘(VII) $8,000,000,000 for fiscal 

24 year 2026; and 

25 ‘‘(VIII) $8,000,000,000 for fiscal 

26 year 2027.’’; and 


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1 (2) in paragraph (8), by striking ‘‘2025’’ and 

2 inserting ‘‘2027’’. 

3 SEC. 228. DELAY OF BIPARTISAN BUDGET ACT OF 2013 

4 THIRD-PARTY LIABILITY PROVISIONS. 

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

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

7 42 U.S.C. 1396a note), as amended by section 211 of the 

8 Protecting Access to Medicare Act of 2014 (Public Law 

9 113–93; 128 Stat. 1047; 42 U.S.C. 1396a note) and sec10 tion 220 of the Medicare Access and CHIP Reauthoriza11 tion Act of 2015 (Public Law 114–10), is amended by 

12 striking ‘‘2017’’ and inserting ‘‘2022’’. 

13 (b) EFFECTIVE DATE; TREATMENT.—The amend14 ment made by subsection (a) shall take effect on Sep15 tember 30, 2017, and shall apply with respect to claims 

16 pending, generated, or filed after such date. 

17 Subtitle C—Continuing the Mater18 nal, Infant, and Early Childhood 

19 Home Visiting Program 

20 SEC. 231. CONTINUING EVIDENCE-BASED HOME VISITING 

21 PROGRAM. 

22 Section 511(j)(1)(H) of the Social Security Act (42 

23 U.S.C. 711(j)(1)(H)) is amended by striking ‘‘fiscal year 

24 2017’’ and inserting ‘‘each of fiscal years 2017 through 

25 2022’’. 


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1 SEC. 232. CONTINUING TO DEMONSTRATE RESULTS TO 

2 HELP FAMILIES. 

3 (a) REQUIRE SERVICE DELIVERY MODELS TO DEM4 ONSTRATE IMPROVEMENT IN APPLICABLE BENCHMARK

5 AREAS.—Section 511 of the Social Security Act (42 

6 U.S.C. 711) is amended in each of subsections (d)(1)(A) 

7 and (h)(4)(A) by striking ‘‘each of’’. 

8 (b) DEMONSTRATION OF IMPROVEMENTS IN SUBSE9 QUENT YEARS.—Section 511(d)(1) of such Act (42 U.S.C. 

10 711(d)(1)) is amended by adding at the end the following: 

11 ‘‘(D) DEMONSTRATION OF IMPROVEMENTS

12 IN SUBSEQUENT YEARS.— 

13 ‘‘(i) CONTINUED MEASUREMENT OF

14 IMPROVEMENT IN APPLICABLE BENCH15 MARK AREAS.—The eligible entity, after 

16 demonstrating improvements for eligible 

17 families as specified in subparagraphs (A) 

18 and (B), shall continue to track and re19 port, not later than 30 days after the end 

20 of fiscal year 2020 and every 3 years 

21 thereafter, information demonstrating that 

22 the program results in improvements for 

23 the eligible families participating in the 

24 program in at least 4 of the areas specified 

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1 ery model or models selected by the entity 

2 are intended to improve. 

3 ‘‘(ii) CORRECTIVE ACTION PLAN.—If 

4 the eligible entity fails to demonstrate im5 provement in at least 4 of the areas speci6 fied in subparagraph (A), as compared to 

7 eligible families who do not receive services 

8 under an early childhood home visitation 

9 program, the entity shall develop and im10 plement a plan to improve outcomes in 

11 each of the areas specified in subparagraph 

12 (A) that the service delivery model or mod13 els selected by the entity are intended to 

14 improve, subject to approval by the Sec15 retary. The plan shall include provisions 

16 for the Secretary to monitor implementa17 tion of the plan and conduct continued 

18 oversight of the program, including 

19 through submission by the entity of reg20 ular reports to the Secretary. 

21 ‘‘(iii) TECHNICAL ASSISTANCE.—The 

22 Secretary shall provide an eligible entity 

23 required to develop and implement an im24 provement plan under clause (ii) with tech25 nical assistance to develop and implement 


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1 the plan. The Secretary may provide the 

2 technical assistance directly or through 

3 grants, contracts, or cooperative agree4 ments. 

5 ‘‘(iv) NO IMPROVEMENT OR FAILURE

6 TO SUBMIT REPORT.—If the Secretary de7 termines after a period of time specified by 

8 the Secretary that an eligible entity imple9 menting an improvement plan under clause 

10 (ii) has failed to demonstrate any improve11 ment in at least 4 of the areas specified in 

12 subparagraph (A), or if the Secretary de13 termines that an eligible entity has failed 

14 to submit the report required by clause (i), 

15 the Secretary shall terminate the grant 

16 made to the entity under this section and 

17 may include any unexpended grant funds 

18 in grants made to nonprofit organizations 

19 under subsection (h)(2)(B).’’. 

20 (c) INCLUDING INFORMATION ON APPLICABLE

21 BENCHMARKS IN APPLICATION.—Section 511(e)(5) of 

22 such Act (42 U.S.C. 711(e)(5)) is amended by inserting 

23 ‘‘that the service delivery model or models selected by the 

24 entity are intended to improve’’ before the period at the 

25 end. 


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1 SEC. 233. REVIEWING STATEWIDE NEEDS TO TARGET RE2 SOURCES. 

3 Section 511(b)(1) of the Social Security Act (42 

4 U.S.C. 711(b)(1)) is amended by striking ‘‘Not later 

5 than’’ and all that follows through ‘‘section 505(a))’’ and 

6 inserting ‘‘Each State shall, as a condition of receiving 

7 payments from an allotment for the State under section 

8 502, conduct a statewide needs assessment (which may be 

9 separate from but in coordination with the statewide needs 

10 assessment required under section 505(a) and which shall 

11 be reviewed and updated by the State not later than Octo12 ber 1, 2020)’’. 

13 SEC. 234. IMPROVING THE LIKELIHOOD OF SUCCESS IN 

14 HIGH-RISK COMMUNITIES. 

15 Section 511(d)(4)(A) of the Social Security Act (42 

16 U.S.C. 711(d)(4)(A)) is amended by inserting ‘‘, taking 

17 into account the staffing, community resource, and other 

18 requirements to operate at least one approved model of 

19 home visiting and demonstrate improvements for eligible 

20 families’’ before the period. 

21 SEC. 235. OPTION TO FUND EVIDENCE-BASED HOME VIS22 ITING ON A PAY FOR OUTCOME BASIS. 

23 (a) IN GENERAL.—Section 511(c) of the Social Secu24 rity Act (42 U.S.C. 711(c)) is amended by redesignating 

25 paragraphs (3) and (4) as paragraphs (4) and (5), respec26 tively, and by inserting after paragraph (2) the following: 


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1 ‘‘(3) AUTHORITY TO USE GRANT FOR A PAY

2 FOR OUTCOMES INITIATIVE.—An eligible entity to 

3 which a grant is made under paragraph (1) may use 

4 up to 25 percent of the grant for outcomes or suc5 cess payments related to a pay for outcomes initia6 tive that will not result in a reduction of funding for 

7 services delivered by the entity under a childhood 

8 home visitation program under this section while the 

9 eligible entity develops or operates such an initia10 tive.’’. 

11 (b) DEFINITION OF PAY FOR OUTCOMES INITIA12 TIVE.—Section 511(k) of such Act (42 U.S.C. 711(k)) is 

13 amended by adding at the end the following: 

14 ‘‘(4) PAY FOR OUTCOMES INITIATIVE.—The 

15 term ‘pay for outcomes initiative’ means a perform16 ance-based grant, contract, cooperative agreement, 

17 or other agreement awarded by a public entity in 

18 which a commitment is made to pay for improved 

19 outcomes achieved as a result of the intervention 

20 that result in social benefit and direct cost savings 

21 or cost avoidance to the public sector. Such an ini22 tiative shall include— 

23 ‘‘(A) a feasibility study that describes how 

24 the proposed intervention is based on evidence 

25 of effectiveness; 


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1 ‘‘(B) a rigorous, third-party evaluation 

2 that uses experimental or quasi-experimental 

3 design or other research methodologies that 

4 allow for the strongest possible causal infer5 ences to determine whether the initiative has 

6 met its proposed outcomes as a result of the 

7 intervention; 

8 ‘‘(C) an annual, publicly available report 

9 on the progress of the initiative; and 

10 ‘‘(D) a requirement that payments are 

11 made to the recipient of a grant, contract, or 

12 cooperative agreement only when agreed upon 

13 outcomes are achieved, except that this require14 ment shall not apply with respect to payments 

15 to a third party conducting the evaluation de16 scribed in subparagraph (B).’’. 

17 (c) EXTENDED AVAILABILITY OF FUNDS.—Section 

18 511(j)(3) of such Act (42 U.S.C. 711(j)(3)) is amended— 

19 (1) by striking ‘‘(3) AVAILABILITY.—Funds’’ 

20 and inserting the following: 

21 ‘‘(3) AVAILABILITY.— 

22 ‘‘(A) IN GENERAL.—Except as provided in 

23 subparagraph (B), funds’’; and 

24 (2) by adding at the end the following: 


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1 ‘‘(B) FUNDS FOR PAY FOR OUTCOMES INI2 TIATIVES.—Funds made available to an eligible 

3 entity under this section for a fiscal year (or 

4 portion of a fiscal year) for a pay for outcomes 

5 initiative shall remain available for expenditure 

6 by the eligible entity for not more than 10 years 

7 after the funds are so made available.’’. 

8 SEC. 236. DATA EXCHANGE STANDARDS FOR IMPROVED 

9 INTEROPERABILITY. 

10 (a) IN GENERAL.—Section 511(h) of the Social Secu11 rity Act (42 U.S.C. 711(h)) is amended by adding at the 

12 end the following: 

13 ‘‘(5) DATA EXCHANGE STANDARDS FOR IM14 PROVED INTEROPERABILITY.— 

15 ‘‘(A) DESIGNATION AND USE OF DATA EX16 CHANGE STANDARDS.— 

17 ‘‘(i) DESIGNATION.—The head of the 

18 department or agency responsible for ad19 ministering a program funded under this 

20 section shall, in consultation with an inter21 agency work group established by the Of22 fice of Management and Budget and con23 sidering State government perspectives, 

24 designate data exchange standards for nec25 essary categories of information that a 


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1 State agency operating the program is re2 quired to electronically exchange with an3 other State agency under applicable Fed4 eral law. 

5 ‘‘(ii) DATA EXCHANGE STANDARDS

6 MUST BE NONPROPRIETARY AND INTER7 OPERABLE.—The data exchange standards 

8 designated under clause (i) shall, to the ex9 tent practicable, be nonproprietary and 

10 interoperable. 

11 ‘‘(iii) OTHER REQUIREMENTS.—In 

12 designating data exchange standards under 

13 this paragraph, the Secretary shall, to the 

14 extent practicable, incorporate— 

15 ‘‘(I) interoperable standards de16 veloped and maintained by an inter17 national voluntary consensus stand18 ards body, as defined by the Office of 

19 Management and Budget; 

20 ‘‘(II) interoperable standards de21 veloped and maintained by intergov22 ernmental partnerships, such as the 

23 National Information Exchange 

24 Model; and 


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1 ‘‘(III) interoperable standards 

2 developed and maintained by Federal 

3 entities with authority over con4 tracting and financial assistance. 

5 ‘‘(B) DATA EXCHANGE STANDARDS FOR

6 FEDERAL REPORTING.— 

7 ‘‘(i) DESIGNATION.—The head of the 

8 department or agency responsible for ad9 ministering a program referred to in this 

10 section shall, in consultation with an inter11 agency work group established by the Of12 fice of Management and Budget, and con13 sidering State government perspectives, 

14 designate data exchange standards to gov15 ern Federal reporting and exchange re16 quirements under applicable Federal law. 

17 ‘‘(ii) REQUIREMENTS.—The data ex18 change reporting standards required by 

19 clause (i) shall, to the extent practicable— 

20 ‘‘(I) incorporate a widely accept21 ed, nonproprietary, searchable, com22 puter-readable format; 

23 ‘‘(II) be consistent with and im24 plement applicable accounting prin25 ciples; 


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1 ‘‘(III) be implemented in a man2 ner that is cost-effective and improves 

3 program efficiency and effectiveness; 

4 and 

5 ‘‘(IV) be capable of being contin6 ually upgraded as necessary. 

7 ‘‘(iii) INCORPORATION OF NONPROPRI8 ETARY STANDARDS.—In designating data 

9 exchange standards under this paragraph, 

10 the Secretary shall, to the extent prac11 ticable, incorporate existing nonproprietary 

12 standards, such as the eXtensible Mark up 

13 Language. 

14 ‘‘(iv) RULE OF CONSTRUCTION.— 

15 Nothing in this paragraph shall be con16 strued to require a change to existing data 

17 exchange standards for Federal reporting 

18 about a program referred to in this sec19 tion, if the head of the department or 

20 agency responsible for administering the 

21 program finds the standards to be effective 

22 and efficient.’’. 

23 (b) EFFECTIVE DATE.—The amendment made by 

24 subsection (a) shall take effect on the date that is 2 years 

25 after the date of enactment of this Act. 


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1 SEC. 237. ALLOCATION OF FUNDS. 

2 Section 511(j) of the Social Security Act (42 U.S.C. 

3 711(j)) is amended by adding at the end the following: 

4 ‘‘(4) ALLOCATION OF FUNDS.—To the extent 

5 that the grant amount awarded under this section to 

6 an eligible entity is determined on the basis of rel7 ative population or poverty considerations, the Sec8 retary shall make the determination using the most 

9 accurate Federal data available for the eligible enti10 ty.’’. 

11 TITLE III—STRENGTHENING 

12 PROTECTIONS FOR SOCIAL 

13 SECURITY BENEFICIARIES 

14 ACT OF 2018 

15 SEC. 300. SHORT TITLE. 

16 This title may be cited as the ‘‘Strengthening Protec17 tions for Social Security Beneficiaries Act of 2018’’. 

18 Subtitle A—Strengthening Over19 sight and Beneficiary Protec20 tion 

21 SEC. 301. STRONGER MONITORING OF REPRESENTATIVE 

22 PAYEES. 

23 (a) PROTECTION AND ADVOCACY FOR BENE24 FICIARIES WITH REPRESENTATIVE PAYEES.—Section 

25 205(j)(6) of the Social Security Act (42 U.S.C. 405(j)(6)) 

26 is amended by adding at the end the following: 


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1 ‘‘(C)(i) The Commissioner of Social Security shall 

2 make annual grants directly to the protection and advo3 cacy system serving each of the States and the American 

4 Indian consortium for the purpose of conducting reviews 

5 of representative payees in accordance with this subpara6 graph. The total amount used by the Commissioner for 

7 such grants each year— 

8 ‘‘(I) shall be an amount sufficient, as deter9 mined by the Commissioner in consultation with 

10 each of the protection and advocacy systems, to 

11 carry out all of the activities described in clause (ii); 

12 and 

13 ‘‘(II) shall not be less than $25,000,000. 

14 ‘‘(ii) A protection and advocacy system awarded a 

15 grant under this subparagraph shall use the grant funds 

16 to— 

17 ‘‘(I) conduct all periodic onsite reviews pursu18 ant to this paragraph and such other reviews of rep19 resentative payees as the Commissioner may request, 

20 including reviews conducted in response to allega21 tions or concerns about the performance or suit22 ability of the payee; 

23 ‘‘(II) conduct additional reviews that the pro24 tection and advocacy system has reason to believe 

25 are warranted; 


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1 ‘‘(III) develop corrective action plans to assist 

2 representative payees in conforming to requirements 

3 specified by the Commissioner; 

4 ‘‘(IV) submit a report to the Commissioner on 

5 each completed review containing such information 

6 as the Commissioner shall require; and 

7 ‘‘(V) conduct an initial onsite assessment of any 

8 organization that begins collecting a fee for its serv9 ices as a representative payee to ensure that such 

10 organization is established as such a representative 

11 payee in accordance with requirements specified by 

12 the Commissioner. 

13 A protection and advocacy system may refer beneficiaries 

14 to other programs or services as the protection and advo15 cacy system considers appropriate. 

16 ‘‘(iii) To be eligible to receive grants under this sec17 tion, a protection and advocacy system shall submit an 

18 initial application to the Commissioner at such time, in 

19 such form and manner, and accompanied by such informa20 tion and assurances as the Commissioner may require. 

21 ‘‘(iv)(I) Subject to subclause (II), the Commissioner 

22 shall ensure that any funds used for grants under clause 

23 (i) shall be allocated to the protection and advocacy sys24 tems serving each of the States and the American Indian 

25 consortium in a manner such that the amount provided 


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1 to each protection and advocacy system bears the same 

2 ratio to the total of such funds as the number of rep3 resented beneficiaries in the State or American Indian 

4 consortium in which such protection and advocacy system 

5 is located bears to the total number of represented bene6 ficiaries. 

7 ‘‘(II) The amount of an annual grant to a protection 

8 and advocacy system under clause (i) shall— 

9 ‘‘(aa) in the case of a protection and advocacy 

10 system serving American Samoa, Guam, the United 

11 States Virgin Islands, or the Commonwealth of the 

12 Northern Mariana Islands, or the American Indian 

13 consortium, not be less than $30,000; and 

14 ‘‘(bb) in the case of a protection and advocacy 

15 system serving any other State, not be less than 

16 $60,000. 

17 ‘‘(III) Funds provided to a protection and advocacy 

18 system through a grant under clause (i) for a one-year 

19 period shall remain available through the end of the fol20 lowing one-year period. 

21 ‘‘(IV) For purposes of this clause, the term ‘rep22 resented beneficiary’ means an individual— 

23 ‘‘(aa) who is entitled to benefits under this title, 

24 title VIII, or title XVI; and 


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1 ‘‘(bb) whose benefits have been certified for 

2 payment to a representative payee. 

3 ‘‘(v)(I) The Commissioner shall make annual grants, 

4 in an amount equal to 4 percent of the total amount of 

5 grants awarded each year under clause (i), to an eligible 

6 national association for the provision of training and tech7 nical assistance, administrative support, and data collec8 tion services to protection and advocacy systems in con9 nection with grants awarded under clause (i). 

10 ‘‘(II) In this clause, the term ‘eligible national asso11 ciation’ means a national disability association with exten12 sive knowledge and demonstrated experience in providing 

13 training, technical assistance, and administrative oversight 

14 to protection and advocacy systems that monitor rep15 resentative payees. 

16 ‘‘(vi) In conducting reviews under this section, a pro17 tection and advocacy system shall have the same authori18 ties, including access to records, facilities, and persons, as 

19 such system would have for purposes of providing services 

20 under subtitle C of title I of the Developmental Disabilities 

21 Assistance and Bill of Rights Act of 2000 (42 U.S.C. 

22 15041 et seq.). 

23 ‘‘(vii) Whenever benefit amounts under this title are 

24 increased by any percentage effective with any month after 

25 November 2018 as a result of a determination made under 


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1 section 215(i), each of the dollar amounts specified in 

2 clauses (i)(II) and (iv)(II) shall be increased by the same 

3 percentage. 

4 ‘‘(viii) No additional funds are authorized to be ap5 propriated to carry out the requirements of this subpara6 graph. Such requirements shall be carried out using 

7 amounts otherwise authorized. 

8 ‘‘(ix) In this subparagraph: 

9 ‘‘(I) The term ‘American Indian consortium’ 

10 means a consortium established under subtitle C of 

11 title I of the Developmental Disabilities Assistance 

12 and Bill of Rights Act of 2000 (42 U.S.C. 15041 et 

13 seq.). 

14 ‘‘(II) The term ‘protection and advocacy sys15 tem’ means a protection and advocacy system estab16 lished under subtitle C of title I of the Develop17 mental Disabilities Assistance and Bill of Rights Act 

18 of 2000 (42 U.S.C. 15041 et seq.). 

19 ‘‘(III) The term ‘State’ means the several 

20 States of the United States, the District of Colum21 bia, the Commonwealth of Puerto Rico, the United 

22 States Virgin Islands, Guam, American Samoa, and 

23 the Commonwealth of the Northern Mariana Is24 lands.’’. 


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1 (b) EXPANSION OF PERIODIC ONSITE REVIEW RE2 QUIREMENTS.—Section 205(j)(6)(A) of the Social Secu3 rity Act (42 U.S.C. 405(j)(6)(A)) is amended— 

4 (1) in clause (ii), by striking ‘‘or’’; 

5 (2) in clause (iii), by striking the period and in6 serting ‘‘; or’’; 

7 (3) by adding after clause (iii) the following: 

8 ‘‘(iv) the representative payee collects a fee for 

9 its services.’’; and 

10 (4) by adding after clause (iv) (as added by 

11 paragraph (3)) the following flush text: 

12 ‘‘The Commissioner shall also conduct periodic onsite re13 views of individual and organizational payees, including 

14 payees who are related to the beneficiary and primarily 

15 reside in the same household, selected on the basis of risk16 factors for potential misuse or unsuitability associated 

17 with such payees or beneficiaries.’’. 

18 (c) AVAILABILITY OF GRANT FUNDS.— 

19 (1) PROTECTION AND ADVOCACY SYSTEM

20 GRANTS.—Grants described under clause (i) of sub21 paragraph (C) of section 205(j)(6) of the Social Se22 curity Act (as added by subsection (a)) shall be 

23 awarded on August 1, 2018, and annually there24 after, and funds provided by such grants to a protec25 tion and advocacy system may be used to reimburse 


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1 the protection and advocacy system for amounts ex2 pended by the protection and advocacy system dur3 ing the period beginning on May 1, 2018, and end4 ing on such date for hiring and start-up costs in 

5 preparation to carry out reviews of representative 

6 payees in accordance with such subparagraph. 

7 (2) NATIONAL ASSOCIATION GRANTS.—Grants 

8 described under clause (v) of such subparagraph 

9 shall be awarded on May 1, 2018, and annually 

10 thereafter. 

11 SEC. 302. REDUCING THE BURDEN ON FAMILIES. 

12 (a) TITLE II.—Section 205(j)(3) of the Social Secu13 rity Act (42 U.S.C. 405(j)(3)) is amended— 

14 (1) by redesignating subparagraphs (D) 

15 through (G) as subparagraphs (E) through (H), re16 spectively; 

17 (2) by inserting after subparagraph (C) the fol18 lowing: 

19 ‘‘(D)(i) Subparagraph (A) shall not apply 

20 in any case where the other person to whom 

21 such payment is made is— 

22 ‘‘(I) a parent, or other individual who 

23 is a legal guardian of, a minor child enti24 tled to such payment who primarily resides 

25 in the same household; 


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1 ‘‘(II) a parent of an individual entitled 

2 to such payment who is under a disability 

3 (as defined in section 223(d)) who pri4 marily resides in the same household; or 

5 ‘‘(III) the spouse of the individual en6 titled to such payment. 

7 ‘‘(ii) The Commissioner of Social Security 

8 shall establish and implement procedures as 

9 necessary for the Commissioner to determine 

10 the eligibility of such parties for the exemption 

11 provided in clause (i). The Commissioner shall 

12 prescribe such regulations as may be necessary 

13 to determine eligibility for such exemption.’’; 

14 (3) in subparagraph (E) (as so redesignated), 

15 by striking ‘‘and (C)’’ and inserting ‘‘(C), and (D)’’; 

16 and 

17 (4) in subparagraph (F) (as so redesignated), 

18 by striking ‘‘(D)’’ each place it appears and insert19 ing ‘‘(E)’’. 

20 (b) TITLE VIII.—Section 807(h) of the Social Secu21 rity Act (42 U.S.C. 1007(h)) is amended— 

22 (1) by redesignating paragraphs (3) through 

23 (5) as paragraphs (4) through (6), respectively; and 

24 (2) by inserting after paragraph (2) the fol25 lowing: 


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1 ‘‘(3)(A) Paragraph (1) shall not apply in any 

2 case where the other person to whom such payment 

3 is made is the spouse of the individual entitled to 

4 such payment. 

5 ‘‘(B) The Commissioner of Social Security shall 

6 establish and implement procedures as necessary for 

7 the Commissioner to determine the eligibility of such 

8 parties for the exemption provided in subparagraph 

9 (A). The Commissioner shall prescribe such regula10 tions as may be necessary to determine eligibility for 

11 such exemption.’’. 

12 (c) TITLE XVI.—Section 1631(a)(2)(C) of the Social 

13 Security Act (42 U.S.C. 1383(a)(2)(C)) is amended— 

14 (1) by redesignating clauses (iv) and (v) as 

15 clauses (v) and (vi), respectively; 

16 (2) by inserting after clause (iii) the following: 

17 ‘‘(iv)(I) Clause (i) shall not apply in any case 

18 where the representative payee is— 

19 ‘‘(aa) a parent, or other individual who is 

20 a legal guardian of, a minor child entitled to 

21 such payment who primarily resides in the same 

22 household; 

23 ‘‘(bb) a parent of an individual entitled to 

24 such payment who is under a disability who pri25 marily resides in the same household; or 


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1 ‘‘(cc) the spouse of the individual entitled 

2 to such payment. 

3 ‘‘(II) The Commissioner of Social Security shall 

4 establish and implement procedures as necessary for 

5 the Commissioner to determine the eligibility of such 

6 parties for the exemption provided in subclause (I). 

7 The Commissioner shall prescribe such regulations 

8 as may be necessary to determine eligibility for such 

9 exemption.’’; 

10 (3) in clause (v) (as so redesignated), by strik11 ing ‘‘and (iii)’’ and inserting ‘‘(iii), and (iv)’’; and 

12 (4) in clause (vi) (as so redesignated), by strik13 ing ‘‘(iv)’’ each time it appears and inserting ‘‘(v)’’. 

14 (d) EFFECTIVE DATE.—The amendments made by 

15 this section shall take effect on the date of the enactment 

16 of this Act. 

17 SEC. 303. PROTECTING BENEFICIARIES THROUGH INFOR18 MATION SHARING. 

19 (a) INFORMATION SHARING TO DETERMINE STATE

20 FOSTER CARE STATUS.— 

21 (1) IN GENERAL.—Section 205(j) of the Social 

22 Security Act (42 U.S.C. 405(j)) is amended by add23 ing at the end the following: 

24 ‘‘(11)(A) The Commissioner of Social Security 

25 shall— 


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1 ‘‘(i) enter into agreements with each State with 

2 a plan approved under part E of title IV for the pur3 pose of sharing and matching data, on an automated 

4 monthly basis, in the system of records of the Social 

5 Security Administration with each Statewide and 

6 Tribal Automated Child Welfare Information System 

7 to identify represented minor beneficiaries who are 

8 in foster care under the responsibility of the State 

9 for such month; and 

10 ‘‘(ii) in any case in which a represented minor 

11 beneficiary has entered or exited foster care or 

12 changed foster care placement in such month, rede13 termine the appropriate representative payee for 

14 such individual. 

15 ‘‘(B) For purposes of this paragraph— 

16 ‘‘(i) the term ‘State’ has the meaning given 

17 such term for purposes of part E of title IV; 

18 ‘‘(ii) the term ‘Statewide and Tribal Automated 

19 Child Welfare Information System’ means a state20 wide mechanized data collection and information re21 trieval system described in section 474(a)(3)(C); and 

22 ‘‘(iii) the term ‘represented minor beneficiary’, 

23 with respect to an individual for a month, means a 

24 child (as defined for purposes of section 475(8)) en25 titled to benefits under this title for such month 


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1 whose benefits are certified for payment to a rep2 resentative payee.’’. 

3 (2) CONFORMING CHANGE.—Section 

4 471(a)(8)(A) of the Social Security Act (42 U.S.C. 

5 671(a)(8)(A)) is amended by inserting ‘‘the program 

6 established by title II,’’ after ‘‘XX,’’. 

7 (3) GAO STUDY AND REPORT.— 

8 (A) EVALUATION.—As soon as possible 

9 after the date of the enactment of this Act, the 

10 Comptroller General shall evaluate— 

11 (i) the number of represented minor 

12 beneficiaries in foster care under the re13 sponsibility of a State for each month dur14 ing the previous year; 

15 (ii) whether the representative payee 

16 for each represented minor beneficiary is— 

17 (I) a governmental child welfare 

18 agency; 

19 (II) an organizational payee that 

20 is not a governmental child welfare 

21 agency; 

22 (III) a foster parent or child-care 

23 institution (within the meaning of 

24 part E of title IV); or 

25 (IV) another individual; and 


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1 (iii) whether funds were conserved, 

2 used for direct expenses of the minor bene3 ficiary, or used to reimburse the State for 

4 foster care maintenance costs. 

5 (B) REPORT TO CONGRESS.—Not later 

6 than 36 months after the date of enactment of 

7 this Act, the Comptroller General shall submit 

8 to Congress a report on the results of the eval9 uation required under subparagraph (A). 

10 (C) DEFINITIONS.—For purposes of this 

11 paragraph— 

12 (i) the term ‘‘State’’ has the meaning 

13 given such term for purposes of part E of 

14 title IV of the Social Security Act; and 

15 (ii) the term ‘‘represented minor bene16 ficiary’’, with respect to an individual for a 

17 month, means a child (as defined for pur18 poses of section 475(8) of the Social Secu19 rity Act) entitled to benefits under title II 

20 of such Act for such month whose benefits 

21 are certified for payment to a representa22 tive payee. 

23 (4) EFFECTIVE DATE.— 

24 (A) IN GENERAL.—The amendments made 

25 by this subsection shall apply with respect to 


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1 months beginning on or after the date that is 

2 1 year after the date of the enactment of this 

3 Act. 

4 (B) EXCEPTION IF STATE LEGISLATION

5 REQUIRED.—In the case of a State plan under 

6 part E of title IV of the Social Security Act 

7 that the Secretary of Health and Human Serv8 ices determines requires State legislation (other 

9 than legislation appropriating funds) in order 

10 for the plan to meet the additional requirement 

11 imposed by the amendments made under this 

12 subsection, such plan shall not be regarded as 

13 failing to comply with the requirements of such 

14 title solely on the basis of its failure to meet 

15 this additional requirement before the first day 

16 of the first calendar quarter beginning after the 

17 close of the first regular session of the State 

18 legislature that begins after the date of the en19 actment of this Act. For purposes of the pre20 vious sentence, in the case of a State that has 

21 a 2-year legislative session, each year of such 

22 session shall be deemed to be a separate regular 

23 session of the State legislature. 

24 (b) IMPROVING COORDINATION WITH ADULT PRO25 TECTIVE SERVICES.— 


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1 (1) IN GENERAL.—The Commissioner of Social 

2 Security shall study and test the administrative fea3 sibility of improving information sharing, in partner4 ship with State agencies that provide adult protec5 tive services, with respect to— 

6 (A) the assessment of an individual’s need 

7 for a representative payee in connection with 

8 benefits to which the individual is entitled 

9 under title II or title XVI of the Social Security 

10 Act; and 

11 (B) oversight of individuals and organiza12 tions serving as representative payees. 

13 (2) REPORT.—Not later than June 30, 2022, 

14 the Commissioner of Social Security shall conclude 

15 the study described in paragraph (1) and submit to 

16 the Committee on Ways and Means of the House of 

17 Representatives and the Committee on Finance of 

18 the Senate a report on the results of such study. 

19 (c) STUDY ON POTENTIAL TO COORDINATE WITH

20 STATE COURTS.— 

21 (1) IN GENERAL.—The Commissioner of Social 

22 Security shall enter into an agreement with the Ad23 ministrative Conference of the United States to con24 duct a study that includes— 


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1 (A) an overview of potential opportunities 

2 for information sharing between the Social Se3 curity Administration and State courts and rel4 evant State agencies; 

5 (B) a detailed analysis of the barriers to 

6 such information sharing, including any Federal 

7 or State statutory barriers; 

8 (C) a description of how such information 

9 sharing would be implemented, including any 

10 additional infrastructure needed; and 

11 (D) a description of any risks or other fac12 tors that the Social Security Administration 

13 and the Congress should consider before imple14 menting such information sharing. 

15 (2) REPORT.—Not later than June 30, 2020, 

16 the Commissioner of Social Security shall submit to 

17 the Committee on Ways and Means of the House of 

18 Representatives and the Committee on Finance of 

19 the Senate and make publicly available a report on 

20 the results of the study conducted under paragraph 

21 (1). 


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1 SEC. 304. CLARIFYING OVERPAYMENT LIABILITY FOR 

2 CHILD IN CHILD WELFARE SYSTEM. 

3 (a) AMENDMENT TO TITLE II.—Section 204(a) of 

4 the Social Security Act (42 U.S.C. 404(a)) is amended 

5 by adding at the end the following: 

6 ‘‘(3)(A) When any payment of more than the correct 

7 amount is made on behalf of an individual who is a rep8 resented minor beneficiary for a month in which such indi9 vidual is in foster care under the responsibility of a State 

10 and the State is the representative payee of such indi11 vidual, the State shall be liable for the repayment of the 

12 overpayment, and there shall be no adjustment of pay13 ments to, or recovery by the United States from, such in14 dividual. 

15 ‘‘(B) For purposes of this paragraph, the term ‘rep16 resented minor beneficiary’ has the meaning given such 

17 term in subsection (j)(11)(B)(iii).’’. 

18 (b) AMENDMENT TO TITLE XVI.—Section 1631(b) 

19 of the Social Security Act (42 U.S.C. 1683(b)) is amend20 ed— 

21 (1) by redesignating paragraphs (3) through 

22 (7) as paragraphs (4) through (8), respectively; and 

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

25 ‘‘(3)(A) When any payment of more than the correct 

26 amount is made on behalf of an individual who is a repVerDate Sep 11 2014 03:15 Jan 20, 2018 Jkt 079200 PO 00000 Frm 00112 Fmt 6652 Sfmt 6201 E:\BILLS\H4820.IH H4820

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1 resented minor beneficiary for a month in which such indi2 vidual is in foster care under the responsibility of a State 

3 and the State is the representative payee of such indi4 vidual, the State shall be liable for the repayment of the 

5 overpayment, and there shall be no adjustment of pay6 ments to, or recovery by the United States from, such in7 dividual. 

8 ‘‘(B) For purposes of this paragraph, the term ‘rep9 resented minor beneficiary’, with respect to an individual 

10 for a month, means a child (as defined for purposes of 

11 section 475(8)) entitled to benefits under this title for 

12 such month whose benefits are certified for payment to 

13 a representative payee.’’. 

14 (c) EFFECTIVE DATE.—The amendment made by 

15 subsection (a) shall apply with respect to overpayment de16 terminations made on or after the date of the enactment 

17 of this Act and to any other overpaid amounts that have 

18 not been recovered as of such date. 

19 SEC. 305. REPORTS. 

20 (a) REPORT ON BENEFITS MISUSED.—Section 

21 205(j) of the Social Security Act (42 U.S.C. 405(j)), as 

22 amended by section 303(a), is further amended— 

23 (1) in paragraph (6)— 

24 (A) by striking ‘‘(A) In addition to’’ and 

25 inserting ‘‘In addition to’’; and 


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1 (B) by striking subparagraph (B); and 

2 (2) by adding at the end the following: 

3 ‘‘(12)(A) Not later than January 31 of each fiscal 

4 year, the Commissioner shall submit to the Committee on 

5 Ways and Means of the House of Representatives and the 

6 Committee on Finance of the Senate a report on the total 

7 number of individuals entitled to benefits under titles II, 

8 VIII, and XVI, respectively (and the number of individuals 

9 concurrently entitled to benefits under more than one such 

10 title), who have a representative payee, the total number 

11 of such representative payees, and the results of all re12 views of representative payees conducted during the pre13 vious fiscal year in connection with benefits under this 

14 title, title VIII, or title XVI. Such report shall summarize 

15 problems identified in such reviews and corrective actions 

16 taken or planned to be taken to correct such problems, 

17 and shall include— 

18 ‘‘(i) the number of such reviews; 

19 ‘‘(ii) the results of such reviews; 

20 ‘‘(iii) the number of cases in which the rep21 resentative payee was changed and why; 

22 ‘‘(iv) the number of reviews conducted in re23 sponse to allegations or concerns about the perform24 ance or suitability of the payee; 


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1 ‘‘(v) the number of cases discovered in which 

2 there was a misuse of funds, and the total dollar 

3 amount of benefits determined by the Commissioner 

4 during such fiscal year to have been misused by a 

5 representative payee (regardless of the fiscal year in 

6 which such misuse occurred); 

7 ‘‘(vi) the number of cases discovered in which 

8 such misuse of funds resulted from the negligent 

9 failure of the Commissioner to investigate or mon10 itor a representative payee; 

11 ‘‘(vii) the final disposition of such cases of mis12 use of funds, including— 

13 ‘‘(I) any criminal, civil, and administrative 

14 penalties imposed; 

15 ‘‘(II) the total dollar amount of misused 

16 benefits repaid to beneficiaries and alternative 

17 representative payees under each of— 

18 ‘‘(aa) paragraph (5) (on the basis of 

19 a negligent failure of the Commissioner de20 scribed in such paragraph); 

21 ‘‘(bb) paragraph (5) (on any other 

22 basis); and 

23 ‘‘(cc) paragraph (7); and 

24 ‘‘(III) the total dollar amount of misused 

25 benefits recovered under each of— 


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1 ‘‘(aa) paragraph (5); and 

2 ‘‘(bb) paragraph (7); 

3 ‘‘(viii) any updates to prior year reports nec4 essary to reflect subsequent recoveries and repay5 ments pertaining to misuse determinations made in 

6 prior years; and 

7 ‘‘(ix) such other information as the Commis8 sioner deems appropriate. 

9 ‘‘(B) Each report required under this paragraph for 

10 a fiscal year shall include the information described in 

11 clauses (i) through (ix) of subparagraph (A) with respect 

12 to— 

13 ‘‘(i) all representative payees reviewed during 

14 such fiscal year; 

15 ‘‘(ii) all such representative payees that are or16 ganizations, separated by whether such organization 

17 collects a fee for its services as a representative 

18 payee; 

19 ‘‘(iii) all such representative payees that are in20 dividuals serving 15 or more individuals; and 

21 ‘‘(iv) all such representative payees that are in22 dividuals serving less than 15 individuals, separated 

23 by whether such representative payee is a family 

24 member.’’. 


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1 (b) REPORT ON ELIMINATION OF THE ACCOUNTING

2 FORM.—The Commissioner shall— 

3 (1) conduct a study on the changes made by the 

4 amendments made by section 102 of the Strength5 ening Protections for Social Security Beneficiaries 

6 Act of 2018, which shall include the impact of such 

7 changes on families, beneficiaries, and the operations 

8 of the Social Security Administration; and 

9 (2) not later than January 1, 2021, submit a 

10 report on the results of such study to the Committee 

11 on Ways and Means of the House of Representatives 

12 and the Committee on Finance of the Senate. 

13 (c) REPORT ON THE ADVANCED DESIGNATION POL14 ICY.—The Commissioner shall— 

15 (1) conduct a study on the changes made by the 

16 amendments made by section 201 of the Strength17 ening Protections for Social Security Beneficiaries 

18 Act of 2018, which shall include the impact of such 

19 changes on beneficiaries and the operations of the 

20 Social Security Administration; and 

21 (2) not later than January 1, 2025, submit a 

22 report on the results of such study to the Committee 

23 on Ways and Means of the House of Representatives 

24 and the Committee on Finance of the Senate. 


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1 Subtitle B—Improving Payee 

2 Selection and Quality 

3 SEC. 311. ADVANCE DESIGNATION OF REPRESENTATIVE 

4 PAYEES. 

5 (a) IN GENERAL.—Section 205(j)(1) of the Social Se6 curity Act (42 U.S.C. 405(j)(1)) is amended by adding 

7 at the end the following: 

8 ‘‘(C)(i) An individual who is entitled to or is an appli9 cant for a benefit under this title, title VIII, or title XVI, 

10 who has attained 18 years of age or is an emancipated 

11 minor, may, at any time, designate one or more other indi12 viduals to serve as a representative payee for such indi13 vidual in the event that the Commissioner of Social Secu14 rity determines under subparagraph (A) that the interest 

15 of such individual would be served by certification for pay16 ment of such benefits to which the individual is entitled 

17 to a representative payee. If the Commissioner of Social 

18 Security makes such a determination with respect to such 

19 individual at any time after such designation has been 

20 made, the Commissioner shall— 

21 ‘‘(I) certify payment of such benefits to the des22 ignated individual, subject to the requirements of 

23 paragraph (2); or 

24 ‘‘(II) if the Commissioner determines that cer25 tification for payment of such benefits to the desVerDate Sep 11 2014 03:15 Jan 20, 2018 Jkt 079200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6201 E:\BILLS\H4820.IH H4820

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1 ignated individual would not satisfy the require2 ments of paragraph (2), that the designated indi3 vidual is unwilling or unable to serve as representa4 tive payee, or that other good cause exists, certify 

5 payment of such benefits to another individual or or6 ganization, in accordance with paragraph (1). 

7 ‘‘(ii) An organization may not be designated to serve 

8 as a representative payee under this subparagraph.’’. 

9 (b) EFFECTIVE DATE.—The amendment made by 

10 subsection (a) shall take effect on the date that is 2 years 

11 after the date of the enactment of this section. 

12 (c) REGULATIONS.—Not later than 18 months after 

13 the date of the enactment of this section, the Commis14 sioner of Social Security shall promulgate regulations 

15 specifying the information an individual is required to pro16 vide to the Commissioner in order to designate another 

17 individual to serve as the individual’s representative payee 

18 under section 205(j)(1)(C) of the Social Security Act (as 

19 added by subsection (a)). 

20 (d) NOTIFICATION TO BENEFICIARIES.—Not later 

21 than January 1, 2020, and annually thereafter, the Com22 missioner of Social Security shall notify each individual 

23 entitled to a benefit under title II, VIII, or XVI of the 

24 Social Security Act of the name of any individual des25 ignated to serve as the individual’s representative payee 


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1 under section 205(j)(1)(C) of such Act (as added by sub2 section (a)). 

3 SEC. 312. PROHIBITION ON INDIVIDUALS CONVICTED OF 

4 CERTAIN CRIMES SERVING AS REPRESENTA5 TIVE PAYEES. 

6 (a) AMENDMENTS TO TITLE II.—Section 205(j)(2) 

7 of the Social Security Act (42 U.S.C. 405(j)(2)) is amend8 ed— 

9 (1) in subparagraph (B)— 

10 (A) in clause (i)— 

11 (i) in subclause (V), by striking ‘‘and’’ 

12 at the end; 

13 (ii) in subclause (VI), by striking the 

14 period and inserting ‘‘, and’’; and 

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

17 ‘‘(VII) determine whether such person has been 

18 convicted (and not subsequently exonerated), under 

19 Federal or State law, of a felony provided under 

20 clause (iv), or of an attempt or a conspiracy to com21 mit such a felony.’’; and 

22 (B) by adding at the end the following: 

23 ‘‘(iv) The felony crimes provided under this clause, 

24 whether an offense under State or Federal law, are the 

25 following: 


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1 ‘‘(I) Human trafficking, including as prohibited 

2 under sections 1590 and 1591 of title 18, United 

3 States Code. 

4 ‘‘(II) False imprisonment, including as prohib5 ited under section 1201 of title 18, United States 

6 Code. 

7 ‘‘(III) Kidnapping, including as prohibited 

8 under section 1201 of title 18, United States Code. 

9 ‘‘(IV) Rape and sexual assault, including as 

10 prohibited under sections 2241, 2242, 2243, and 

11 2244 of title 18, United States Code. 

12 ‘‘(V) First-degree homicide, including as prohib13 ited under section 1111 of title 18, United States 

14 Code. 

15 ‘‘(VI) Robbery, including as prohibited under 

16 section 2111 of title 18, United States Code. 

17 ‘‘(VII) Fraud to obtain access to government 

18 assistance, including as prohibited under sections 

19 287, 1001, and 1343 of title 18, United States 

20 Code. 

21 ‘‘(VIII) Fraud by scheme, including as prohib22 ited under section 1343 of title 18, United States 

23 Code. 


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1 ‘‘(IX) Theft of government funds or property, 

2 including as prohibited under section 641 of title 18, 

3 United States Code. 

4 ‘‘(X) Abuse or neglect, including as prohibited 

5 under section 111, 113, 114, 115, 116, or 117 of 

6 title 18, United States Code. 

7 ‘‘(XI) Forgery, including as prohibited under 

8 section 642 and chapter 25 (except section 512) of 

9 title 18, United States Code. 

10 ‘‘(XII) Identity theft or identity fraud, includ11 ing as prohibited under sections 1028 and 1028A of 

12 title 18, United States Code. 

13 The Commissioner of Social Security may promulgate reg14 ulations to provide for additional felony crimes under this 

15 clause. 

16 ‘‘(v)(I) For the purpose of carrying out the activities 

17 required under subparagraph (B)(i) as part of the inves18 tigation under subparagraph (A)(i), the Commissioner 

19 may conduct a background check of any individual seeking 

20 to serve as a representative payee under this subsection 

21 and may disqualify from service as a representative payee 

22 any such individual who fails to grant permission for the 

23 Commissioner to conduct such a background check. 

24 ‘‘(II) The Commissioner may revoke certification of 

25 payment of benefits under this subsection to any indiVerDate Sep 11 2014 03:15 Jan 20, 2018 Jkt 079200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6201 E:\BILLS\H4820.IH H4820

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1 vidual serving as a representative payee on or after Janu2 ary 1, 2019, who fails to grant permission for the Commis3 sioner to conduct such a background check.’’; and 

4 (2) in subparagraph (C)— 

5 (A) in clause (i)— 

6 (i) in subclause (IV), by striking ‘‘or’’ 

7 at the end; 

8 (ii) in subclause (V), by striking the 

9 period at the end and inserting ‘‘, or’’; and 

10 (iii) by adding at the end the fol11 lowing: 

12 ‘‘(VI) except as provided in clause (vi), such 

13 person has previously been convicted (and not subse14 quently exonerated) as described in subparagraph 

15 (B)(i)(VII).’’; and 

16 (B) by adding at the end the following: 

17 ‘‘(vi)(I) With respect to any person described in sub18 clause (II)— 

19 ‘‘(aa) subparagraph (B)(i)(VII) shall not apply; 

20 and 

21 ‘‘(bb) the Commissioner may grant an exemp22 tion from the provisions of clause (i)(VI) if the Com23 missioner determines that such exemption is in the 

24 best interest of the individual entitled to benefits. 


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1 ‘‘(II) A person is described in this subclause if the 

2 person— 

3 ‘‘(aa) is the custodial parent of a minor child 

4 for whom the person applies to serve, 

5 ‘‘(bb) is the custodial spouse of the beneficiary 

6 for whom the person applies to serve, 

7 ‘‘(cc) is the custodial parent of a beneficiary 

8 who is under a disability (as defined in section 

9 223(d)) which began before the beneficiary attained 

10 the age of 22, for whom the person applies to serve, 

11 ‘‘(dd) is the custodial court appointed guardian 

12 of the beneficiary for whom the person applies to 

13 serve, 

14 ‘‘(ee) is the custodial grandparent of a minor 

15 grandchild for whom the person applies to serve, 

16 ‘‘(ff) is the parent who was previously rep17 resentative payee for his or her minor child who has 

18 since turned 18 and continues to be eligible for such 

19 benefit, or 

20 ‘‘(gg) received a presidential or gubernatorial 

21 pardon for the relevant conviction.’’. 

22 (b) AMENDMENTS TO TITLE VIII.—Section 807 of 

23 the Social Security Act (42 U.S.C. 1007) is amended— 

24 (1) in subsection (b)— 

25 (A) in paragraph (2)— 


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

2 ‘‘and’’ at the end; 

3 (ii) in subparagraph (F), by striking 

4 the period and inserting ‘‘, and’’; and 

5 (iii) by adding at the end the fol6 lowing: 

7 ‘‘(G) determine whether such person has 

8 been convicted (and not subsequently exoner9 ated), under Federal or State law, of a felony 

10 provided under paragraph (4), or of an attempt 

11 or a conspiracy to commit such a felony.’’; and 

12 (B) by adding at the end the following: 

13 ‘‘(4) The felony crimes provided under this 

14 paragraph, whether an offense under State or Fed15 eral law, are the following: 

16 ‘‘(A) Human trafficking, including as pro17 hibited under sections 1590 and 1591 of title 

18 18, United States Code. 

19 ‘‘(B) False imprisonment, including as 

20 prohibited under section 1201 of title 18, 

21 United States Code. 

22 ‘‘(C) Kidnapping, including as prohibited 

23 under section 1201 of title 18, United States 

24 Code. 


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1 ‘‘(D) Rape and sexual assault, including as 

2 prohibited under sections 2241, 2242, 2243, 

3 and 2244 of title 18, United States Code. 

4 ‘‘(E) First-degree homicide, including as 

5 prohibited under section 1111 of title 18, 

6 United States Code. 

7 ‘‘(F) Robbery, including as prohibited 

8 under section 2111 of title 18, United States 

9 Code. 

10 ‘‘(G) Fraud to obtain access to government 

11 assistance, including as prohibited under sec12 tions 287, 1001, and 1343 of title 18, United 

13 States Code. 

14 ‘‘(H) Fraud by scheme, including as pro15 hibited under section 1343 of title 18, United 

16 States Code. 

17 ‘‘(I) Theft of government funds or prop18 erty, including as prohibited under section 641 

19 of title 18, United States Code. 

20 ‘‘(J) Abuse or neglect, including as prohib21 ited under section 111, 113, 114, 115, 116, or 

22 117 of title 18, United States Code. 

23 ‘‘(K) Forgery, including as prohibited 

24 under section 642 and chapter 25 (except sec25 tion 512) of title 18, United States Code. 


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1 ‘‘(L) Identity theft or identity fraud, in2 cluding as prohibited under sections 1028 and 

3 1028A of title 18, United States Code. 

4 The Commissioner of Social Security may promul5 gate regulations to provide for additional felony 

6 crimes under this clause. 

7 ‘‘(5)(A) For the purpose of carrying out the activities 

8 required under paragraph (2) as part of the investigation 

9 under paragraph (1)(A), the Commissioner may conduct 

10 a background check of any individual seeking to serve as 

11 a representative payee under this subsection and may dis12 qualify from service as a representative payee any such 

13 individual who fails to grant permission for the Commis14 sioner to conduct such a background check. 

15 ‘‘(B) The Commissioner may revoke certification of 

16 payment of benefits under this subsection to any indi17 vidual serving as a representative payee on or after Janu18 ary 1, 2019, who fails to grant permission for the Commis19 sioner to conduct such a background check.’’; and 

20 (2) in subsection (d)— 

21 (A) in paragraph (1)— 

22 (i) in subparagraph (D), by striking 

23 ‘‘or’’ at the end; 


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1 (ii) in subparagraph (E), by striking 

2 the period at the end and inserting ‘‘, or’’; 

3 and 

4 (iii) by adding at the end the fol5 lowing: 

6 ‘‘(F) except as provided in paragraph 

7 (2)(D), such person has previously been con8 victed (and not subsequently exonerated) as de9 scribed in subsection (b)(2)(G).’’; and 

10 (B) in paragraph (2), by adding at the end 

11 the following: 

12 ‘‘(D)(i) With respect to any person described in 

13 clause (II)— 

14 ‘‘(I) subsection (b)(2)(G) shall not apply; and 

15 ‘‘(II) the Commissioner may grant an exemp16 tion from the provisions of paragraph (1)(F) if the 

17 Commissioner determines that such exemption is in 

18 the best interest of the individual entitled to bene19 fits. 

20 ‘‘(ii) A person is described in this clause if the per21 son— 

22 ‘‘(I) is the custodial spouse of the beneficiary 

23 for whom the person applies to serve; 


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1 ‘‘(II) is the custodial court appointed guardian 

2 of the beneficiary for whom the person applies to 

3 serve; or 

4 ‘‘(III) received a presidential or gubernatorial 

5 pardon for the relevant conviction.’’. 

6 (c) AMENDMENTS TO TITLE XVI.—Section 

7 1631(a)(2)(B) of the Social Security Act (42 U.S.C. 

8 1383(a)(2)(B)) is amended— 

9 (1) in clause (ii)— 

10 (A) in subclause (V), by striking ‘‘and’’ at 

11 the end; 

12 (B) in subclause (VI), by striking the pe13 riod and inserting ‘‘, and’’; and 

14 (C) by adding at the end the following: 

15 ‘‘(VII) determine whether such person has been 

16 convicted (and not subsequently exonerated), under 

17 Federal or State law, of a felony provided under 

18 clause (xv), or of an attempt or a conspiracy to com19 mit such a felony.’’; 

20 (2) in clause (iii)— 

21 (A) in subclause (IV), by striking ‘‘or’’ at 

22 the end; 

23 (B) in subclause (V), by striking the period 

24 at the end and inserting ‘‘, or’’; and 

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


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1 ‘‘(VI) except as provided in clause (xvii), such 

2 person has previously been convicted (and not subse3 quently exonerated) as described in clause 

4 (ii)(VII).’’; and 

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

6 ‘‘(xv) The felony crimes provided under this clause, 

7 whether an offense under State or Federal law, are the 

8 following: 

9 ‘‘(I) Human trafficking, including as prohibited 

10 under sections 1590 and 1591 of title 18, United 

11 States Code. 

12 ‘‘(II) False imprisonment, including as prohib13 ited under section 1201 of title 18, United States 

14 Code. 

15 ‘‘(III) Kidnapping, including as prohibited 

16 under section 1201 of title 18, United States Code. 

17 ‘‘(IV) Rape and sexual assault, including as 

18 prohibited under sections 2241, 2242, 2243, and 

19 2244 of title 18, United States Code. 

20 ‘‘(V) First-degree homicide, including as prohib21 ited under section 1111 of title 18, United States 

22 Code. 

23 ‘‘(VI) Robbery, including as prohibited under 

24 section 2111 of title 18, United States Code. 


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1 ‘‘(VII) Fraud to obtain access to government 

2 assistance, including as prohibited under sections 

3 287, 1001, and 1343 of title 18, United States 

4 Code. 

5 ‘‘(VIII) Fraud by scheme, including as prohib6 ited under section 1343 of title 18, United States 

7 Code. 

8 ‘‘(IX) Theft of government funds or property, 

9 including as prohibited under section 641 of title 18, 

10 United States Code. 

11 ‘‘(X) Abuse or neglect, including as prohibited 

12 under section 111, 113, 114, 115, 116, or 117 of 

13 title 18, United States Code. 

14 ‘‘(XI) Forgery, including as prohibited under 

15 section 642 and chapter 25 (except section 512) of 

16 title 18, United States Code. 

17 ‘‘(XII) Identity theft or identity fraud, includ18 ing as prohibited under sections 1028 and 1028A of 

19 title 18, United States Code. 

20 The Commissioner of Social Security may promulgate reg21 ulations to provide for additional felony crimes under this 

22 clause. 

23 ‘‘(xvi)(I) For the purpose of carrying out the activi24 ties required under clause (ii) as part of the investigation 

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1 ground check of any individual seeking to serve as a rep2 resentative payee under this subsection and may disqualify 

3 from service as a representative payee any such individual 

4 who fails to grant permission for the Commissioner to con5 duct such a background check. 

6 ‘‘(II) The Commissioner may revoke certification of 

7 payment of benefits under this subsection to any indi8 vidual serving as a representative payee on or after Janu9 ary 1, 2019, who fails to grant permission for the Commis10 sioner to conduct such a background check. 

11 ‘‘(xvii)(I) With respect to any person described in 

12 subclause (II)— 

13 ‘‘(aa) clause (ii)(VII) shall not apply; and 

14 ‘‘(bb) the Commissioner may grant an exemp15 tion from the provisions of clause (iii)(VI) if the 

16 Commissioner determines that such exemption is in 

17 the best interest of the individual entitled to bene18 fits. 

19 ‘‘(II) A person is described in this subclause if the 

20 person— 

21 ‘‘(aa) is the custodial parent of a minor child 

22 for whom the person applies to serve, 

23 ‘‘(bb) is the custodial spouse of the beneficiary 

24 for whom the person applies to serve, 


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1 ‘‘(cc) is the custodial parent of a beneficiary 

2 who is under a disability which began before the 

3 beneficiary attained the age of 22, for whom the per4 son applies to serve, 

5 ‘‘(dd) is the custodial court appointed guardian 

6 of the beneficiary for whom the person applies to 

7 serve, 

8 ‘‘(ee) is the custodial grandparent of a minor 

9 grandchild for whom the person applies to serve, 

10 ‘‘(ff) is the parent who was previously rep11 resentative payee for his or her minor child who has 

12 since turned 18 and continues to be eligible for such 

13 benefit, or 

14 ‘‘(gg) received a presidential or gubernatorial 

15 pardon for the relevant conviction.’’. 

16 (d) APPLICATION TO NEW APPOINTMENTS.—Subject 

17 to subsection (e), the amendments made by subsections 

18 (a), (b), and (c) shall apply with respect to any individual 

19 appointed to serve as a representative payee pursuant to 

20 section 205(j), 807, or 1631(a)(2) of the Social Security 

21 Act on or after January 1, 2019. 

22 (e) APPLICATION TO PRIOR APPOINTMENTS.— 

23 (1) IN GENERAL.—Not later than January 1, 

24 2024, the Commissioner of Social Security shall con25 duct a review of each individual serving as a repVerDate Sep 11 2014 03:15 Jan 20, 2018 Jkt 079200 PO 00000 Frm 00133 Fmt 6652 Sfmt 6201 E:\BILLS\H4820.IH H4820

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1 resentative payee pursuant to section 205(j), 807, or 

2 1631(a)(2) of the Social Security Act, to determine 

3 whether such individual has been convicted of a fel4 ony as described in section 205(j)(2)(B)(i)(VII), 

5 807(b)(2)(G), or 1631(a)(2)(B)(ii)(VII), respectively 

6 (as such provisions are added by this section). Ex7 cept as provided in section 205(j)(2)(C)(vi), 

8 807(d)(2)(D), or 1631(a)(2)(B)(xvii) (as so added), 

9 any individual determined by the Commissioner to 

10 have been so convicted may not serve as a represent11 ative payee on or after the date of such determina12 tion. 

13 (2) PRIORITY.—In conducting reviews under 

14 paragraph (1), the Commissioner shall prioritize re15 views of the following categories of individuals, in 

16 the following order: 

17 (A) An individual serving as representative 

18 payee for 15 or more individuals. 

19 (B) An individual serving as representative 

20 payee for an individual who is not related to the 

21 representative payee. 

22 (C) An individual serving as representative 

23 payee for an individual who has attained the 

24 age of 18 and is not the spouse of the rep25 resentative payee. 


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1 (f) PERIODIC REVIEW.—Not later than 1 year after 

2 the date of enactment of this section, the Commissioner 

3 of Social Security shall issue regulations to establish a 

4 process for reviewing each individual serving as a rep5 resentative payee pursuant to section 205(j), 807, or 

6 1631(a)(2) of the Social Security Act (other than individ7 uals with respect to whom an exemption has been granted 

8 under section 205(j)(2)(C)(vi), 807(d)(2)(D), or 

9 1631(a)(2)(B)(xvii)) not less than once every 5 years to 

10 determine whether any such individual has been convicted 

11 of a felony as described in subsection (e)(1) of this section. 

12 SEC. 313. PROHIBITION ON INDIVIDUALS WITH REP13 RESENTATIVE PAYEES SERVING AS REP14 RESENTATIVE PAYEES. 

15 (a) AMENDMENT TO TITLE II.—Section 

16 205(j)(2)(C)(i) of the Social Security Act (42 U.S.C. 

17 405(j)(2)(C)(i)), as amended by section 312(a)(2), is fur18 ther amended— 

19 (1) in subclause (V), by striking ‘‘or’’ at the 

20 end; 

21 (2) in subclause (VI), by striking the period 

22 and inserting ‘‘, or’’; and 

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

24 ‘‘(VII) such person’s benefits under this title, 

25 title VIII, or title XVI are certified for payment to 


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1 a representative payee during the period for which 

2 the individual’s benefits would be certified for pay3 ment to another person.’’. 

4 (b) AMENDMENT TO TITLE VIII.—Section 807(d)(1) 

5 of the Social Security Act (42 U.S.C. 1007(d)(1)), as 

6 amended by section 312(b)(2), is further amended— 

7 (1) in subparagraph (E), by striking ‘‘or’’ at 

8 the end; 

9 (2) in subparagraph (F), by striking the period 

10 and inserting ‘‘, or’’; and 

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

12 ‘‘(G) such person’s benefits under this 

13 title, title II, or title XVI are certified for pay14 ment to a representative payee during the pe15 riod for which the individual’s benefits would be 

16 certified for payment to another person.’’. 

17 (c) AMENDMENT TO TITLE XVI.—Section 

18 1631(a)(2)(B)(iii) of the Social Security Act (42 U.S.C. 

19 1383(a)(2)(B)(iii)), as amended by section 312(c)(2), is 

20 further amended— 

21 (1) in subclause (V), by striking ‘‘or’’ at the 

22 end; 

23 (2) in subclause (VI), by striking the period 

24 and inserting ‘‘, or’’; and 

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


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1 ‘‘(VII) such person’s benefits under this title, 

2 title II, or title VIII are certified for payment to a 

3 representative payee during the period for which the 

4 individual’s benefits would be certified for payment 

5 to another person.’’. 

6 (d) EFFECTIVE DATE.— 

7 (1) NEW APPOINTMENTS.—Subject to para8 graph (2), the amendments made by this section 

9 shall apply with respect to any individual appointed 

10 to serve as a representative payee under title II, title 

11 VIII, or title XVI of the Social Security Act on or 

12 after January 1, 2019. 

13 (2) PRIOR APPOINTMENTS.—With respect to in14 dividuals serving as a representative payee whose 

15 benefits under this title, title VIII, or title XVI are 

16 certified for payment to another representative payee 

17 as of January 1, 2019, the Commissioner shall take 

18 any steps necessary to terminate such individual’s 

19 service as a representative payee as soon as possible, 

20 but no later than January 1, 2024. 

21 SEC. 314. REASSESSMENT OF PAYEE SELECTION AND RE22 PLACEMENT POLICIES. 

23 (a) IN GENERAL.—The Commissioner of Social Secu24 rity shall conduct, with opportunity for public comment, 

25 a review and reassessment of— 


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1 (1) the appropriateness of its order of pref2 erence for selecting representative payees, including 

3 payees who may be creditors of the beneficiary or 

4 who are private, for-profit institutions; and 

5 (2) the effectiveness of its policy and oper6 ational procedures in properly determining when to 

7 change a representative payee, including— 

8 (A) from a payee that has a higher order 

9 of preference (such as a family member) to a 

10 payee that has a lower order of preference 

11 (such as a creditor); or 

12 (B) when a request to change payees arises 

13 from someone other than the beneficiary. 

14 (b) REPORT.—Not later than 18 months after the 

15 date of the enactment of this Act, the Commissioner of 

16 Social Security shall submit to the Committee on Ways 

17 and Means of the House of Representatives and the Com18 mittee on Finance of the Senate and make publicly avail19 able a report on the results of the review and reassessment 

20 under subsection (a). 

Æ 


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