In the House of Representatives, U. S., 

February 6, 2018. 

Resolved, That the House agree to the amendment of the 

Senate to the bill (H.R. 1892) entitled ‘‘An Act to amend 

title 4, United States Code, to provide for the flying of the 

flag at half-staff in the event of the death of a first responder 

in the line of duty.’’, with the following 

HOUSE AMENDMENT TO SENATE AMENDMENT: 

At the end of the matter inserted by the Senate 

amendment, insert the following: 

1 DIVISION B—FURTHER EXTENSION OF 

2 CONTINUING APPROPRIATIONS ACT, 2018 

3 SEC. 1001. The Continuing Appropriations Act, 2018 

4 (division D of Public Law 115–56) is further amended— 

5 (1) by striking the date specified in section 

6 106(3) and inserting ‘‘March 23, 2018’’; and 

7 (2) by adding after section 155 the following: 

8 ‘‘SEC. 156. Notwithstanding section 101, amounts are 

9 provided for ‘Department of Commerce—Bureau of the Cen10 sus—Periodic Censuses and Programs’ at a rate for oper11 ations of $1,251,000,000, and such amounts may be appor12 tioned up to the rate for operations necessary to maintain 

13 the schedule and deliver the required data according to stat14 utory deadlines in the 2020 Decennial Census Program. 
2 

•HR 1892 EAH 

1 ‘‘SEC. 157. Notwithstanding section 101, the matter 

2 preceding the first proviso and the first proviso under the 

3 heading ‘Power Marketing Administrations—Operation 

4 and Maintenance, Southeastern Power Administration’ in 

5 division D of Public Law 115–31 shall be applied by sub6 stituting ‘$6,379,000’ for ‘$1,000,000’ each place it appears. 

7 ‘‘SEC. 158. As authorized by section 404 of the Bipar8 tisan Budget Act of 2015 (Public Law 114–74; 42 U.S.C. 

9 6239 note), the Secretary of Energy shall draw down and 

10 sell not to exceed $350,000,000 of crude oil from the Stra11 tegic Petroleum Reserve in fiscal year 2018: Provided, That 

12 the proceeds from such drawdown and sale shall be depos13 ited into the ‘Energy Security and Infrastructure Mod14 ernization Fund’ (in this section referred to as the ‘Fund’) 

15 during fiscal year 2018: Provided further, That in addition 

16 to amounts otherwise made available by section 101, and 

17 notwithstanding section 104, any amounts deposited in the 

18 Fund shall be made available and shall remain available 

19 until expended at a rate for operations of $350,000,000, for 

20 necessary expenses in carrying out the Life Extension II 

21 project for the Strategic Petroleum Reserve. 

22 ‘‘SEC. 159. Amounts made available by section 101 for 

23 ‘The Judiciary—Courts of Appeals, District Courts, and 

24 Other Judicial Services—Fees of Jurors and Commis-
3 

•HR 1892 EAH 

1 sioners’ may be apportioned up to the rate for operations 

2 necessary to accommodate increased juror usage. 

3 ‘‘SEC. 160. (a) In addition to amounts otherwise made 

4 available by section 101, there is appropriated for an addi5 tional amount for the ‘Small Business Administration— 

6 Disaster Loans Program Account’ $225,000,000, to remain 

7 available until expended, for the cost of direct loans author8 ized by section 7(b) of the Small Business Act: Provided, 

9 That such amount is designated by the Congress as an emer10 gency requirement pursuant to section 251(b)(2)(A)(i) of 

11 the Balanced Budget and Emergency Deficit Control Act 

12 of 1985. 

13 ‘‘(b) The amount designated in subsection (a) by the 

14 Congress as an emergency requirement pursuant to section 

15 251(b)(2)(A)(i) of the Balanced Budget and Emergency 

16 Deficit Control Act of 1985 shall be available only if the 

17 President subsequently so designates such amount and 

18 transmits such designation to the Congress.’’. 

19 This division may be cited as the ‘‘Further Extension 

20 of Continuing Appropriations Act, 2018’’. 

21 DIVISION C—DEPARTMENT OF DEFENSE 

22 APPROPRIATIONS ACT, 2018 

23 That the following sums are appropriated, out of any 

24 money in the Treasury not otherwise appropriated, for the 

25 fiscal year ending September 30, 2018, for military func-
4 

•HR 1892 EAH 

1 tions administered by the Department of Defense and for 

2 other purposes, namely: 

3 TITLE I 

4 MILITARY PERSONNEL 

5 MILITARY PERSONNEL, ARMY

6 For pay, allowances, individual clothing, subsistence, 

7 interest on deposits, gratuities, permanent change of station 

8 travel (including all expenses thereof for organizational 

9 movements), and expenses of temporary duty travel between 

10 permanent duty stations, for members of the Army on active 

11 duty (except members of reserve components provided for 

12 elsewhere), cadets, and aviation cadets; for members of the 

13 Reserve Officers’ Training Corps; and for payments pursu14 ant to section 156 of Public Law 97–377, as amended (42 

15 U.S.C. 402 note), and to the Department of Defense Mili16 tary Retirement Fund, $41,427,054,000. 

17 MILITARY PERSONNEL, NAVY

18 For pay, allowances, individual clothing, subsistence, 

19 interest on deposits, gratuities, permanent change of station 

20 travel (including all expenses thereof for organizational 

21 movements), and expenses of temporary duty travel between 

22 permanent duty stations, for members of the Navy on active 

23 duty (except members of the Reserve provided for elsewhere), 

24 midshipmen, and aviation cadets; for members of the Re25 serve Officers’ Training Corps; and for payments pursuant 
5 

•HR 1892 EAH 

1 to section 156 of Public Law 97–377, as amended (42 

2 U.S.C. 402 note), and to the Department of Defense Mili3 tary Retirement Fund, $28,707,918,000 (reduced by 

4 $2,000,000) (increased by $2,000,000). 

5 MILITARY PERSONNEL, MARINE CORPS

6 For pay, allowances, individual clothing, subsistence, 

7 interest on deposits, gratuities, permanent change of station 

8 travel (including all expenses thereof for organizational 

9 movements), and expenses of temporary duty travel between 

10 permanent duty stations, for members of the Marine Corps 

11 on active duty (except members of the Reserve provided for 

12 elsewhere); and for payments pursuant to section 156 of 

13 Public Law 97–377, as amended (42 U.S.C. 402 note), and 

14 to the Department of Defense Military Retirement Fund, 

15 $13,165,714,000. 

16 MILITARY PERSONNEL, AIR FORCE

17 For pay, allowances, individual clothing, subsistence, 

18 interest on deposits, gratuities, permanent change of station 

19 travel (including all expenses thereof for organizational 

20 movements), and expenses of temporary duty travel between 

21 permanent duty stations, for members of the Air Force on 

22 active duty (except members of reserve components provided 

23 for elsewhere), cadets, and aviation cadets; for members of 

24 the Reserve Officers’ Training Corps; and for payments 

25 pursuant to section 156 of Public Law 97–377, as amended 
6 

•HR 1892 EAH 

1 (42 U.S.C. 402 note), and to the Department of Defense 

2 Military Retirement Fund, $28,738,320,000. 

3 RESERVE PERSONNEL, ARMY

4 For pay, allowances, clothing, subsistence, gratuities, 

5 travel, and related expenses for personnel of the Army Re6 serve on active duty under sections 10211, 10302, and 3038 

7 of title 10, United States Code, or while serving on active 

8 duty under section 12301(d) of title 10, United States Code, 

9 in connection with performing duty specified in section 

10 12310(a) of title 10, United States Code, or while under11 going reserve training, or while performing drills or equiva12 lent duty or other duty, and expenses authorized by section 

13 16131 of title 10, United States Code; and for payments 

14 to the Department of Defense Military Retirement Fund, 

15 $4,721,128,000. 

16 RESERVE PERSONNEL, NAVY

17 For pay, allowances, clothing, subsistence, gratuities, 

18 travel, and related expenses for personnel of the Navy Re19 serve on active duty under section 10211 of title 10, United 

20 States Code, or while serving on active duty under section 

21 12301(d) of title 10, United States Code, in connection with 

22 performing duty specified in section 12310(a) of title 10, 

23 United States Code, or while undergoing reserve training, 

24 or while performing drills or equivalent duty, and expenses 

25 authorized by section 16131 of title 10, United States Code; 
7 

•HR 1892 EAH 

1 and for payments to the Department of Defense Military 

2 Retirement Fund, $1,987,662,000. 

3 RESERVE PERSONNEL, MARINE CORPS

4 For pay, allowances, clothing, subsistence, gratuities, 

5 travel, and related expenses for personnel of the Marine 

6 Corps Reserve on active duty under section 10211 of title 

7 10, United States Code, or while serving on active duty 

8 under section 12301(d) of title 10, United States Code, in 

9 connection with performing duty specified in section 

10 12310(a) of title 10, United States Code, or while under11 going reserve training, or while performing drills or equiva12 lent duty, and for members of the Marine Corps platoon 

13 leaders class, and expenses authorized by section 16131 of 

14 title 10, United States Code; and for payments to the De15 partment of Defense Military Retirement Fund, 

16 $762,793,000. 

17 RESERVE PERSONNEL, AIR FORCE

18 For pay, allowances, clothing, subsistence, gratuities, 

19 travel, and related expenses for personnel of the Air Force 

20 Reserve on active duty under sections 10211, 10305, and 

21 8038 of title 10, United States Code, or while serving on 

22 active duty under section 12301(d) of title 10, United States 

23 Code, in connection with performing duty specified in sec24 tion 12310(a) of title 10, United States Code, or while un25 dergoing reserve training, or while performing drills or 
8 

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1 equivalent duty or other duty, and expenses authorized by 

2 section 16131 of title 10, United States Code; and for pay3 ments to the Department of Defense Military Retirement 

4 Fund, $1,808,434,000. 

5 NATIONAL GUARD PERSONNEL, ARMY

6 For pay, allowances, clothing, subsistence, gratuities, 

7 travel, and related expenses for personnel of the Army Na8 tional Guard while on duty under sections 10211, 10302, 

9 or 12402 of title 10 or section 708 of title 32, United States 

10 Code, or while serving on duty under section 12301(d) of 

11 title 10 or section 502(f) of title 32, United States Code, 

12 in connection with performing duty specified in section 

13 12310(a) of title 10, United States Code, or while under14 going training, or while performing drills or equivalent 

15 duty or other duty, and expenses authorized by section 

16 16131 of title 10, United States Code; and for payments 

17 to the Department of Defense Military Retirement Fund, 

18 $8,252,426,000. 

19 NATIONAL GUARD PERSONNEL, AIR FORCE

20 For pay, allowances, clothing, subsistence, gratuities, 

21 travel, and related expenses for personnel of the Air Na22 tional Guard on duty under sections 10211, 10305, or 

23 12402 of title 10 or section 708 of title 32, United States 

24 Code, or while serving on duty under section 12301(d) of 

25 title 10 or section 502(f) of title 32, United States Code, 
9 

•HR 1892 EAH 

1 in connection with performing duty specified in section 

2 12310(a) of title 10, United States Code, or while under3 going training, or while performing drills or equivalent 

4 duty or other duty, and expenses authorized by section 

5 16131 of title 10, United States Code; and for payments 

6 to the Department of Defense Military Retirement Fund, 

7 $3,406,137,000. 

8 TITLE II 

9 OPERATION AND MAINTENANCE 

10 OPERATION AND MAINTENANCE, ARMY

11 For expenses, not otherwise provided for, necessary for 

12 the operation and maintenance of the Army, as authorized 

13 by law, $38,483,846,000 (reduced by $5,000,000) (reduced 

14 by $5,600,000) (reduced by $6,000,000): Provided, That not 

15 to exceed $12,478,000 can be used for emergencies and ex16 traordinary expenses, to be expended on the approval or au17 thority of the Secretary of the Army, and payments may 

18 be made on his certificate of necessity for confidential mili19 tary purposes. 

20 OPERATION AND MAINTENANCE, NAVY

21 For expenses, not otherwise provided for, necessary for 

22 the operation and maintenance of the Navy and the Marine 

23 Corps, as authorized by law, $45,980,133,000 (reduced by 

24 $598,000) (reduced by $7,000,000): Provided, That not to 

25 exceed $15,055,000 can be used for emergencies and extraor-
10 

•HR 1892 EAH 

1 dinary expenses, to be expended on the approval or author2 ity of the Secretary of the Navy, and payments may be 

3 made on his certificate of necessity for confidential military 

4 purposes. 

5 OPERATION AND MAINTENANCE, MARINE CORPS

6 For expenses, not otherwise provided for, necessary for 

7 the operation and maintenance of the Marine Corps, as au8 thorized by law, $6,885,884,000. 

9 OPERATION AND MAINTENANCE, AIR FORCE

10 For expenses, not otherwise provided for, necessary for 

11 the operation and maintenance of the Air Force, as author12 ized by law, $38,592,745,000: Provided, That not to exceed 

13 $7,699,000 can be used for emergencies and extraordinary 

14 expenses, to be expended on the approval or authority of 

15 the Secretary of the Air Force, and payments may be made 

16 on his certificate of necessity for confidential military pur17 poses. 

18 OPERATION AND MAINTENANCE, DEFENSE-WIDE

19 (INCLUDING TRANSFER OF FUNDS)

20 For expenses, not otherwise provided for, necessary for 

21 the operation and maintenance of activities and agencies 

22 of the Department of Defense (other than the military de23 partments), as authorized by law, $33,771,769,000 (in24 creased by $5,000,000) (reduced by $10,000,000) (reduced 

25 by $100,000) (increased by $100,000) (reduced by 
11 

•HR 1892 EAH 

1 $194,897,000) (increased by $194,897,000) (reduced by 

2 $26,200,000) (reduced by $20,000,000) (reduced by 

3 $6,000,000) (reduced by $4,000,000) (reduced by 

4 $20,000,000) (reduced by $1,000,000) (reduced by 

5 $10,000,000) (reduced by $2,500,000) (reduced by 

6 $2,000,000) (reduced by $8,000,000) (reduced by 

7 $6,250,000) (reduced by $10,000,000) (reduced by 

8 $10,000,000) (reduced by $30,000,000) (reduced by 

9 $34,734,000) (reduced by $60,000,000): Provided, That not 

10 more than $15,000,000 may be used for the Combatant 

11 Commander Initiative Fund authorized under section 166a 

12 of title 10, United States Code: Provided further, That not 

13 to exceed $36,000,000 can be used for emergencies and ex14 traordinary expenses, to be expended on the approval or au15 thority of the Secretary of Defense, and payments may be 

16 made on his certificate of necessity for confidential military 

17 purposes: Provided further, That of the funds provided 

18 under this heading, not less than $38,458,000 shall be made 

19 available for the Procurement Technical Assistance Cooper20 ative Agreement Program, of which not less than $3,600,000 

21 shall be available for centers defined in 10 U.S.C. 

22 2411(1)(D): Provided further, That none of the funds ap23 propriated or otherwise made available by this Act may be 

24 used to plan or implement the consolidation of a budget 

25 or appropriations liaison office of the Office of the Secretary 
12 

•HR 1892 EAH 

1 of Defense, the office of the Secretary of a military depart2 ment, or the service headquarters of one of the Armed Forces 

3 into a legislative affairs or legislative liaison office: Pro4 vided further, That $9,385,000, to remain available until 

5 expended, is available only for expenses relating to certain 

6 classified activities, and may be transferred as necessary 

7 by the Secretary of Defense to operation and maintenance 

8 appropriations or research, development, test and evalua9 tion appropriations, to be merged with and to be available 

10 for the same time period as the appropriations to which 

11 transferred: Provided further, That any ceiling on the in12 vestment item unit cost of items that may be purchased with 

13 operation and maintenance funds shall not apply to the 

14 funds described in the preceding proviso: Provided further, 

15 That of the funds provided under this heading, 

16 $415,000,000, of which $100,000,000 to remain available 

17 until September 30, 2019, shall be available to provide sup18 port and assistance to foreign security forces or other groups 

19 or individuals to conduct, support or facilitate counterter20 rorism, crisis response, or other Department of Defense se21 curity cooperation programs: Provided further, That the 

22 transfer authority provided under this heading is in addi23 tion to any other transfer authority provided elsewhere in 

24 this Act. 
13 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, ARMY RESERVE

2 For expenses, not otherwise provided for, necessary for 

3 the operation and maintenance, including training, organi4 zation, and administration, of the Army Reserve; repair of 

5 facilities and equipment; hire of passenger motor vehicles; 

6 travel and transportation; care of the dead; recruiting; pro7 curement of services, supplies, and equipment; and commu8 nications, $2,870,163,000. 

9 OPERATION AND MAINTENANCE, NAVY RESERVE

10 For expenses, not otherwise provided for, necessary for 

11 the operation and maintenance, including training, organi12 zation, and administration, of the Navy Reserve; repair of 

13 facilities and equipment; hire of passenger motor vehicles; 

14 travel and transportation; care of the dead; recruiting; pro15 curement of services, supplies, and equipment; and commu16 nications, $1,038,507,000. 

17 OPERATION AND MAINTENANCE, MARINE CORPS RESERVE

18 For expenses, not otherwise provided for, necessary for 

19 the operation and maintenance, including training, organi20 zation, and administration, of the Marine Corps Reserve; 

21 repair of facilities and equipment; hire of passenger motor 

22 vehicles; travel and transportation; care of the dead; recruit23 ing; procurement of services, supplies, and equipment; and 

24 communications, $282,337,000. 
14 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, AIR FORCE RESERVE

2 For expenses, not otherwise provided for, necessary for 

3 the operation and maintenance, including training, organi4 zation, and administration, of the Air Force Reserve; repair 

5 of facilities and equipment; hire of passenger motor vehicles; 

6 travel and transportation; care of the dead; recruiting; pro7 curement of services, supplies, and equipment; and commu8 nications, $3,233,745,000. 

9 OPERATION AND MAINTENANCE, ARMY NATIONAL GUARD

10 For expenses of training, organizing, and admin11 istering the Army National Guard, including medical and 

12 hospital treatment and related expenses in non-Federal hos13 pitals; maintenance, operation, and repairs to structures 

14 and facilities; hire of passenger motor vehicles; personnel 

15 services in the National Guard Bureau; travel expenses 

16 (other than mileage), as authorized by law for Army per17 sonnel on active duty, for Army National Guard division, 

18 regimental, and battalion commanders while inspecting 

19 units in compliance with National Guard Bureau regula20 tions when specifically authorized by the Chief, National 

21 Guard Bureau; supplying and equipping the Army Na22 tional Guard as authorized by law; and expenses of repair, 

23 modification, maintenance, and issue of supplies and 

24 equipment (including aircraft), $7,275,820,000. 
15 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, AIR NATIONAL GUARD

2 For expenses of training, organizing, and admin3 istering the Air National Guard, including medical and 

4 hospital treatment and related expenses in non-Federal hos5 pitals; maintenance, operation, and repairs to structures 

6 and facilities; transportation of things, hire of passenger 

7 motor vehicles; supplying and equipping the Air National 

8 Guard, as authorized by law; expenses for repair, modifica9 tion, maintenance, and issue of supplies and equipment, 

10 including those furnished from stocks under the control of 

11 agencies of the Department of Defense; travel expenses (other 

12 than mileage) on the same basis as authorized by law for 

13 Air National Guard personnel on active Federal duty, for 

14 Air National Guard commanders while inspecting units in 

15 compliance with National Guard Bureau regulations when 

16 specifically authorized by the Chief, National Guard Bu17 reau, $6,735,930,000. 

18 UNITED STATES COURT OF APPEALS FOR THE ARMED

19 FORCES

20 For salaries and expenses necessary for the United 

21 States Court of Appeals for the Armed Forces, $14,538,000, 

22 of which not to exceed $5,000 may be used for official rep23 resentation purposes. 
16 

•HR 1892 EAH 

1 ENVIRONMENTAL RESTORATION, ARMY

2 (INCLUDING TRANSFER OF FUNDS)

3 For the Department of the Army, $215,809,000, to re4 main available until transferred: Provided, That the Sec5 retary of the Army shall, upon determining that such funds 

6 are required for environmental restoration, reduction and 

7 recycling of hazardous waste, removal of unsafe buildings 

8 and debris of the Department of the Army, or for similar 

9 purposes, transfer the funds made available by this appro10 priation to other appropriations made available to the De11 partment of the Army, to be merged with and to be available 

12 for the same purposes and for the same time period as the 

13 appropriations to which transferred: Provided further, That 

14 upon a determination that all or part of the funds trans15 ferred from this appropriation are not necessary for the 

16 purposes provided herein, such amounts may be transferred 

17 back to this appropriation: Provided further, That the 

18 transfer authority provided under this heading is in addi19 tion to any other transfer authority provided elsewhere in 

20 this Act. 

21 ENVIRONMENTAL RESTORATION, NAVY

22 (INCLUDING TRANSFER OF FUNDS)

23 For the Department of the Navy, $288,915,000 (in24 creased by $34,734,000) (increased by $30,000,000), to re25 main available until transferred: Provided, That the Sec-
17 

•HR 1892 EAH 

1 retary of the Navy shall, upon determining that such funds 

2 are required for environmental restoration, reduction and 

3 recycling of hazardous waste, removal of unsafe buildings 

4 and debris of the Department of the Navy, or for similar 

5 purposes, transfer the funds made available by this appro6 priation to other appropriations made available to the De7 partment of the Navy, to be merged with and to be available 

8 for the same purposes and for the same time period as the 

9 appropriations to which transferred: Provided further, That 

10 upon a determination that all or part of the funds trans11 ferred from this appropriation are not necessary for the 

12 purposes provided herein, such amounts may be transferred 

13 back to this appropriation: Provided further, That the 

14 transfer authority provided under this heading is in addi15 tion to any other transfer authority provided elsewhere in 

16 this Act. 

17 ENVIRONMENTAL RESTORATION, AIR FORCE

18 (INCLUDING TRANSFER OF FUNDS)

19 For the Department of the Air Force, $308,749,000 

20 (increased by $30,000,000), to remain available until trans21 ferred: Provided, That the Secretary of the Air Force shall, 

22 upon determining that such funds are required for environ23 mental restoration, reduction and recycling of hazardous 

24 waste, removal of unsafe buildings and debris of the Depart25 ment of the Air Force, or for similar purposes, transfer the 
18 

•HR 1892 EAH 

1 funds made available by this appropriation to other appro2 priations made available to the Department of the Air 

3 Force, to be merged with and to be available for the same 

4 purposes and for the same time period as the appropria5 tions to which transferred: Provided further, That upon a 

6 determination that all or part of the funds transferred from 

7 this appropriation are not necessary for the purposes pro8 vided herein, such amounts may be transferred back to this 

9 appropriation: Provided further, That the transfer author10 ity provided under this heading is in addition to any other 

11 transfer authority provided elsewhere in this Act. 

12 ENVIRONMENTAL RESTORATION, DEFENSE-WIDE

13 (INCLUDING TRANSFER OF FUNDS)

14 For the Department of Defense, $9,002,000 (increased 

15 by $10,000,000), to remain available until transferred: Pro16 vided, That the Secretary of Defense shall, upon deter17 mining that such funds are required for environmental res18 toration, reduction and recycling of hazardous waste, re19 moval of unsafe buildings and debris of the Department of 

20 Defense, or for similar purposes, transfer the funds made 

21 available by this appropriation to other appropriations 

22 made available to the Department of Defense, to be merged 

23 with and to be available for the same purposes and for the 

24 same time period as the appropriations to which trans25 ferred: Provided further, That upon a determination that 
19 

•HR 1892 EAH 

1 all or part of the funds transferred from this appropriation 

2 are not necessary for the purposes provided herein, such 

3 amounts may be transferred back to this appropriation: 

4 Provided further, That the transfer authority provided 

5 under this heading is in addition to any other transfer au6 thority provided elsewhere in this Act. 

7 ENVIRONMENTAL RESTORATION, FORMERLY USED

8 DEFENSE SITES

9 (INCLUDING TRANSFER OF FUNDS)

10 For the Department of the Army, $233,673,000, to re11 main available until transferred: Provided, That the Sec12 retary of the Army shall, upon determining that such funds 

13 are required for environmental restoration, reduction and 

14 recycling of hazardous waste, removal of unsafe buildings 

15 and debris at sites formerly used by the Department of De16 fense, transfer the funds made available by this appropria17 tion to other appropriations made available to the Depart18 ment of the Army, to be merged with and to be available 

19 for the same purposes and for the same time period as the 

20 appropriations to which transferred: Provided further, That 

21 upon a determination that all or part of the funds trans22 ferred from this appropriation are not necessary for the 

23 purposes provided herein, such amounts may be transferred 

24 back to this appropriation: Provided further, That the 

25 transfer authority provided under this heading is in addi-
20 

•HR 1892 EAH 

1 tion to any other transfer authority provided elsewhere in 

2 this Act. 

3 OVERSEAS HUMANITARIAN, DISASTER, AND CIVIC AID

4 For expenses relating to the Overseas Humanitarian, 

5 Disaster, and Civic Aid programs of the Department of De6 fense (consisting of the programs provided under sections 

7 401, 402, 404, 407, 2557, and 2561 of title 10, United 

8 States Code), $107,900,000, to remain available until Sep9 tember 30, 2018. 

10 COOPERATIVE THREAT REDUCTION ACCOUNT

11 For assistance, including assistance provided by con12 tract or by grants, under programs and activities of the 

13 Department of Defense Cooperative Threat Reduction Pro14 gram authorized under the Department of Defense Coopera15 tive Threat Reduction Act, $324,600,000, to remain avail16 able until September 30, 2019. 

17 OPERATION AND MAINTENANCE, NATIONAL DEFENSE

18 RESTORATION FUND

19 (INCLUDING TRANSFER OF FUNDS)

20 In addition to amounts provided elsewhere in this Act, 

21 there is appropriated $5,000,000,000, for the ‘‘Operation 

22 and Maintenance, National Defense Restoration Fund’’: 

23 Provided, That such funds provided under this heading 

24 shall only be available for programs, projects and activities 

25 necessary to implement the 2018 National Defense Strategy: 
21 

•HR 1892 EAH 

1 Provided further, That such funds shall not be available for 

2 transfer until 30 days after the Secretary has submitted, 

3 and the congressional defense committees have approved, the 

4 proposed allocation plan for the use of such funds to imple5 ment such strategy: Provided further, That such allocation 

6 plan shall include a detailed justification for the use of such 

7 funds and a description of how such investments are nec8 essary to implement the strategy: Provided further, That the 

9 Secretary of Defense may transfer these funds only to oper10 ation and maintenance accounts: Provided further, That the 

11 funds transferred shall be merged with and shall be avail12 able for the same purposes and for the same time period, 

13 as the appropriation to which transferred: Provided further, 

14 That none of the funds made available under this heading 

15 may be transferred to any program, project, or activity spe16 cifically limited or denied by this Act: Provided further, 

17 That the transfer authority provided under this heading is 

18 in addition to any other transfer authority available to the 

19 Department of Defense. 

20 TITLE III 

21 PROCUREMENT 

22 AIRCRAFT PROCUREMENT, ARMY

23 For construction, procurement, production, modifica24 tion, and modernization of aircraft, equipment, including 

25 ordnance, ground handling equipment, spare parts, and ac-
22 

•HR 1892 EAH 

1 cessories therefor; specialized equipment and training de2 vices; expansion of public and private plants, including the 

3 land necessary therefor, for the foregoing purposes, and such 

4 lands and interests therein, may be acquired, and construc5 tion prosecuted thereon prior to approval of title; and pro6 curement and installation of equipment, appliances, and 

7 machine tools in public and private plants; reserve plant 

8 and Government and contractor-owned equipment layaway; 

9 and other expenses necessary for the foregoing purposes, 

10 $4,456,533,000, to remain available for obligation until 

11 September 30, 2020. 

12 MISSILE PROCUREMENT, ARMY

13 For construction, procurement, production, modifica14 tion, and modernization of missiles, equipment, including 

15 ordnance, ground handling equipment, spare parts, and ac16 cessories therefor; specialized equipment and training de17 vices; expansion of public and private plants, including the 

18 land necessary therefor, for the foregoing purposes, and such 

19 lands and interests therein, may be acquired, and construc20 tion prosecuted thereon prior to approval of title; and pro21 curement and installation of equipment, appliances, and 

22 machine tools in public and private plants; reserve plant 

23 and Government and contractor-owned equipment layaway; 

24 and other expenses necessary for the foregoing purposes, 
23 

•HR 1892 EAH 

1 $2,581,600,000, to remain available for obligation until 

2 September 30, 2020. 

3 PROCUREMENT OF WEAPONS AND TRACKED COMBAT

4 VEHICLES, ARMY

5 For construction, procurement, production, and modi6 fication of weapons and tracked combat vehicles, equipment, 

7 including ordnance, spare parts, and accessories therefor; 

8 specialized equipment and training devices; expansion of 

9 public and private plants, including the land necessary 

10 therefor, for the foregoing purposes, and such lands and in11 terests therein, may be acquired, and construction pros12 ecuted thereon prior to approval of title; and procurement 

13 and installation of equipment, appliances, and machine 

14 tools in public and private plants; reserve plant and Gov15 ernment and contractor-owned equipment layaway; and 

16 other expenses necessary for the foregoing purposes, 

17 $3,556,175,000, to remain available for obligation until 

18 September 30, 2020. 

19 PROCUREMENT OF AMMUNITION, ARMY

20 For construction, procurement, production, and modi21 fication of ammunition, and accessories therefor; specialized 

22 equipment and training devices; expansion of public and 

23 private plants, including ammunition facilities, authorized 

24 by section 2854 of title 10, United States Code, and the 

25 land necessary therefor, for the foregoing purposes, and such 
24 

•HR 1892 EAH 

1 lands and interests therein, may be acquired, and construc2 tion prosecuted thereon prior to approval of title; and pro3 curement and installation of equipment, appliances, and 

4 machine tools in public and private plants; reserve plant 

5 and Government and contractor-owned equipment layaway; 

6 and other expenses necessary for the foregoing purposes, 

7 $1,811,808,000, to remain available for obligation until 

8 September 30, 2020. 

9 OTHER PROCUREMENT, ARMY

10 For construction, procurement, production, and modi11 fication of vehicles, including tactical, support, and non12 tracked combat vehicles; the purchase of passenger motor ve13 hicles for replacement only; communications and electronic 

14 equipment; other support equipment; spare parts, ordnance, 

15 and accessories therefor; specialized equipment and training 

16 devices; expansion of public and private plants, including 

17 the land necessary therefor, for the foregoing purposes, and 

18 such lands and interests therein, may be acquired, and con19 struction prosecuted thereon prior to approval of title; and 

20 procurement and installation of equipment, appliances, 

21 and machine tools in public and private plants; reserve 

22 plant and Government and contractor-owned equipment 

23 layaway; and other expenses necessary for the foregoing 

24 purposes, $6,356,044,000 (increased by $30,000,000), to re25 main available for obligation until September 30, 2020. 
25 

•HR 1892 EAH 

1 AIRCRAFT PROCUREMENT, NAVY

2 For construction, procurement, production, modifica3 tion, and modernization of aircraft, equipment, including 

4 ordnance, spare parts, and accessories therefor; specialized 

5 equipment; expansion of public and private plants, includ6 ing the land necessary therefor, and such lands and inter7 ests therein, may be acquired, and construction prosecuted 

8 thereon prior to approval of title; and procurement and in9 stallation of equipment, appliances, and machine tools in 

10 public and private plants; reserve plant and Government 

11 and contractor-owned equipment layaway, 

12 $17,908,270,000, to remain available for obligation until 

13 September 30, 2020. 

14 WEAPONS PROCUREMENT, NAVY

15 For construction, procurement, production, modifica16 tion, and modernization of missiles, torpedoes, other weap17 ons, and related support equipment including spare parts, 

18 and accessories therefor; expansion of public and private 

19 plants, including the land necessary therefor, and such 

20 lands and interests therein, may be acquired, and construc21 tion prosecuted thereon prior to approval of title; and pro22 curement and installation of equipment, appliances, and 

23 machine tools in public and private plants; reserve plant 

24 and Government and contractor-owned equipment layaway, 
26 

•HR 1892 EAH 

1 $3,387,826,000 (increased by $26,200,000), to remain 

2 available for obligation until September 30, 2020. 

3 PROCUREMENT OF AMMUNITION, NAVY AND MARINE

4 CORPS

5 For construction, procurement, production, and modi6 fication of ammunition, and accessories therefor; specialized 

7 equipment and training devices; expansion of public and 

8 private plants, including ammunition facilities, authorized 

9 by section 2854 of title 10, United States Code, and the 

10 land necessary therefor, for the foregoing purposes, and such 

11 lands and interests therein, may be acquired, and construc12 tion prosecuted thereon prior to approval of title; and pro13 curement and installation of equipment, appliances, and 

14 machine tools in public and private plants; reserve plant 

15 and Government and contractor-owned equipment layaway; 

16 and other expenses necessary for the foregoing purposes, 

17 $735,651,000, to remain available for obligation until Sep18 tember 30, 2020. 

19 SHIPBUILDING AND CONVERSION, NAVY

20 For expenses necessary for the construction, acquisi21 tion, or conversion of vessels as authorized by law, includ22 ing armor and armament thereof, plant equipment, appli23 ances, and machine tools and installation thereof in public 

24 and private plants; reserve plant and Government and con25 tractor-owned equipment layaway; procurement of critical, 
27 

•HR 1892 EAH 

1 long lead time components and designs for vessels to be con2 structed or converted in the future; and expansion of public 

3 and private plants, including land necessary therefor, and 

4 such lands and interests therein, may be acquired, and con5 struction prosecuted thereon prior to approval of title, as 

6 follows: 

7 Ohio Replacement Submarine (AP), 

8 $842,853,000; 

9 Carrier Replacement Program, $1,869,646,000; 

10 Carrier Replacement Program (AP), 

11 $2,561,058,000; 

12 Virginia Class Submarine, $3,305,315,000; 

13 Virginia Class Submarine (AP), $1,920,596,000; 

14 CVN Refueling Overhauls, $1,569,669,000; 

15 CVN Refueling Overhauls (AP), $75,897,000; 

16 DDG–1000 Program, $164,976,000; 

17 DDG–51 Destroyer, $3,499,079,000; 

18 DDG–51 Destroyer (AP), $90,336,000; 

19 Littoral Combat Ship, $1,566,971,000; 

20 Expeditionary Sea Base, $635,000,000; 

21 LHA Replacement, $1,695,077,000; 

22 TAO Fleet Oiler, $449,415,000; 

23 TAO Fleet Oiler (AP), $75,068,000; 

24 Ship to Shore Connector, $390,554,000; 

25 Service Craft, $23,994,000; 
28 

•HR 1892 EAH 

1 Towing, Salvage, and Rescue Ship, $76,204,000; 

2 LCU 1700, $31,850,000; 

3 For outfitting, post delivery, conversions, and 

4 first destination transportation, $542,626,000; and 

5 Completion of Prior Year Shipbuilding Pro6 grams, $117,542,000. 

7 In all: $21,503,726,000, to remain available for obliga8 tion until September 30, 2022: Provided, That additional 

9 obligations may be incurred after September 30, 2022, for 

10 engineering services, tests, evaluations, and other such budg11 eted work that must be performed in the final stage of ship 

12 construction: Provided further, That none of the funds pro13 vided under this heading for the construction or conversion 

14 of any naval vessel to be constructed in shipyards in the 

15 United States shall be expended in foreign facilities for the 

16 construction of major components of such vessel: Provided 

17 further, That none of the funds provided under this heading 

18 shall be used for the construction of any naval vessel in 

19 foreign shipyards: Provided further, That funds appro20 priated or otherwise made available by this Act for produc21 tion of the common missile compartment of nuclear-powered 

22 vessels may be available for multiyear procurement of crit23 ical components to support continuous production of such 

24 compartments only in accordance with the provisions of 

25 subsection (i) of section 2218a of title 10, United States 
29 

•HR 1892 EAH 

1 Code (as added by section 1023 of the National Defense Au2 thorization Act for Fiscal Year 2017 (Public Law 114– 

3 328)). 

4 OTHER PROCUREMENT, NAVY

5 For procurement, production, and modernization of 

6 support equipment and materials not otherwise provided 

7 for, Navy ordnance (except ordnance for new aircraft, new 

8 ships, and ships authorized for conversion); the purchase 

9 of passenger motor vehicles for replacement only; expansion 

10 of public and private plants, including the land necessary 

11 therefor, and such lands and interests therein, may be ac12 quired, and construction prosecuted thereon prior to ap13 proval of title; and procurement and installation of equip14 ment, appliances, and machine tools in public and private 

15 plants; reserve plant and Government and contractor-owned 

16 equipment layaway, $7,852,952,000, to remain available 

17 for obligation until September 30, 2020. 

18 PROCUREMENT, MARINE CORPS

19 For expenses necessary for the procurement, manufac20 ture, and modification of missiles, armament, military 

21 equipment, spare parts, and accessories therefor; plant 

22 equipment, appliances, and machine tools, and installation 

23 thereof in public and private plants; reserve plant and Gov24 ernment and contractor-owned equipment layaway; vehicles 

25 for the Marine Corps, including the purchase of passenger 
30 

•HR 1892 EAH 

1 motor vehicles for replacement only; and expansion of pub2 lic and private plants, including land necessary therefor, 

3 and such lands and interests therein, may be acquired, and 

4 construction prosecuted thereon prior to approval of title, 

5 $1,818,846,000 (increased by $20,000,000), to remain 

6 available for obligation until September 30, 2020. 

7 AIRCRAFT PROCUREMENT, AIR FORCE

8 For construction, procurement, and modification of 

9 aircraft and equipment, including armor and armament, 

10 specialized ground handling equipment, and training de11 vices, spare parts, and accessories therefor; specialized 

12 equipment; expansion of public and private plants, Govern13 ment-owned equipment and installation thereof in such 

14 plants, erection of structures, and acquisition of land, for 

15 the foregoing purposes, and such lands and interests therein, 

16 may be acquired, and construction prosecuted thereon prior 

17 to approval of title; reserve plant and Government and con18 tractor-owned equipment layaway; and other expenses nec19 essary for the foregoing purposes including rents and trans20 portation of things, $16,553,196,000 (increased by 

21 $16,000,000), to remain available for obligation until Sep22 tember 30, 2020. 

23 MISSILE PROCUREMENT, AIR FORCE

24 For construction, procurement, and modification of 

25 missiles, rockets, and related equipment, including spare 
31 

•HR 1892 EAH 

1 parts and accessories therefor; ground handling equipment, 

2 and training devices; expansion of public and private 

3 plants, Government-owned equipment and installation 

4 thereof in such plants, erection of structures, and acquisi5 tion of land, for the foregoing purposes, and such lands and 

6 interests therein, may be acquired, and construction pros7 ecuted thereon prior to approval of title; reserve plant and 

8 Government and contractor-owned equipment layaway; and 

9 other expenses necessary for the foregoing purposes includ10 ing rents and transportation of things, $2,203,101,000, to 

11 remain available for obligation until September 30, 2020. 

12 SPACE PROCUREMENT, AIR FORCE

13 For construction, procurement, and modification of 

14 spacecraft, rockets, and related equipment, including spare 

15 parts and accessories therefor; ground handling equipment, 

16 and training devices; expansion of public and private 

17 plants, Government-owned equipment and installation 

18 thereof in such plants, erection of structures, and acquisi19 tion of land, for the foregoing purposes, and such lands and 

20 interests therein, may be acquired, and construction pros21 ecuted thereon prior to approval of title; reserve plant and 

22 Government and contractor-owned equipment layaway; and 

23 other expenses necessary for the foregoing purposes includ24 ing rents and transportation of things, $3,210,355,000, to 

25 remain available for obligation until September 30, 2020. 
32 

•HR 1892 EAH 

1 PROCUREMENT OF AMMUNITION, AIR FORCE

2 For construction, procurement, production, and modi3 fication of ammunition, and accessories therefor; specialized 

4 equipment and training devices; expansion of public and 

5 private plants, including ammunition facilities, authorized 

6 by section 2854 of title 10, United States Code, and the 

7 land necessary therefor, for the foregoing purposes, and such 

8 lands and interests therein, may be acquired, and construc9 tion prosecuted thereon prior to approval of title; and pro10 curement and installation of equipment, appliances, and 

11 machine tools in public and private plants; reserve plant 

12 and Government and contractor-owned equipment layaway; 

13 and other expenses necessary for the foregoing purposes, 

14 $1,316,977,000, to remain available for obligation until 

15 September 30, 2020. 

16 OTHER PROCUREMENT, AIR FORCE

17 For procurement and modification of equipment (in18 cluding ground guidance and electronic control equipment, 

19 and ground electronic and communication equipment), and 

20 supplies, materials, and spare parts therefor, not otherwise 

21 provided for; the purchase of passenger motor vehicles for 

22 replacement only; lease of passenger motor vehicles; and ex23 pansion of public and private plants, Government-owned 

24 equipment and installation thereof in such plants, erection 

25 of structures, and acquisition of land, for the foregoing pur-
33 

•HR 1892 EAH 

1 poses, and such lands and interests therein, may be ac2 quired, and construction prosecuted thereon, prior to ap3 proval of title; reserve plant and Government and con4 tractor-owned equipment layaway, $19,318,814,000, to re5 main available for obligation until September 30, 2020. 

6 PROCUREMENT, DEFENSE-WIDE

7 For expenses of activities and agencies of the Depart8 ment of Defense (other than the military departments) nec9 essary for procurement, production, and modification of 

10 equipment, supplies, materials, and spare parts therefor, 

11 not otherwise provided for; the purchase of passenger motor 

12 vehicles for replacement only; expansion of public and pri13 vate plants, equipment, and installation thereof in such 

14 plants, erection of structures, and acquisition of land for 

15 the foregoing purposes, and such lands and interests therein, 

16 may be acquired, and construction prosecuted thereon prior 

17 to approval of title; reserve plant and Government and con18 tractor-owned equipment layaway, $5,239,239,000 (reduced 

19 by $10,000,000), to remain available for obligation until 

20 September 30, 2020. 

21 DEFENSE PRODUCTION ACT PURCHASES

22 For activities by the Department of Defense pursuant 

23 to sections 108, 301, 302, and 303 of the Defense Production 

24 Act of 1950 (50 U.S.C. 4518, 4531, 4532, and 4533), 

25 $67,401,000, to remain available until expended. 
34 

•HR 1892 EAH 

1 PROCUREMENT, NATIONAL DEFENSE RESTORATION FUND

2 (INCLUDING TRANSFER OF FUNDS)

3 In addition to amounts provided elsewhere in this Act, 

4 there is appropriated $12,622,931,000, for the ‘‘Procure5 ment, National Defense Restoration Fund’’: Provided, That 

6 such funds provided under this heading shall only be avail7 able for programs, projects and activities necessary to im8 plement the 2018 National Defense Strategy: Provided fur9 ther, That such funds shall not be available for transfer 

10 until 30 days after the Secretary has submitted, and the 

11 congressional defense committees have approved, the pro12 posed allocation plan for the use of such funds to implement 

13 such strategy: Provided further, That such allocation plan 

14 shall include a detailed justification for the use of such 

15 funds and a description of how such investments are nec16 essary to implement the strategy: Provided further, That the 

17 Secretary of Defense may transfer these funds only to pro18 curement accounts: Provided further, That the funds trans19 ferred shall be merged with and shall be available for the 

20 same purposes and for the same time period, as the appro21 priation to which transferred: Provided further, That none 

22 of the funds made available under this heading may be 

23 transferred to any program, project, or activity specifically 

24 limited or denied by this Act, except for missile defense re25 quirements resulting from urgent or emergent operational 
35 

•HR 1892 EAH 

1 needs: Provided further, That the transfer authority pro2 vided under this heading is in addition to any other trans3 fer authority available to the Department of Defense. 

4 TITLE IV 

5 RESEARCH, DEVELOPMENT, TEST AND 

6 EVALUATION 

7 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, ARMY

8 For expenses necessary for basic and applied scientific 

9 research, development, test and evaluation, including main10 tenance, rehabilitation, lease, and operation of facilities 

11 and equipment, $9,674,222,000 (increased by $6,000,000) 

12 (increased by $4,000,000) (increased by $12,000,000) (in13 creased by $5,000,000), to remain available for obligation 

14 until September 30, 2019. 

15 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, NAVY

16 For expenses necessary for basic and applied scientific 

17 research, development, test and evaluation, including main18 tenance, rehabilitation, lease, and operation of facilities 

19 and equipment, $17,196,521,000 (increased by $598,000) 

20 (increased by $20,000,000) (reduced by $2,500,000) (in21 creased by $24,000,000), to remain available for obligation 

22 until September 30, 2019: Provided, That funds appro23 priated in this paragraph which are available for the V– 

24 22 may be used to meet unique operational requirements 

25 of the Special Operations Forces. 
36 

•HR 1892 EAH 

1 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, AIR

2 FORCE

3 For expenses necessary for basic and applied scientific 

4 research, development, test and evaluation, including main5 tenance, rehabilitation, lease, and operation of facilities 

6 and equipment, $33,874,980,000 (increased by $5,000,000) 

7 (increased by $6,000,000) (increased by $10,000,000) (re8 duced by $30,000,000) (increased by $30,000,000), to re9 main available for obligation until September 30, 2019. 

10 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, 

11 DEFENSE-WIDE

12 (INCLUDING TRANSFER OF FUNDS)

13 For expenses of activities and agencies of the Depart14 ment of Defense (other than the military departments), nec15 essary for basic and applied scientific research, develop16 ment, test and evaluation; advanced research projects as 

17 may be designated and determined by the Secretary of De18 fense, pursuant to law; maintenance, rehabilitation, lease, 

19 and operation of facilities and equipment, $20,698,353,000 

20 (reduced by $16,000,000) (reduced by $12,000,000) (reduced 

21 by $2,500,000) (reduced by $12,500,000) (increased by 

22 $20,000,000) (reduced by $20,000,000) (reduced by 

23 $4,135,000) (increased by $4,135,000) (reduced by 

24 $27,500,000) (increased by $10,000,000), to remain avail25 able for obligation until September 30, 2019: Provided, 
37 

•HR 1892 EAH 

1 That, of the funds made available in this paragraph, 

2 $250,000,000 for the Defense Rapid Innovation Program 

3 shall only be available for expenses, not otherwise provided 

4 for, to include program management and oversight, to con5 duct research, development, test and evaluation to include 

6 proof of concept demonstration; engineering, testing, and 

7 validation; and transition to full-scale production: Provided 

8 further, That the Secretary of Defense may transfer funds 

9 provided herein for the Defense Rapid Innovation Program 

10 to appropriations for research, development, test and eval11 uation to accomplish the purpose provided herein: Provided 

12 further, That this transfer authority is in addition to any 

13 other transfer authority available to the Department of De14 fense: Provided further, That the Secretary of Defense shall, 

15 not fewer than 30 days prior to making transfers from this 

16 appropriation, notify the congressional defense committees 

17 in writing of the details of any such transfer. 

18 OPERATIONAL TEST AND EVALUATION, DEFENSE

19 For expenses, not otherwise provided for, necessary for 

20 the independent activities of the Director, Operational Test 

21 and Evaluation, in the direction and supervision of oper22 ational test and evaluation, including initial operational 

23 test and evaluation which is conducted prior to, and in sup24 port of, production decisions; joint operational testing and 

25 evaluation; and administrative expenses in connection 
38 

•HR 1892 EAH 

1 therewith, $210,900,000, to remain available for obligation 

2 until September 30, 2019. 

3 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, 

4 NATIONAL DEFENSE RESTORATION FUND

5 (INCLUDING TRANSFER OF FUNDS)

6 In addition to amounts provided elsewhere in this Act, 

7 there is appropriated $1,000,000,000, for the ‘‘Research, De8 velopment, Test and Evaluation, National Defense Restora9 tion Fund’’: Provided, That such funds provided under this 

10 heading shall only be available for programs, projects and 

11 activities necessary to implement the 2018 National Defense 

12 Strategy: Provided further, That such funds shall not be 

13 available for transfer until 30 days after the Secretary has 

14 submitted, and the congressional defense committees have 

15 approved, the proposed allocation plan for the use of such 

16 funds to implement such strategy: Provided further, That 

17 such allocation plan shall include a detailed justification 

18 for the use of such funds and a description of how such 

19 investments are necessary to implement the strategy: Pro20 vided further, That the Secretary of Defense may transfer 

21 these funds only to research, development, test and evalua22 tion accounts: Provided further, That the funds transferred 

23 shall be merged with and shall be available for the same 

24 purposes and for the same time period, as the appropriation 

25 to which transferred: Provided further, That none of the 
39 

•HR 1892 EAH 

1 funds made available under this heading may be trans2 ferred to any program, project, or activity specifically lim3 ited or denied by this Act, except for missile defense require4 ments resulting from urgent or emergent operational needs: 

5 Provided further, That the transfer authority provided 

6 under this heading is in addition to any other transfer au7 thority available to the Department of Defense. 

8 TITLE V 

9 REVOLVING AND MANAGEMENT FUNDS 

10 DEFENSE WORKING CAPITAL FUNDS

11 For the Defense Working Capital Funds, 

12 $1,586,596,000. 

13 TITLE VI 

14 OTHER DEPARTMENT OF DEFENSE PROGRAMS 

15 DEFENSE HEALTH PROGRAM

16 For expenses, not otherwise provided for, for medical 

17 and health care programs of the Department of Defense as 

18 authorized by law, $33,931,566,000 (increased by 

19 $7,000,000) (increased by $1,000,000) (increased by 

20 $10,000,000) (increased by $2,000,000) (increased by 

21 $2,000,000) (increased by $10,000,000) (increased by 

22 $5,000,000) (increased by $10,000,000); of which 

23 $31,735,923,000 (increased by $2,000,000) (increased by 

24 $5,000,000) shall be for operation and maintenance, of 

25 which not to exceed one percent shall remain available for 
40 

•HR 1892 EAH 

1 obligation until September 30, 2019, and of which up to 

2 $15,349,700,000 may be available for contracts entered into 

3 under the TRICARE program; of which $895,328,000, to 

4 remain available for obligation until September 30, 2020, 

5 shall be for procurement; and of which $1,300,315,000 (in6 creased by $7,000,000) (increased by $1,000,000) (increased 

7 by $10,000,000) (increased by $2,000,000) (increased by 

8 $10,000,000) (increased by $10,000,000), to remain avail9 able for obligation until September 30, 2019, shall be for 

10 research, development, test and evaluation: Provided, That, 

11 notwithstanding any other provision of law, of the amount 

12 made available under this heading for research, develop13 ment, test and evaluation, not less than $8,000,000 shall 

14 be available for HIV prevention educational activities un15 dertaken in connection with United States military train16 ing, exercises, and humanitarian assistance activities con17 ducted primarily in African nations: Provided further, 

18 That of the funds provided under this heading for research, 

19 development, test and evaluation, not less than 

20 $627,100,000 shall be made available to the United States 

21 Army Medical Research and Materiel Command to carry 

22 out the congressionally directed medical research programs. 
41 

•HR 1892 EAH 

1 CHEMICAL AGENTS AND MUNITIONS DESTRUCTION, 

2 DEFENSE

3 For expenses, not otherwise provided for, necessary for 

4 the destruction of the United States stockpile of lethal chem5 ical agents and munitions in accordance with the provi6 sions of section 1412 of the Department of Defense Author7 ization Act, 1986 (50 U.S.C. 1521), and for the destruction 

8 of other chemical warfare materials that are not in the 

9 chemical weapon stockpile, $961,732,000, of which 

10 $104,237,000 shall be for operation and maintenance, of 

11 which no less than $49,401,000 shall be for the Chemical 

12 Stockpile Emergency Preparedness Program, consisting of 

13 $21,045,000 for activities on military installations and 

14 $28,356,000, to remain available until September 30, 2019, 

15 to assist State and local governments; $18,081,000 shall be 

16 for procurement, to remain available until September 30, 

17 2020, of which $18,081,000 shall be for the Chemical Stock18 pile Emergency Preparedness Program to assist State and 

19 local governments; and $839,414,000, to remain available 

20 until September 30, 2019, shall be for research, develop21 ment, test and evaluation, of which $750,700,000 shall only 

22 be for the Assembled Chemical Weapons Alternatives pro23 gram. 
42 

•HR 1892 EAH 

1 DRUG INTERDICTION AND COUNTER-DRUG ACTIVITIES, 

2 DEFENSE

3 (INCLUDING TRANSFER OF FUNDS)

4 For drug interdiction and counter-drug activities of 

5 the Department of Defense, for transfer to appropriations 

6 available to the Department of Defense for military per7 sonnel of the reserve components serving under the provi8 sions of title 10 and title 32, United States Code; for oper9 ation and maintenance; for procurement; and for research, 

10 development, test and evaluation, $854,814,000, of which 

11 $532,648,000 shall be for counter-narcotics support; 

12 $120,813,000 shall be for the drug demand reduction pro13 gram; and $201,353,000 shall be for the National Guard 

14 counter-drug program: Provided, That the funds appro15 priated under this heading shall be available for obligation 

16 for the same time period and for the same purpose as the 

17 appropriation to which transferred: Provided further, That 

18 upon a determination that all or part of the funds trans19 ferred from this appropriation are not necessary for the 

20 purposes provided herein, such amounts may be transferred 

21 back to this appropriation: Provided further, That the 

22 transfer authority provided under this heading is in addi23 tion to any other transfer authority contained elsewhere in 

24 this Act. 
43 

•HR 1892 EAH 

1 OFFICE OF THE INSPECTOR GENERAL

2 For expenses and activities of the Office of the Inspec3 tor General in carrying out the provisions of the Inspector 

4 General Act of 1978, as amended, $336,887,000, of which 

5 $334,087,000 shall be for operation and maintenance, of 

6 which not to exceed $700,000 is available for emergencies 

7 and extraordinary expenses to be expended on the approval 

8 or authority of the Inspector General, and payments may 

9 be made on the Inspector General’s certificate of necessity 

10 for confidential military purposes; and of which $2,800,000, 

11 to remain available until September 30, 2019, shall be for 

12 research, development, test and evaluation. 

13 TITLE VII 

14 RELATED AGENCIES 

15 CENTRAL INTELLIGENCE AGENCY RETIREMENT AND

16 DISABILITY SYSTEM FUND

17 For payment to the Central Intelligence Agency Retire18 ment and Disability System Fund, to maintain the proper 

19 funding level for continuing the operation of the Central 

20 Intelligence Agency Retirement and Disability System, 

21 $514,000,000. 

22 INTELLIGENCE COMMUNITY MANAGEMENT ACCOUNT

23 For necessary expenses of the Intelligence Community 

24 Management Account, $522,100,000. 
44 

•HR 1892 EAH 

1 TITLE VIII 

2 GENERAL PROVISIONS 

3 SEC. 1101. No part of any appropriation contained 

4 in this Act shall be used for publicity or propaganda pur5 poses not authorized by the Congress. 

6 SEC. 1102. During the current fiscal year, provisions 

7 of law prohibiting the payment of compensation to, or em8 ployment of, any person not a citizen of the United States 

9 shall not apply to personnel of the Department of Defense: 

10 Provided, That salary increases granted to direct and indi11 rect hire foreign national employees of the Department of 

12 Defense funded by this Act shall not be at a rate in excess 

13 of the percentage increase authorized by law for civilian 

14 employees of the Department of Defense whose pay is com15 puted under the provisions of section 5332 of title 5, United 

16 States Code, or at a rate in excess of the percentage increase 

17 provided by the appropriate host nation to its own employ18 ees, whichever is higher: Provided further, That this section 

19 shall not apply to Department of Defense foreign service 

20 national employees serving at United States diplomatic 

21 missions whose pay is set by the Department of State under 

22 the Foreign Service Act of 1980: Provided further, That the 

23 limitations of this provision shall not apply to foreign na24 tional employees of the Department of Defense in the Re25 public of Turkey. 
45 

•HR 1892 EAH 

1 SEC. 1103. No part of any appropriation contained 

2 in this Act shall remain available for obligation beyond the 

3 current fiscal year, unless expressly so provided herein. 

4 SEC. 1104. No more than 20 percent of the appropria5 tions in this Act which are limited for obligation during 

6 the current fiscal year shall be obligated during the last 2 

7 months of the fiscal year: Provided, That this section shall 

8 not apply to obligations for support of active duty training 

9 of reserve components or summer camp training of the Re10 serve Officers’ Training Corps. 

11 (TRANSFER OF FUNDS)

12 SEC. 1105. Upon determination by the Secretary of 

13 Defense that such action is necessary in the national inter14 est, he may, with the approval of the Office of Management 

15 and Budget, transfer not to exceed $4,500,000,000 of work16 ing capital funds of the Department of Defense or funds 

17 made available in this Act to the Department of Defense 

18 for military functions (except military construction) be19 tween such appropriations or funds or any subdivision 

20 thereof, to be merged with and to be available for the same 

21 purposes, and for the same time period, as the appropria22 tion or fund to which transferred: Provided, That such au23 thority to transfer may not be used unless for higher pri24 ority items, based on unforeseen military requirements, 

25 than those for which originally appropriated and in no case 
46 

•HR 1892 EAH 

1 where the item for which funds are requested has been de2 nied by the Congress: Provided further, That the Secretary 

3 of Defense shall notify the Congress promptly of all transfers 

4 made pursuant to this authority or any other authority in 

5 this Act: Provided further, That no part of the funds in 

6 this Act shall be available to prepare or present a request 

7 to the Committees on Appropriations for reprogramming 

8 of funds, unless for higher priority items, based on unfore9 seen military requirements, than those for which originally 

10 appropriated and in no case where the item for which re11 programming is requested has been denied by the Congress: 

12 Provided further, That a request for multiple 

13 reprogrammings of funds using authority provided in this 

14 section shall be made prior to June 30, 2017: Provided fur15 ther, That transfers among military personnel appropria16 tions shall not be taken into account for purposes of the 

17 limitation on the amount of funds that may be transferred 

18 under this section. 

19 SEC. 1106. (a) With regard to the list of specific pro20 grams, projects, and activities (and the dollar amounts and 

21 adjustments to budget activities corresponding to such pro22 grams, projects, and activities) contained in the tables titled 

23 Explanation of Project Level Adjustments in the explana24 tory statement regarding this Act, the obligation and ex25 penditure of amounts appropriated or otherwise made 
47 

•HR 1892 EAH 

1 available in this Act for those programs, projects, and ac2 tivities for which the amounts appropriated exceed the 

3 amounts requested are hereby required by law to be carried 

4 out in the manner provided by such tables to the same ex5 tent as if the tables were included in the text of this Act. 

6 (b) Amounts specified in the referenced tables described 

7 in subsection (a) shall not be treated as subdivisions of ap8 propriations for purposes of section 8005 of this Act: Pro9 vided, That section 8005 shall apply when transfers of the 

10 amounts described in subsection (a) occur between appro11 priation accounts. 

12 SEC. 1107. (a) Not later than 60 days after enactment 

13 of this Act, the Department of Defense shall submit a report 

14 to the congressional defense committees to establish the base15 line for application of reprogramming and transfer au16 thorities for fiscal year 2018: Provided, That the report 

17 shall include— 

18 (1) a table for each appropriation with a sepa19 rate column to display the President’s budget request, 

20 adjustments made by Congress, adjustments due to 

21 enacted rescissions, if appropriate, and the fiscal year 

22 enacted level; 

23 (2) a delineation in the table for each appropria24 tion both by budget activity and program, project, 

25 and activity as detailed in the Budget Appendix; and 
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•HR 1892 EAH 

1 (3) an identification of items of special congres2 sional interest. 

3 (b) Notwithstanding section 8005 of this Act, none of 

4 the funds provided in this Act shall be available for re5 programming or transfer until the report identified in sub6 section (a) is submitted to the congressional defense commit7 tees, unless the Secretary of Defense certifies in writing to 

8 the congressional defense committees that such reprogram9 ming or transfer is necessary as an emergency requirement: 

10 Provided, That this subsection shall not apply to transfers 

11 from the following appropriations accounts: 

12 (1) ‘‘Environmental Restoration, Army’’; 

13 (2) ‘‘Environmental Restoration, Navy’’ ; 

14 (3) ‘‘Environmental Restoration, Air Force’’; 

15 (4) ‘‘Environmental Restoration, Defense-Wide’’ 

16 (5) ‘‘Environmental Restoration, Formerly Used 

17 Defense Sites’’; and 

18 (6) ‘‘Drug Interdiction and Counter-drug Activi19 ties, Defense’’. 

20 (TRANSFER OF FUNDS)

21 SEC. 1108. During the current fiscal year, cash bal22 ances in working capital funds of the Department of De23 fense established pursuant to section 2208 of title 10, United 

24 States Code, may be maintained in only such amounts as 

25 are necessary at any time for cash disbursements to be made 
49 

•HR 1892 EAH 

1 from such funds: Provided, That transfers may be made be2 tween such funds: Provided further, That transfers may be 

3 made between working capital funds and the ‘‘Foreign Cur4 rency Fluctuations, Defense’’ appropriation and the ‘‘Oper5 ation and Maintenance’’ appropriation accounts in such 

6 amounts as may be determined by the Secretary of Defense, 

7 with the approval of the Office of Management and Budget, 

8 except that such transfers may not be made unless the Sec9 retary of Defense has notified the Congress of the proposed 

10 transfer: Provided further, That except in amounts equal 

11 to the amounts appropriated to working capital funds in 

12 this Act, no obligations may be made against a working 

13 capital fund to procure or increase the value of war reserve 

14 material inventory, unless the Secretary of Defense has no15 tified the Congress prior to any such obligation. 

16 SEC. 1109. Funds appropriated by this Act may not 

17 be used to initiate a special access program without prior 

18 notification 30 calendar days in advance to the congres19 sional defense committees. 

20 SEC. 1110. None of the funds provided in this Act shall 

21 be available to initiate: (1) a multiyear contract that em22 ploys economic order quantity procurement in excess of 

23 $20,000,000 in any one year of the contract or that includes 

24 an unfunded contingent liability in excess of $20,000,000; 

25 or (2) a contract for advance procurement leading to a 
50 

•HR 1892 EAH 

1 multiyear contract that employs economic order quantity 

2 procurement in excess of $20,000,000 in any one year, un3 less the congressional defense committees have been notified 

4 at least 30 days in advance of the proposed contract award: 

5 Provided, That no part of any appropriation contained in 

6 this Act shall be available to initiate a multiyear contract 

7 for which the economic order quantity advance procurement 

8 is not funded at least to the limits of the Government’s li9 ability: Provided further, That no part of any appropria10 tion contained in this Act shall be available to initiate 

11 multiyear procurement contracts for any systems or compo12 nent thereof if the value of the multiyear contract would 

13 exceed $500,000,000 unless specifically provided in this Act: 

14 Provided further, That no multiyear procurement contract 

15 can be terminated without 30-day prior notification to the 

16 congressional defense committees: Provided further, That the 

17 execution of multiyear authority shall require the use of a 

18 present value analysis to determine lowest cost compared 

19 to an annual procurement: Provided further, That none of 

20 the funds provided in this Act may be used for a multiyear 

21 contract executed after the date of the enactment of this Act 

22 unless in the case of any such contract— 

23 (1) the Secretary of Defense has submitted to 

24 Congress a budget request for full funding of units to 

25 be procured through the contract and, in the case of 
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•HR 1892 EAH 

1 a contract for procurement of aircraft, that includes, 

2 for any aircraft unit to be procured through the con3 tract for which procurement funds are requested in 

4 that budget request for production beyond advance 

5 procurement activities in the fiscal year covered by 

6 the budget, full funding of procurement of such unit 

7 in that fiscal year; 

8 (2) cancellation provisions in the contract do not 

9 include consideration of recurring manufacturing 

10 costs of the contractor associated with the production 

11 of unfunded units to be delivered under the contract; 

12 (3) the contract provides that payments to the 

13 contractor under the contract shall not be made in 

14 advance of incurred costs on funded units; and 

15 (4) the contract does not provide for a price ad16 justment based on a failure to award a follow-on con17 tract. 

18 Funds appropriated in title III of this Act may be used, 

19 subject to section 2306b of title 10 , United States Code, 

20 for multiyear procurement contracts as follows: V–22 Os21 prey aircraft variants; up to 13 SSN Virginia Class Sub22 marines and Government-furnished equipment; and DDG– 

23 51 Arleigh Burke class Flight III guided missile destroyers, 

24 the MK 41 Vertical Launching Systems, and associated 

25 Government-furnished systems and subsystems. 
52 

•HR 1892 EAH 

1 SEC. 1111. Within the funds appropriated for the oper2 ation and maintenance of the Armed Forces, funds are here3 by appropriated pursuant to section 401 of title 10, United 

4 States Code, for humanitarian and civic assistance costs 

5 under chapter 20 of title 10, United States Code. Such funds 

6 may also be obligated for humanitarian and civic assist7 ance costs incidental to authorized operations and pursuant 

8 to authority granted in section 401 of chapter 20 of title 

9 10, United States Code, and these obligations shall be re10 ported as required by section 401(d) of title 10, United 

11 States Code: Provided, That funds available for operation 

12 and maintenance shall be available for providing humani13 tarian and similar assistance by using Civic Action Teams 

14 in the Trust Territories of the Pacific Islands and freely 

15 associated states of Micronesia, pursuant to the Compact 

16 of Free Association as authorized by Public Law 99–239: 

17 Provided further, That upon a determination by the Sec18 retary of the Army that such action is beneficial for grad19 uate medical education programs conducted at Army med20 ical facilities located in Hawaii, the Secretary of the Army 

21 may authorize the provision of medical services at such fa22 cilities and transportation to such facilities, on a nonreim23 bursable basis, for civilian patients from American Samoa, 

24 the Commonwealth of the Northern Mariana Islands, the 
53 

•HR 1892 EAH 

1 Marshall Islands, the Federated States of Micronesia, 

2 Palau, and Guam. 

3 SEC. 1112. (a) During the current fiscal year, the ci4 vilian personnel of the Department of Defense may not be 

5 managed on the basis of any end-strength, and the manage6 ment of such personnel during that fiscal year shall not be 

7 subject to any constraint or limitation (known as an end8 strength) on the number of such personnel who may be em9 ployed on the last day of such fiscal year. 

10 (b) The fiscal year 2019 budget request for the Depart11 ment of Defense as well as all justification material and 

12 other documentation supporting the fiscal year 2019 De13 partment of Defense budget request shall be prepared and 

14 submitted to the Congress as if subsections (a) and (b) of 

15 this provision were effective with regard to fiscal year 2019. 

16 (c) As required by section 1107 of the National Defense 

17 Authorization Act for Fiscal Year 2014 (Public Law 113– 

18 66; 10 U.S.C. 2358 note) civilian personnel at the Depart19 ment of Army Science and Technology Reinvention Labora20 tories may not be managed on the basis of the Table of Dis21 tribution and Allowances, and the management of the work22 force strength shall be done in a manner consistent with 

23 the budget available with respect to such Laboratories. 

24 (d) Nothing in this section shall be construed to apply 

25 to military (civilian) technicians. 
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•HR 1892 EAH 

1 SEC. 1113. None of the funds made available by this 

2 Act shall be used in any way, directly or indirectly, to in3 fluence congressional action on any legislation or appro4 priation matters pending before the Congress. 

5 SEC. 1114. None of the funds appropriated by this Act 

6 shall be available for the basic pay and allowances of any 

7 member of the Army participating as a full-time student 

8 and receiving benefits paid by the Secretary of Veterans Af9 fairs from the Department of Defense Education Benefits 

10 Fund when time spent as a full-time student is credited 

11 toward completion of a service commitment: Provided, That 

12 this section shall not apply to those members who have reen13 listed with this option prior to October 1, 1987: Provided 

14 further, That this section applies only to active components 

15 of the Army. 

16 (TRANSFER OF FUNDS)

17 SEC. 1115. Funds appropriated in title III of this Act 

18 for the Department of Defense Pilot Mentor-Prote ́ge ́ Pro19 gram may be transferred to any other appropriation con20 tained in this Act solely for the purpose of implementing 

21 a Mentor-Prote ́ge ́ Program developmental assistance agree22 ment pursuant to section 831 of the National Defense Au23 thorization Act for Fiscal Year 1991 (Public Law 101–510; 

24 10 U.S.C. 2302 note), as amended, under the authority of 
55 

•HR 1892 EAH 

1 this provision or any other transfer authority contained in 

2 this Act. 

3 SEC. 1116. None of the funds in this Act may be avail4 able for the purchase by the Department of Defense (and 

5 its departments and agencies) of welded shipboard anchor 

6 and mooring chain 4 inches in diameter and under unless 

7 the anchor and mooring chain are manufactured in the 

8 United States from components which are substantially 

9 manufactured in the United States: Provided, That for the 

10 purpose of this section, the term ‘‘manufactured’’ shall in11 clude cutting, heat treating, quality control, testing of chain 

12 and welding (including the forging and shot blasting proc13 ess): Provided further, That for the purpose of this section 

14 substantially all of the components of anchor and mooring 

15 chain shall be considered to be produced or manufactured 

16 in the United States if the aggregate cost of the components 

17 produced or manufactured in the United States exceeds the 

18 aggregate cost of the components produced or manufactured 

19 outside the United States: Provided further, That when ade20 quate domestic supplies are not available to meet Depart21 ment of Defense requirements on a timely basis, the Sec22 retary of the service responsible for the procurement may 

23 waive this restriction on a case-by-case basis by certifying 

24 in writing to the Committees on Appropriations that such 
56 

•HR 1892 EAH 

1 an acquisition must be made in order to acquire capability 

2 for national security purposes. 

3 SEC. 1117. None of the funds available to the Depart4 ment of Defense may be used to demilitarize or dispose of 

5 M–1 Carbines, M–1 Garand rifles, M–14 rifles, .22 caliber 

6 rifles, .30 caliber rifles, or M–1911 pistols, or to demili7 tarize or destroy small arms ammunition or ammunition 

8 components that are not otherwise prohibited from commer9 cial sale under Federal law, unless the small arms ammuni10 tion or ammunition components are certified by the Sec11 retary of the Army or designee as unserviceable or unsafe 

12 for further use. 

13 SEC. 1118. No more than $500,000 of the funds appro14 priated or made available in this Act shall be used during 

15 a single fiscal year for any single relocation of an organiza16 tion, unit, activity or function of the Department of Defense 

17 into or within the National Capital Region: Provided, That 

18 the Secretary of Defense may waive this restriction on a 

19 case-by-case basis by certifying in writing to the congres20 sional defense committees that such a relocation is required 

21 in the best interest of the Government. 

22 SEC. 1119. Of the funds made available in this Act, 

23 $20,000,000 shall be available for incentive payments au24 thorized by section 504 of the Indian Financing Act of 1974 

25 (25 U.S.C. 1544): Provided, That a prime contractor or a 
57 

•HR 1892 EAH 

1 subcontractor at any tier that makes a subcontract award 

2 to any subcontractor or supplier as defined in section 1544 

3 of title 25, United States Code, or a small business owned 

4 and controlled by an individual or individuals defined 

5 under section 4221(9) of title 25, United States Code, shall 

6 be considered a contractor for the purposes of being allowed 

7 additional compensation under section 504 of the Indian 

8 Financing Act of 1974 (25 U.S.C. 1544) whenever the 

9 prime contract or subcontract amount is over $500,000 and 

10 involves the expenditure of funds appropriated by an Act 

11 making appropriations for the Department of Defense with 

12 respect to any fiscal year: Provided further, That notwith13 standing section 1906 of title 41, United States Code, this 

14 section shall be applicable to any Department of Defense 

15 acquisition of supplies or services, including any contract 

16 and any subcontract at any tier for acquisition of commer17 cial items produced or manufactured, in whole or in part, 

18 by any subcontractor or supplier defined in section 1544 

19 of title 25, United States Code, or a small business owned 

20 and controlled by an individual or individuals defined 

21 under section 4221(9) of title 25, United States Code. 

22 SEC. 1120. Funds appropriated by this Act for the De23 fense Media Activity shall not be used for any national or 

24 international political or psychological activities. 
58 

•HR 1892 EAH 

1 SEC. 1121. During the current fiscal year, the Depart2 ment of Defense is authorized to incur obligations of not 

3 to exceed $350,000,000 for purposes specified in section 

4 2350j(c) of title 10, United States Code, in anticipation of 

5 receipt of contributions, only from the Government of Ku6 wait, under that section: Provided, That, upon receipt, such 

7 contributions from the Government of Kuwait shall be cred8 ited to the appropriations or fund which incurred such obli9 gations. 

10 SEC. 1122. (a) Of the funds made available in this 

11 Act, not less than $43,100,000 shall be available for the 

12 Civil Air Patrol Corporation, of which— 

13 (1) $30,800,000 shall be available from ‘‘Oper14 ation and Maintenance, Air Force’’ to support Civil 

15 Air Patrol Corporation operation and maintenance, 

16 readiness, counter-drug activities, and drug demand 

17 reduction activities involving youth programs; 

18 (2) $10,600,000 shall be available from ‘‘Aircraft 

19 Procurement, Air Force’’; and 

20 (3) $1,700,000 shall be available from ‘‘Other 

21 Procurement, Air Force’’ for vehicle procurement. 

22 (b) The Secretary of the Air Force should waive reim23 bursement for any funds used by the Civil Air Patrol for 

24 counter-drug activities in support of Federal, State, and 

25 local government agencies. 
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•HR 1892 EAH 

1 SEC. 1123. (a) None of the funds appropriated in this 

2 Act are available to establish a new Department of Defense 

3 (department) federally funded research and development 

4 center (FFRDC), either as a new entity, or as a separate 

5 entity administrated by an organization managing another 

6 FFRDC, or as a nonprofit membership corporation con7 sisting of a consortium of other FFRDCs and other non8 profit entities. 

9 (b) No member of a Board of Directors, Trustees, Over10 seers, Advisory Group, Special Issues Panel, Visiting Com11 mittee, or any similar entity of a defense FFRDC, and no 

12 paid consultant to any defense FFRDC, except when acting 

13 in a technical advisory capacity, may be compensated for 

14 his or her services as a member of such entity, or as a paid 

15 consultant by more than one FFRDC in a fiscal year: Pro16 vided, That a member of any such entity referred to pre17 viously in this subsection shall be allowed travel expenses 

18 and per diem as authorized under the Federal Joint Travel 

19 Regulations, when engaged in the performance of member20 ship duties. 

21 (c) Notwithstanding any other provision of law, none 

22 of the funds available to the department from any source 

23 during the current fiscal year may be used by a defense 

24 FFRDC, through a fee or other payment mechanism, for 

25 construction of new buildings not located on a military in-
60 

•HR 1892 EAH 

1 stallation, for payment of cost sharing for projects funded 

2 by Government grants, for absorption of contract overruns, 

3 or for certain charitable contributions, not to include em4 ployee participation in community service and/or develop5 ment. 

6 (d) Notwithstanding any other provision of law, of the 

7 funds available to the department during fiscal year 2018, 

8 not more than 6,000 staff years of technical effort (staff 

9 years) may be funded for defense FFRDCs: Provided, That, 

10 of the specific amount referred to previously in this sub11 section, not more than 1,180 staff years may be funded for 

12 the defense studies and analysis FFRDCs: Provided further, 

13 That this subsection shall not apply to staff years funded 

14 in the National Intelligence Program (NIP) and the Mili15 tary Intelligence Program (MIP). 

16 (e) The Secretary of Defense shall, with the submission 

17 of the department’s fiscal year 2019 budget request, submit 

18 a report presenting the specific amounts of staff years of 

19 technical effort to be allocated for each defense FFRDC dur20 ing that fiscal year and the associated budget estimates. 

21 (f) Notwithstanding any other provision of this Act, 

22 the total amount appropriated in this Act for FFRDCs is 

23 hereby reduced by $210,000,000. 

24 SEC. 1124. None of the funds appropriated or made 

25 available in this Act shall be used to procure carbon, alloy, 
61 

•HR 1892 EAH 

1 or armor steel plate for use in any Government-owned facil2 ity or property under the control of the Department of De3 fense which were not melted and rolled in the United States 

4 or Canada: Provided, That these procurement restrictions 

5 shall apply to any and all Federal Supply Class 9515, 

6 American Society of Testing and Materials (ASTM) or 

7 American Iron and Steel Institute (AISI) specifications of 

8 carbon, alloy or armor steel plate: Provided further, That 

9 the Secretary of the military department responsible for the 

10 procurement may waive this restriction on a case-by-case 

11 basis by certifying in writing to the Committees on Appro12 priations of the House of Representatives and the Senate 

13 that adequate domestic supplies are not available to meet 

14 Department of Defense requirements on a timely basis and 

15 that such an acquisition must be made in order to acquire 

16 capability for national security purposes: Provided further, 

17 That these restrictions shall not apply to contracts which 

18 are in being as of the date of the enactment of this Act. 

19 SEC. 1125. For the purposes of this Act, the term ‘‘con20 gressional defense committees’’ means the Armed Services 

21 Committee of the House of Representatives, the Armed Serv22 ices Committee of the Senate, the Subcommittee on Defense 

23 of the Committee on Appropriations of the Senate, and the 

24 Subcommittee on Defense of the Committee on Appropria25 tions of the House of Representatives. 
62 

•HR 1892 EAH 

1 SEC. 1126. During the current fiscal year, the Depart2 ment of Defense may acquire the modification, depot main3 tenance and repair of aircraft, vehicles and vessels as well 

4 as the production of components and other Defense-related 

5 articles, through competition between Department of De6 fense depot maintenance activities and private firms: Pro7 vided, That the Senior Acquisition Executive of the military 

8 department or Defense Agency concerned, with power of del9 egation, shall certify that successful bids include comparable 

10 estimates of all direct and indirect costs for both public and 

11 private bids: Provided further, That Office of Management 

12 and Budget Circular A–76 shall not apply to competitions 

13 conducted under this section. 

14 SEC. 1127. (a)(1) If the Secretary of Defense, after con15 sultation with the United States Trade Representative, de16 termines that a foreign country which is party to an agree17 ment described in paragraph (2) has violated the terms of 

18 the agreement by discriminating against certain types of 

19 products produced in the United States that are covered by 

20 the agreement, the Secretary of Defense shall rescind the 

21 Secretary’s blanket waiver of the Buy American Act with 

22 respect to such types of products produced in that foreign 

23 country. 

24 (2) An agreement referred to in paragraph (1) is any 

25 reciprocal defense procurement memorandum of under-
63 

•HR 1892 EAH 

1 standing, between the United States and a foreign country 

2 pursuant to which the Secretary of Defense has prospec3 tively waived the Buy American Act for certain products 

4 in that country. 

5 (b) The Secretary of Defense shall submit to the Con6 gress a report on the amount of Department of Defense pur7 chases from foreign entities in fiscal year 2018. Such report 

8 shall separately indicate the dollar value of items for which 

9 the Buy American Act was waived pursuant to any agree10 ment described in subsection (a)(2), the Trade Agreement 

11 Act of 1979 (19 U.S.C. 2501 et seq.), or any international 

12 agreement to which the United States is a party. 

13 (c) For purposes of this section, the term Buy Amer14 ican Act means chapter 83 of title 41, United States Code. 

15 SEC. 1128. During the current fiscal year, amounts 

16 contained in the Department of Defense Overseas Military 

17 Facility Investment Recovery Account established by section 

18 2921(c)(1) of the National Defense Authorization Act of 

19 1991 (Public Law 101–510; 10 U.S.C. 2687 note) shall be 

20 available until expended for the payments specified by sec21 tion 2921(c)(2) of that Act. 

22 SEC. 1129. (a) Notwithstanding any other provision 

23 of law, the Secretary of the Air Force may convey at no 

24 cost to the Air Force, without consideration, to Indian 

25 tribes located in the States of Nevada, Idaho, North Dakota, 
64 

•HR 1892 EAH 

1 South Dakota, Montana, Oregon, Minnesota, and Wash2 ington relocatable military housing units located at Grand 

3 Forks Air Force Base, Malmstrom Air Force Base, Moun4 tain Home Air Force Base, Ellsworth Air Force Base, and 

5 Minot Air Force Base that are excess to the needs of the 

6 Air Force. 

7 (b) The Secretary of the Air Force shall convey, at no 

8 cost to the Air Force, military housing units under sub9 section (a) in accordance with the request for such units 

10 that are submitted to the Secretary by the Operation Walk11 ing Shield Program on behalf of Indian tribes located in 

12 the States of Nevada, Idaho, North Dakota, South Dakota, 

13 Montana, Oregon, Minnesota, and Washington. Any such 

14 conveyance shall be subject to the condition that the housing 

15 units shall be removed within a reasonable period of time, 

16 as determined by the Secretary. 

17 (c) The Operation Walking Shield Program shall re18 solve any conflicts among requests of Indian tribes for hous19 ing units under subsection (a) before submitting requests 

20 to the Secretary of the Air Force under subsection (b). 

21 (d) In this section, the term Indian tribe means any 

22 recognized Indian tribe included on the current list pub23 lished by the Secretary of the Interior under section 104 

24 of the Federally Recognized Indian Tribe Act of 1994 (Pub25 lic Law 103–454; 108 Stat. 4792; 25 U.S.C. 479a–1). 
65 

•HR 1892 EAH 

1 SEC. 1130. During the current fiscal year, appropria2 tions which are available to the Department of Defense for 

3 operation and maintenance may be used to purchase items 

4 having an investment item unit cost of not more than 

5 $250,000. 

6 SEC. 1131. None of the funds made available by this 

7 Act may be used to— 

8 (1) disestablish, or prepare to disestablish, a 

9 Senior Reserve Officers’ Training Corps program in 

10 accordance with Department of Defense Instruction 

11 Number 1215.08, dated June 26, 2006; or 

12 (2) close, downgrade from host to extension cen13 ter, or place on probation a Senior Reserve Officers’ 

14 Training Corps program in accordance with the in15 formation paper of the Department of the Army titled 

16 ‘‘Army Senior Reserve Officers’ Training Corps 

17 (SROTC) Program Review and Criteria’’, dated Jan18 uary 27, 2014. 

19 SEC. 1132. The Secretary of Defense shall issue regula20 tions to prohibit the sale of any tobacco or tobacco-related 

21 products in military resale outlets in the United States, its 

22 territories and possessions at a price below the most com23 petitive price in the local community: Provided, That such 

24 regulations shall direct that the prices of tobacco or tobacco25 related products in overseas military retail outlets shall be 
66 

•HR 1892 EAH 

1 within the range of prices established for military retail 

2 system stores located in the United States. 

3 SEC. 1133. (a) During the current fiscal year, none 

4 of the appropriations or funds available to the Department 

5 of Defense Working Capital Funds shall be used for the pur6 chase of an investment item for the purpose of acquiring 

7 a new inventory item for sale or anticipated sale during 

8 the current fiscal year or a subsequent fiscal year to cus9 tomers of the Department of Defense Working Capital 

10 Funds if such an item would not have been chargeable to 

11 the Department of Defense Business Operations Fund dur12 ing fiscal year 1994 and if the purchase of such an invest13 ment item would be chargeable during the current fiscal 

14 year to appropriations made to the Department of Defense 

15 for procurement. 

16 (b) The fiscal year 2019 budget request for the Depart17 ment of Defense as well as all justification material and 

18 other documentation supporting the fiscal year 2019 De19 partment of Defense budget shall be prepared and submitted 

20 to the Congress on the basis that any equipment which was 

21 classified as an end item and funded in a procurement ap22 propriation contained in this Act shall be budgeted for in 

23 a proposed fiscal year 2019 procurement appropriation and 

24 not in the supply management business area or any other 
67 

•HR 1892 EAH 

1 area or category of the Department of Defense Working 

2 Capital Funds. 

3 SEC. 1134. None of the funds appropriated by this Act 

4 for programs of the Central Intelligence Agency shall re5 main available for obligation beyond the current fiscal year, 

6 except for funds appropriated for the Reserve for Contin7 gencies, which shall remain available until September 30, 

8 2019: Provided, That funds appropriated, transferred, or 

9 otherwise credited to the Central Intelligence Agency Cen10 tral Services Working Capital Fund during this or any 

11 prior or subsequent fiscal year shall remain available until 

12 expended: Provided further, That any funds appropriated 

13 or transferred to the Central Intelligence Agency for ad14 vanced research and development acquisition, for agent op15 erations, and for covert action programs authorized by the 

16 President under section 503 of the National Security Act 

17 of 1947 (50 U.S.C. 3093) shall remain available until Sep18 tember 30, 2019. 

19 SEC. 1135. Notwithstanding any other provision of 

20 law, funds made available in this Act and hereafter for the 

21 Defense Intelligence Agency may be used for the design, de22 velopment, and deployment of General Defense Intelligence 

23 Program intelligence communications and intelligence in24 formation systems for the Services, the Unified and Speci25 fied Commands, and the component commands. 
68 

•HR 1892 EAH 

1 SEC. 1136. Of the funds appropriated to the Depart2 ment of Defense under the heading ‘‘Operation and Mainte3 nance, Defense-Wide’’, not less than $12,000,000 shall be 

4 made available only for the mitigation of environmental 

5 impacts, including training and technical assistance to 

6 tribes, related administrative support, the gathering of in7 formation, documenting of environmental damage, and de8 veloping a system for prioritization of mitigation and cost 

9 to complete estimates for mitigation, on Indian lands re10 sulting from Department of Defense activities. 

11 SEC. 1137. (a) None of the funds appropriated in this 

12 Act may be expended by an entity of the Department of 

13 Defense unless the entity, in expending the funds, complies 

14 with the Buy American Act. For purposes of this subsection, 

15 the term Buy American Act means chapter 83 of title 41, 

16 United States Code. 

17 (b) If the Secretary of Defense determines that a person 

18 has been convicted of intentionally affixing a label bearing 

19 a ‘‘Made in America’’ inscription to any product sold in 

20 or shipped to the United States that is not made in Amer21 ica, the Secretary shall determine, in accordance with sec22 tion 2410f of title 10, United States Code, whether the per23 son should be debarred from contracting with the Depart24 ment of Defense. 
69 

•HR 1892 EAH 

1 (c) In the case of any equipment or products purchased 

2 with appropriations provided under this Act, it is the sense 

3 of the Congress that any entity of the Department of De4 fense, in expending the appropriation, purchase only Amer5 ican-made equipment and products, provided that Amer6 ican-made equipment and products are cost-competitive, 

7 quality competitive, and available in a timely fashion. 

8 SEC. 1138. (a) Except as provided in subsections (b) 

9 and (c), none of the funds made available by this Act may 

10 be used— 

11 (1) to establish a field operating agency; or 

12 (2) to pay the basic pay of a member of the 

13 Armed Forces or civilian employee of the department 

14 who is transferred or reassigned from a headquarters 

15 activity if the member or employee’s place of duty re16 mains at the location of that headquarters. 

17 (b) The Secretary of Defense or Secretary of a military 

18 department may waive the limitations in subsection (a), 

19 on a case-by-case basis, if the Secretary determines, and cer20 tifies to the Committees on Appropriations of the House of 

21 Representatives and the Senate that the granting of the 

22 waiver will reduce the personnel requirements or the finan23 cial requirements of the department. 

24 (c) This section does not apply to— 
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•HR 1892 EAH 

1 (1) field operating agencies funded within the 

2 National Intelligence Program; 

3 (2) an Army field operating agency established 

4 to eliminate, mitigate, or counter the effects of impro5 vised explosive devices, and, as determined by the Sec6 retary of the Army, other similar threats; 

7 (3) an Army field operating agency established 

8 to improve the effectiveness and efficiencies of biomet9 ric activities and to integrate common biometric tech10 nologies throughout the Department of Defense; or 

11 (4) an Air Force field operating agency estab12 lished to administer the Air Force Mortuary Affairs 

13 Program and Mortuary Operations for the Depart14 ment of Defense and authorized Federal entities. 

15 SEC. 1139. (a) None of the funds appropriated by this 

16 Act shall be available to convert to contractor performance 

17 an activity or function of the Department of Defense that, 

18 on or after the date of the enactment of this Act, is per19 formed by Department of Defense civilian employees un20 less— 

21 (1) the conversion is based on the result of a pub22 lic-private competition that includes a most efficient 

23 and cost effective organization plan developed by such 

24 activity or function; 
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•HR 1892 EAH 

1 (2) the Competitive Sourcing Official determines 

2 that, over all performance periods stated in the solici3 tation of offers for performance of the activity or 

4 function, the cost of performance of the activity or 

5 function by a contractor would be less costly to the 

6 Department of Defense by an amount that equals or 

7 exceeds the lesser of— 

8 (A) 10 percent of the most efficient organi9 zation’s personnel-related costs for performance 

10 of that activity or function by Federal employ11 ees; or 

12 (B) $10,000,000; and 

13 (3) the contractor does not receive an advantage 

14 for a proposal that would reduce costs for the Depart15 ment of Defense by— 

16 (A) not making an employer-sponsored 

17 health insurance plan available to the workers 

18 who are to be employed in the performance of 

19 that activity or function under the contract; or 

20 (B) offering to such workers an employer21 sponsored health benefits plan that requires the 

22 employer to contribute less towards the premium 

23 or subscription share than the amount that is 

24 paid by the Department of Defense for health 
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•HR 1892 EAH 

1 benefits for civilian employees under chapter 89 

2 of title 5, United States Code. 

3 (b)(1) The Department of Defense, without regard to 

4 subsection (a) of this section or subsection (a), (b), or (c) 

5 of section 2461 of title 10, United States Code, and notwith6 standing any administrative regulation, requirement, or 

7 policy to the contrary shall have full authority to enter into 

8 a contract for the performance of any commercial or indus9 trial type function of the Department of Defense that— 

10 (A) is included on the procurement list estab11 lished pursuant to section 2 of the Javits-Wagner12 O’Day Act (section 8503 of title 41, United States 

13 Code); 

14 (B) is planned to be converted to performance by 

15 a qualified nonprofit agency for the blind or by a 

16 qualified nonprofit agency for other severely handi17 capped individuals in accordance with that Act; or 

18 (C) is planned to be converted to performance by 

19 a qualified firm under at least 51 percent ownership 

20 by an Indian tribe, as defined in section 4(e) of the 

21 Indian Self-Determination and Education Assistance 

22 Act (25 U.S.C. 450b(e)), or a Native Hawaiian Orga23 nization, as defined in section 8(a)(15) of the Small 

24 Business Act (15 U.S.C. 637(a)(15)). 
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1 (2) This section shall not apply to depot contracts or 

2 contracts for depot maintenance as provided in sections 

3 2469 and 2474 of title 10, United States Code. 

4 (c) The conversion of any activity or function of the 

5 Department of Defense under the authority provided by this 

6 section shall be credited toward any competitive or out7 sourcing goal, target, or measurement that may be estab8 lished by statute, regulation, or policy and is deemed to 

9 be awarded under the authority of, and in compliance with, 

10 subsection (h) of section 2304 of title 10, United States 

11 Code, for the competition or outsourcing of commercial ac12 tivities. 

13 (RESCISSIONS)

14 SEC. 1140. Of the funds appropriated in Department 

15 of Defense Appropriations Acts, the following funds are 

16 hereby rescinded from the following accounts and programs 

17 in the specified amounts: Provided, That no amounts may 

18 be rescinded from amounts that were designated by the Con19 gress for Overseas Contingency Operations/Global War on 

20 Terrorism or as an emergency requirement pursuant to the 

21 Concurrent Resolution on the Budget or the Balanced Budg22 et and Emergency Deficit Control Act of 1985, as amended: 

23 ‘‘Aircraft Procurement, Navy’’, 2016/2018, 

24 $274,000,000; 
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•HR 1892 EAH 

1 ‘‘Aircraft Procurement, Air Force’’, 2016/2018, 

2 $82,700,000; 

3 ‘‘Missile Procurement, Army’’, 2017/2019, 

4 $19,319,000; 

5 ‘‘Procurement of Weapons and Tracked Combat 

6 Vehicles, Army’’, 2017/2019, $9,764,000; 

7 ‘‘Other Procurement, Army’’, 2017/2019, 

8 $10,000,000; 

9 ‘‘Aircraft Procurement, Navy’’, 2017/2019, 

10 $105,600,000; 

11 ‘‘Weapons Procurement, Navy’’, 2017/2019, 

12 $54,122,000; 

13 ‘‘Shipbuilding and Conversion, Navy’’, 2017/ 

14 2021, $45,116,000; 

15 ‘‘Aircraft Procurement, Air Force’’, 2017/2019, 

16 $63,293,000; 

17 ‘‘Missile Procurement, Air Force’’, 2017/2019, 

18 $31,639,000; 

19 ‘‘Space Procurement, Air Force’’, 2017/2019, 

20 $15,000,000; 

21 ‘‘Other Procurement, Air Force’’, 2017/2019, 

22 $105,000,000; 

23 ‘‘Research, Development, Test and Evaluation, 

24 Navy’’, 2017/2018, $34,128,000; 
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•HR 1892 EAH 

1 ‘‘Research, Development, Test and Evaluation, 

2 Air Force’’, 2017/2018, $41,700,000. 

3 SEC. 1141. None of the funds available in this Act may 

4 be used to reduce the authorized positions for military tech5 nicians (dual status) of the Army National Guard, Air Na6 tional Guard, Army Reserve and Air Force Reserve for the 

7 purpose of applying any administratively imposed civilian 

8 personnel ceiling, freeze, or reduction on military techni9 cians (dual status), unless such reductions are a direct re10 sult of a reduction in military force structure. 

11 SEC. 1142. None of the funds appropriated or other12 wise made available in this Act may be obligated or ex13 pended for assistance to the Democratic People’s Republic 

14 of Korea unless specifically appropriated for that purpose. 

15 SEC. 1143. Funds appropriated in this Act for oper16 ation and maintenance of the Military Departments, Com17 batant Commands and Defense Agencies shall be available 

18 for reimbursement of pay, allowances and other expenses 

19 which would otherwise be incurred against appropriations 

20 for the National Guard and Reserve when members of the 

21 National Guard and Reserve provide intelligence or coun22 terintelligence support to Combatant Commands, Defense 

23 Agencies and Joint Intelligence Activities, including the ac24 tivities and programs included within the National Intel25 ligence Program and the Military Intelligence Program: 
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•HR 1892 EAH 

1 Provided, That nothing in this section authorizes deviation 

2 from established Reserve and National Guard personnel and 

3 training procedures. 

4 SEC. 1144. (a) None of the funds available to the De5 partment of Defense for any fiscal year for drug interdic6 tion or counter-drug activities may be transferred to any 

7 other department or agency of the United States except as 

8 specifically provided in an appropriations law. 

9 (b) None of the funds available to the Central Intel10 ligence Agency for any fiscal year for drug interdiction or 

11 counter-drug activities may be transferred to any other de12 partment or agency of the United States except as specifi13 cally provided in an appropriations law. 

14 SEC. 1145. None of the funds appropriated by this Act 

15 may be used for the procurement of ball and roller bearings 

16 other than those produced by a domestic source and of do17 mestic origin: Provided, That the Secretary of the military 

18 department responsible for such procurement may waive 

19 this restriction on a case-by-case basis by certifying in writ20 ing to the Committees on Appropriations of the House of 

21 Representatives and the Senate, that adequate domestic 

22 supplies are not available to meet Department of Defense 

23 requirements on a timely basis and that such an acquisition 

24 must be made in order to acquire capability for national 

25 security purposes: Provided further, That this restriction 
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•HR 1892 EAH 

1 shall not apply to the purchase of ‘‘commercial items’’, as 

2 defined by section 103 of title 41, United States Code, except 

3 that the restriction shall apply to ball or roller bearings 

4 purchased as end items. 

5 SEC. 1146. None of the funds made available by this 

6 Act for Evolved Expendable Launch Vehicle service competi7 tive procurements may be used unless the competitive pro8 curements are open for award to all certified providers of 

9 Evolved Expendable Launch Vehicle-class systems: Pro10 vided, That the award shall be made to the provider that 

11 offers the best value to the government. 

12 SEC. 1147. In addition to the amounts appropriated 

13 or otherwise made available elsewhere in this Act, 

14 $44,000,000 is hereby appropriated to the Department of 

15 Defense: Provided, That upon the determination of the Sec16 retary of Defense that it shall serve the national interest, 

17 the Secretary shall make grants in the amounts specified 

18 as follows: $20,000,000 to the United Service Organizations 

19 and $24,000,000 to the Red Cross. 

20 SEC. 1148. None of the funds in this Act may be used 

21 to purchase any supercomputer which is not manufactured 

22 in the United States, unless the Secretary of Defense cer23 tifies to the congressional defense committees that such an 

24 acquisition must be made in order to acquire capability for 
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•HR 1892 EAH 

1 national security purposes that is not available from 

2 United States manufacturers. 

3 SEC. 1149. Notwithstanding any other provision in 

4 this Act, the Small Business Innovation Research program 

5 and the Small Business Technology Transfer program set6 asides shall be taken proportionally from all programs, 

7 projects, or activities to the extent they contribute to the 

8 extramural budget. 

9 SEC. 1150. None of the funds available to the Depart10 ment of Defense under this Act shall be obligated or ex11 pended to pay a contractor under a contract with the De12 partment of Defense for costs of any amount paid by the 

13 contractor to an employee when— 

14 (1) such costs are for a bonus or otherwise in ex15 cess of the normal salary paid by the contractor to the 

16 employee; and 

17 (2) such bonus is part of restructuring costs asso18 ciated with a business combination. 

19 (INCLUDING TRANSFER OF FUNDS)

20 SEC. 1151. During the current fiscal year, no more 

21 than $30,000,000 of appropriations made in this Act under 

22 the heading ‘‘Operation and Maintenance, Defense-Wide’’ 

23 may be transferred to appropriations available for the pay 

24 of military personnel, to be merged with, and to be available 

25 for the same time period as the appropriations to which 
79 

•HR 1892 EAH 

1 transferred, to be used in support of such personnel in con2 nection with support and services for eligible organizations 

3 and activities outside the Department of Defense pursuant 

4 to section 2012 of title 10, United States Code. 

5 SEC. 1152. During the current fiscal year, in the case 

6 of an appropriation account of the Department of Defense 

7 for which the period of availability for obligation has ex8 pired or which has closed under the provisions of section 

9 1552 of title 31, United States Code, and which has a nega10 tive unliquidated or unexpended balance, an obligation or 

11 an adjustment of an obligation may be charged to any cur12 rent appropriation account for the same purpose as the ex13 pired or closed account if— 

14 (1) the obligation would have been properly 

15 chargeable (except as to amount) to the expired or 

16 closed account before the end of the period of avail17 ability or closing of that account; 

18 (2) the obligation is not otherwise properly 

19 chargeable to any current appropriation account of 

20 the Department of Defense; and 

21 (3) in the case of an expired account, the obliga22 tion is not chargeable to a current appropriation of 

23 the Department of Defense under the provisions of sec24 tion 1405(b)(8) of the National Defense Authorization 

25 Act for Fiscal Year 1991, Public Law 101–510, as 
80 

•HR 1892 EAH 

1 amended (31 U.S.C. 1551 note): Provided, That in 

2 the case of an expired account, if subsequent review 

3 or investigation discloses that there was not in fact a 

4 negative unliquidated or unexpended balance in the 

5 account, any charge to a current account under the 

6 authority of this section shall be reversed and re7 corded against the expired account: Provided further, 

8 That the total amount charged to a current appro9 priation under this section may not exceed an 

10 amount equal to 1 percent of the total appropriation 

11 for that account. 

12 SEC. 1153. (a) Notwithstanding any other provision 

13 of law, the Chief of the National Guard Bureau may permit 

14 the use of equipment of the National Guard Distance Learn15 ing Project by any person or entity on a space-available, 

16 reimbursable basis. The Chief of the National Guard Bu17 reau shall establish the amount of reimbursement for such 

18 use on a case-by-case basis. 

19 (b) Amounts collected under subsection (a) shall be 

20 credited to funds available for the National Guard Distance 

21 Learning Project and be available to defray the costs associ22 ated with the use of equipment of the project under that 

23 subsection. Such funds shall be available for such purposes 

24 without fiscal year limitation. 
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•HR 1892 EAH 

1 SEC. 1154. None of the funds available to the Depart2 ment of Defense may be obligated to modify command and 

3 control relationships to give Fleet Forces Command oper4 ational and administrative control of United States Navy 

5 forces assigned to the Pacific fleet: Provided, That the com6 mand and control relationships which existed on October 

7 1, 2004, shall remain in force until a written modification 

8 has been proposed to the House and Senate Appropriations 

9 Committees: Provided further, That the proposed modifica10 tion may be implemented 30 days after the notification un11 less an objection is received from either the House or Senate 

12 Appropriations Committees: Provided further, That any 

13 proposed modification shall not preclude the ability of the 

14 commander of United States Pacific Command to meet 

15 operational requirements. 

16 (INCLUDING TRANSFER OF FUNDS)

17 SEC. 1155. Of the funds appropriated in this Act 

18 under the heading ‘‘Operation and Maintenance, Defense19 Wide’’, $25,000,000 (increased by $10,000,000) shall be for 

20 continued implementation and expansion of the Sexual As21 sault Special Victims’ Counsel Program: Provided, That the 

22 funds are made available for transfer to the Department 

23 of the Army, the Department of the Navy, and the Depart24 ment of the Air Force: Provided further, That funds trans25 ferred shall be merged with and available for the same pur-
82 

•HR 1892 EAH 

1 poses and for the same time period as the appropriations 

2 to which the funds are transferred: Provided further, That 

3 this transfer authority is in addition to any other transfer 

4 authority provided in this Act. 

5 SEC. 1156. None of the funds appropriated in title IV 

6 of this Act may be used to procure end-items for delivery 

7 to military forces for operational training, operational use 

8 or inventory requirements: Provided, That this restriction 

9 does not apply to end-items used in development, proto10 typing, and test activities preceding and leading to accept11 ance for operational use: Provided further, That this restric12 tion does not apply to programs funded within the National 

13 Intelligence Program: Provided further, That the Secretary 

14 of Defense may waive this restriction on a case-by-case basis 

15 by certifying in writing to the Committees on Appropria16 tions of the House of Representatives and the Senate that 

17 it is in the national security interest to do so. 

18 SEC. 1157. (a) The Secretary of Defense may, on a 

19 case-by-case basis, waive with respect to a foreign country 

20 each limitation on the procurement of defense items from 

21 foreign sources provided in law if the Secretary determines 

22 that the application of the limitation with respect to that 

23 country would invalidate cooperative programs entered into 

24 between the Department of Defense and the foreign country, 

25 or would invalidate reciprocal trade agreements for the pro-
83 

•HR 1892 EAH 

1 curement of defense items entered into under section 2531 

2 of title 10, United States Code, and the country does not 

3 discriminate against the same or similar defense items pro4 duced in the United States for that country. 

5 (b) Subsection (a) applies with respect to— 

6 (1) contracts and subcontracts entered into on or 

7 after the date of the enactment of this Act; and 

8 (2) options for the procurement of items that are 

9 exercised after such date under contracts that are en10 tered into before such date if the option prices are ad11 justed for any reason other than the application of a 

12 waiver granted under subsection (a). 

13 (c) Subsection (a) does not apply to a limitation re14 garding construction of public vessels, ball and roller bear15 ings, food, and clothing or textile materials as defined by 

16 section XI (chapters 50–65) of the Harmonized Tariff 

17 Schedule of the United States and products classified under 

18 headings 4010, 4202, 4203, 6401 through 6406, 6505, 7019, 

19 7218 through 7229, 7304.41 through 7304.49, 7306.40, 7502 

20 through 7508, 8105, 8108, 8109, 8211, 8215, and 9404. 

21 SEC. 1158. None of the funds appropriated or other22 wise made available by this or other Department of Defense 

23 Appropriations Acts may be obligated or expended for the 

24 purpose of performing repairs or maintenance to military 

25 family housing units of the Department of Defense, includ-
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•HR 1892 EAH 

1 ing areas in such military family housing units that may 

2 be used for the purpose of conducting official Department 

3 of Defense business. 

4 SEC. 1159. Notwithstanding any other provision of 

5 law, funds appropriated in this Act under the heading ‘‘Re6 search, Development, Test and Evaluation, Defense-Wide’’ 

7 for any new start advanced concept technology demonstra8 tion project or joint capability demonstration project may 

9 only be obligated 45 days after a report, including a de10 scription of the project, the planned acquisition and transi11 tion strategy and its estimated annual and total cost, has 

12 been provided in writing to the congressional defense com13 mittees: Provided, That the Secretary of Defense may waive 

14 this restriction on a case-by-case basis by certifying to the 

15 congressional defense committees that it is in the national 

16 interest to do so. 

17 SEC. 1160. The Secretary of Defense shall continue to 

18 provide a classified quarterly report to the House and Sen19 ate Appropriations Committees, Subcommittees on Defense 

20 on certain matters as directed in the classified annex ac21 companying this Act. 

22 SEC. 1161. Notwithstanding section 12310(b) of title 

23 10, United States Code, a Reserve who is a member of the 

24 National Guard serving on full-time National Guard duty 

25 under section 502(f) of title 32, United States Code, may 
85 

•HR 1892 EAH 

1 perform duties in support of the ground-based elements of 

2 the National Ballistic Missile Defense System. 

3 SEC. 1162. None of the funds provided in this Act may 

4 be used to transfer to any nongovernmental entity ammuni5 tion held by the Department of Defense that has a center6 fire cartridge and a United States military nomenclature 

7 designation of ‘‘armor penetrator’’, ‘‘armor piercing (AP)’’, 

8 ‘‘armor piercing incendiary (API)’’, or ‘‘armor-piercing in9 cendiary tracer (API–T)’’, except to an entity performing 

10 demilitarization services for the Department of Defense 

11 under a contract that requires the entity to demonstrate to 

12 the satisfaction of the Department of Defense that armor 

13 piercing projectiles are either: 

14 (1) rendered incapable of reuse by the demili15 tarization process; or 

16 (2) used to manufacture ammunition pursuant 

17 to a contract with the Department of Defense or the 

18 manufacture of ammunition for export pursuant to a 

19 License for Permanent Export of Unclassified Mili20 tary Articles issued by the Department of State. 

21 SEC. 1163. Notwithstanding any other provision of 

22 law, the Chief of the National Guard Bureau, or his des23 ignee, may waive payment of all or part of the consider24 ation that otherwise would be required under section 2667 

25 of title 10, United States Code, in the case of a lease of 
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•HR 1892 EAH 

1 personal property for a period not in excess of 1 year to 

2 any organization specified in section 508(d) of title 32, 

3 United States Code, or any other youth, social, or fraternal 

4 nonprofit organization as may be approved by the Chief 

5 of the National Guard Bureau, or his designee, on a case6 by-case basis. 

7 (INCLUDING TRANSFER OF FUNDS)

8 SEC. 1164. Of the amounts appropriated in this Act 

9 under the heading ‘‘Operation and Maintenance, Army’’, 

10 $66,881,780 shall remain available until expended: Pro11 vided, That, notwithstanding any other provision of law, 

12 the Secretary of Defense is authorized to transfer such funds 

13 to other activities of the Federal Government: Provided fur14 ther, That the Secretary of Defense is authorized to enter 

15 into and carry out contracts for the acquisition of real 

16 property, construction, personal services, and operations re17 lated to projects carrying out the purposes of this section: 

18 Provided further, That contracts entered into under the au19 thority of this section may provide for such indemnification 

20 as the Secretary determines to be necessary: Provided fur21 ther, That projects authorized by this section shall comply 

22 with applicable Federal, State, and local law to the max23 imum extent consistent with the national security, as deter24 mined by the Secretary of Defense. 
87 

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1 SEC. 1165. (a) None of the funds appropriated in this 

2 or any other Act may be used to take any action to mod3 ify— 

4 (1) the appropriations account structure for the 

5 National Intelligence Program budget, including 

6 through the creation of a new appropriation or new 

7 appropriation account; 

8 (2) how the National Intelligence Program budg9 et request is presented in the unclassified P–1, R–1, 

10 and O–1 documents supporting the Department of 

11 Defense budget request; 

12 (3) the process by which the National Intelligence 

13 Program appropriations are apportioned to the exe14 cuting agencies; or 

15 (4) the process by which the National Intelligence 

16 Program appropriations are allotted, obligated and 

17 disbursed. 

18 (b) Nothing in section (a) shall be construed to prohibit 

19 the merger of programs or changes to the National Intel20 ligence Program budget at or below the Expenditure Center 

21 level, provided such change is otherwise in accordance with 

22 paragraphs (a)(1)–(3). 

23 (c) The Director of National Intelligence and the Sec24 retary of Defense may jointly, only for the purposes of 

25 achieving auditable financial statements and improving fis-
88 

•HR 1892 EAH 

1 cal reporting, study and develop detailed proposals for al2 ternative financial management processes. Such study shall 

3 include a comprehensive counterintelligence risk assessment 

4 to ensure that none of the alternative processes will ad5 versely affect counterintelligence. 

6 (d) Upon development of the detailed proposals defined 

7 under subsection (c), the Director of National Intelligence 

8 and the Secretary of Defense shall— 

9 (1) provide the proposed alternatives to all af10 fected agencies; 

11 (2) receive certification from all affected agencies 

12 attesting that the proposed alternatives will help 

13 achieve auditability, improve fiscal reporting, and 

14 will not adversely affect counterintelligence; and 

15 (3) not later than 30 days after receiving all nec16 essary certifications under paragraph (2), present the 

17 proposed alternatives and certifications to the con18 gressional defense and intelligence committees. 

19 SEC. 1166. In addition to amounts provided elsewhere 

20 in this Act, $5,000,000 (increased by $5,000,000) is hereby 

21 appropriated to the Department of Defense, to remain 

22 available for obligation until expended: Provided, That not23 withstanding any other provision of law, that upon the de24 termination of the Secretary of Defense that it shall serve 

25 the national interest, these funds shall be available only for 
89 

•HR 1892 EAH 

1 a grant to the Fisher House Foundation, Inc., only for the 

2 construction and furnishing of additional Fisher Houses to 

3 meet the needs of military family members when confronted 

4 with the illness or hospitalization of an eligible military 

5 beneficiary. 

6 (INCLUDING TRANSFER OF FUNDS)

7 SEC. 1167. Of the amounts appropriated in this Act 

8 under the headings ‘‘Procurement, Defense-Wide’’ and ‘‘Re9 search, Development, Test and Evaluation, Defense-Wide’’, 

10 $705,800,000 shall be for the Israeli Cooperative Programs: 

11 Provided, That of this amount, $92,000,000 shall be for the 

12 Secretary of Defense to provide to the Government of Israel 

13 for the procurement of the Iron Dome defense system to 

14 counter short-range rocket threats, subject to the U.S.-Israel 

15 Iron Dome Procurement Agreement, as amended; 

16 $221,500,000 shall be for the Short Range Ballistic Missile 

17 Defense (SRBMD) program, including cruise missile de18 fense research and development under the SRBMD pro19 gram, of which $120,000,000 shall be for co-production ac20 tivities of SRBMD missiles in the United States and in 

21 Israel to meet Israel’s defense requirements consistent with 

22 each nation’s laws, regulations, and procedures, subject to 

23 the U.S.-Israeli co-production agreement for SRBMD, as 

24 amended; $205,000,000 shall be for an upper-tier compo25 nent to the Israeli Missile Defense Architecture, of which 
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•HR 1892 EAH 

1 $120,000,000 shall be for co-production activities of Arrow 

2 3 Upper Tier missiles in the United States and in Israel 

3 to meet Israel’s defense requirements consistent with each 

4 nation’s laws, regulations, and procedures, subject to the 

5 U.S.-Israeli co-production agreement for Arrow 3 Upper 

6 Tier, as amended; $105,000,000 shall be for testing of the 

7 upper-tier component to the Israeli Missile Defense Archi8 tecture in the United States; and $82,300,000 shall be for 

9 the Arrow System Improvement Program including devel10 opment of a long range, ground and airborne, detection 

11 suite: Provided further, That the transfer authority pro12 vided under this provision is in addition to any other 

13 transfer authority contained in this Act. 

14 (INCLUDING TRANSFER OF FUNDS)

15 SEC. 1168. Of the amounts appropriated in this Act 

16 under the heading ‘‘Shipbuilding and Conversion, Navy’’, 

17 $117,542,000 shall be available until September 30, 2018, 

18 to fund prior year shipbuilding cost increases: Provided, 

19 That upon enactment of this Act, the Secretary of the Navy 

20 shall transfer funds to the following appropriations in the 

21 amounts specified: Provided further, That the amounts 

22 transferred shall be merged with and be available for the 

23 same purposes as the appropriations to which transferred 

24 to: 
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•HR 1892 EAH 

1 (1) Under the heading ‘‘Shipbuilding and Con2 version, Navy’’, 2012/2018: Carrier Replacement Pro3 gram $20,000,000; 

4 (2) Under the heading ‘‘Shipbuilding and Con5 version, Navy’’, 2008/2018: DDG–51 Destroyer 

6 $19,436,000; 

7 (3) Under the heading ‘‘Shipbuilding and Con8 version, Navy’’, 2012/2018: Littoral Combat Ship 

9 $6,394,000; 

10 (4) Under the heading ‘‘Shipbuilding and Con11 version, Navy’’, 2012/2018: LHA Replacement 

12 $14,200,000; 

13 (5) Under the heading ‘‘Shipbuilding and Con14 version, Navy’’, 2013/2018: DDG–51 Destroyer 

15 $31,941,000; 

16 (6) Under the heading ‘‘Shipbuilding and Con17 version, Navy’’, 2014/2018: Litoral Combat Ship 

18 $20,471,000; and 

19 (7) Under the heading ‘‘Shipbuilding and Con20 version, Navy’’, 2015/2018: LCAC $5,100,000. 

21 SEC. 1169. Funds appropriated by this Act, or made 

22 available by the transfer of funds in this Act, for intelligence 

23 activities are deemed to be specifically authorized by the 

24 Congress for purposes of section 504 of the National Secu25 rity Act of 1947 (50 U.S.C. 3094) during fiscal year 2018 
92 

•HR 1892 EAH 

1 until the enactment of the Intelligence Authorization Act 

2 for Fiscal Year 2018. 

3 SEC. 1170. None of the funds provided in this Act shall 

4 be available for obligation or expenditure through a re5 programming of funds that creates or initiates a new pro6 gram, project, or activity unless such program, project, or 

7 activity must be undertaken immediately in the interest of 

8 national security and only after written prior notification 

9 to the congressional defense committees. 

10 SEC. 1171. The budget of the President for fiscal year 

11 2018 submitted to the Congress pursuant to section 1105 

12 of title 31, United States Code, shall include separate budget 

13 justification documents for costs of United States Armed 

14 Forces’ participation in contingency operations for the 

15 Military Personnel accounts, the Operation and Mainte16 nance accounts, the Procurement accounts, and the Re17 search, Development, Test and Evaluation accounts: Pro18 vided, That these documents shall include a description of 

19 the funding requested for each contingency operation, for 

20 each military service, to include all Active and Reserve 

21 components, and for each appropriations account: Provided 

22 further, That these documents shall include estimated costs 

23 for each element of expense or object class, a reconciliation 

24 of increases and decreases for each contingency operation, 

25 and programmatic data including, but not limited to, troop 
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•HR 1892 EAH 

1 strength for each Active and Reserve component, and esti2 mates of the major weapons systems deployed in support 

3 of each contingency: Provided further, That these documents 

4 shall include budget exhibits OP–5 and OP–32 (as defined 

5 in the Department of Defense Financial Management Regu6 lation) for all contingency operations for the budget year 

7 and the two preceding fiscal years. 

8 SEC. 1172. None of the funds in this Act may be used 

9 for research, development, test, evaluation, procurement or 

10 deployment of nuclear armed interceptors of a missile de11 fense system. 

12 SEC. 1173. Notwithstanding any other provision of 

13 this Act, to reflect savings due to favorable foreign exchange 

14 rates, the total amount appropriated in this Act is hereby 

15 reduced by $289,000,000. 

16 SEC. 1174. None of the funds appropriated or made 

17 available in this Act shall be used to reduce or disestablish 

18 the operation of the 53rd Weather Reconnaissance Squad19 ron of the Air Force Reserve, if such action would reduce 

20 the WC–130 Weather Reconnaissance mission below the lev21 els funded in this Act: Provided, That the Air Force shall 

22 allow the 53rd Weather Reconnaissance Squadron to per23 form other missions in support of national defense require24 ments during the non-hurricane season. 
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•HR 1892 EAH 

1 SEC. 1175. None of the funds provided in this Act shall 

2 be available for integration of foreign intelligence informa3 tion unless the information has been lawfully collected and 

4 processed during the conduct of authorized foreign intel5 ligence activities: Provided, That information pertaining to 

6 United States persons shall only be handled in accordance 

7 with protections provided in the Fourth Amendment of the 

8 United States Constitution as implemented through Execu9 tive Order No. 12333. 

10 SEC. 1176. (a) None of the funds appropriated by this 

11 Act may be used to transfer research and development, ac12 quisition, or other program authority relating to current 

13 tactical unmanned aerial vehicles (TUAVs) from the Army. 

14 (b) The Army shall retain responsibility for and oper15 ational control of the MQ–1C Gray Eagle Unmanned Aerial 

16 Vehicle (UAV) in order to support the Secretary of Defense 

17 in matters relating to the employment of unmanned aerial 

18 vehicles. 

19 SEC. 1177. None of the funds appropriated by this Act 

20 for programs of the Office of the Director of National Intel21 ligence shall remain available for obligation beyond the cur22 rent fiscal year, except for funds appropriated for research 

23 and technology, which shall remain available until Sep24 tember 30, 2019. 
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1 SEC. 1178. For purposes of section 1553(b) of title 31, 

2 United States Code, any subdivision of appropriations 

3 made in this Act under the heading ‘‘Shipbuilding and 

4 Conversion, Navy’’ shall be considered to be for the same 

5 purpose as any subdivision under the heading ‘‘Ship6 building and Conversion, Navy’’ appropriations in any 

7 prior fiscal year, and the 1 percent limitation shall apply 

8 to the total amount of the appropriation. 

9 SEC. 1179. (a) Not later than 60 days after the date 

10 of enactment of this Act, the Director of National Intel11 ligence shall submit a report to the congressional intel12 ligence committees to establish the baseline for application 

13 of reprogramming and transfer authorities for fiscal year 

14 2018: Provided, That the report shall include— 

15 (1) a table for each appropriation with a sepa16 rate column to display the President’s budget request, 

17 adjustments made by Congress, adjustments due to 

18 enacted rescissions, if appropriate, and the fiscal year 

19 enacted level; 

20 (2) a delineation in the table for each appropria21 tion by Expenditure Center and project; and 

22 (3) an identification of items of special congres23 sional interest. 

24 (b) None of the funds provided for the National Intel25 ligence Program in this Act shall be available for re-
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1 programming or transfer until the report identified in sub2 section (a) is submitted to the congressional intelligence 

3 committees, unless the Director of National Intelligence cer4 tifies in writing to the congressional intelligence committees 

5 that such reprogramming or transfer is necessary as an 

6 emergency requirement. 

7 SEC. 1180. None of the funds made available by this 

8 Act may be used to eliminate, restructure, or realign Army 

9 Contracting Command—New Jersey or make dispropor10 tionate personnel reductions at any Army Contracting 

11 Command—New Jersey sites without 30-day prior notifica12 tion to the congressional defense committees. 

13 (RESCISSION)

14 SEC. 1181. Of the unobligated balances available to the 

15 Department of Defense, the following funds are permanently 

16 rescinded from the following accounts and programs in the 

17 specified amounts to reflect excess cash balances in the De18 partment of Defense Acquisition Workforce Development 

19 Fund: 

20 From ‘‘Department of Defense Acquisition Work21 force Development Fund, Defense’’, $10,000,000. 

22 SEC. 1182. None of the funds made available by this 

23 Act for excess defense articles, assistance under section 333 

24 of title 10, United States Code, or peacekeeping operations 

25 for the countries designated annually to be in violation of 
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1 the standards of the Child Soldiers Prevention Act of 2008 

2 (Public Law 110–457; 22 U.S.C. 2370c–1) may be used to 

3 support any military training or operation that includes 

4 child soldiers, as defined by the Child Soldiers Prevention 

5 Act of 2008, unless such assistance is otherwise permitted 

6 under section 404 of the Child Soldiers Prevention Act of 

7 2008. 

8 SEC. 1183. (a) None of the funds provided for the Na9 tional Intelligence Program in this or any prior appropria10 tions Act shall be available for obligation or expenditure 

11 through a reprogramming or transfer of funds in accord12 ance with section 102A(d) of the National Security Act of 

13 1947 (50 U.S.C. 3024(d)) that— 

14 (1) creates a new start effort; 

15 (2) terminates a program with appropriated 

16 funding of $10,000,000 or more; 

17 (3) transfers funding into or out of the National 

18 Intelligence Program; or 

19 (4) transfers funding between appropriations, 

20 unless the congressional intelligence committees are 

21 notified 30 days in advance of such reprogramming 

22 of funds; this notification period may be reduced for 

23 urgent national security requirements. 

24 (b) None of the funds provided for the National Intel25 ligence Program in this or any prior appropriations Act 
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1 shall be available for obligation or expenditure through a 

2 reprogramming or transfer of funds in accordance with sec3 tion 102A(d) of the National Security Act of 1947 (50 

4 U.S.C. 3024(d)) that results in a cumulative increase or 

5 decrease of the levels specified in the classified annex accom6 panying the Act unless the congressional intelligence com7 mittees are notified 30 days in advance of such reprogram8 ming of funds; this notification period may be reduced for 

9 urgent national security requirements. 

10 SEC. 1184. The Director of National Intelligence shall 

11 submit to Congress each year, at or about the time that 

12 the President’s budget is submitted to Congress that year 

13 under section 1105(a) of title 31, United States Code, a fu14 ture-years intelligence program (including associated an15 nexes) reflecting the estimated expenditures and proposed 

16 appropriations included in that budget. Any such future17 years intelligence program shall cover the fiscal year with 

18 respect to which the budget is submitted and at least the 

19 four succeeding fiscal years. 

20 SEC. 1185. For the purposes of this Act, the term ‘‘con21 gressional intelligence committees’’ means the Permanent 

22 Select Committee on Intelligence of the House of Represent23 atives, the Select Committee on Intelligence of the Senate, 

24 the Subcommittee on Defense of the Committee on Appro25 priations of the House of Representatives, and the Sub-
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1 committee on Defense of the Committee on Appropriations 

2 of the Senate. 

3 (INCLUDING TRANSFER OF FUNDS)

4 SEC. 1186. During the current fiscal year, not to ex5 ceed $11,000,000 from each of the appropriations made in 

6 title II of this Act for ‘‘Operation and Maintenance, Army’’, 

7 ‘‘Operation and Maintenance, Navy’’, and ‘‘Operation and 

8 Maintenance, Air Force’’ may be transferred by the mili9 tary department concerned to its central fund established 

10 for Fisher Houses and Suites pursuant to section 2493(d) 

11 of title 10, United States Code. 

12 (INCLUDING TRANSFER OF FUNDS)

13 SEC. 1187. Not to exceed $500,000,000 appropriated 

14 by this Act for operation and maintenance may be available 

15 for the purpose of making remittances and transfer to the 

16 Defense Acquisition Workforce Development Fund in ac17 cordance with section 1705 of title 10, United States Code. 

18 SEC. 1188. (a) Any agency receiving funds made 

19 available in this Act, shall, subject to subsections (b) and 

20 (c), post on the public website of that agency any report 

21 required to be submitted by the Congress in this or any 

22 other Act, upon the determination by the head of the agency 

23 that it shall serve the national interest. 

24 (b) Subsection (a) shall not apply to a report if— 
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1 (1) the public posting of the report compromises 

2 national security; or 

3 (2) the report contains proprietary information. 

4 (c) The head of the agency posting such report shall 

5 do so only after such report has been made available to the 

6 requesting Committee or Committees of Congress for no less 

7 than 45 days. 

8 SEC. 1189. (a) None of the funds appropriated or oth9 erwise made available by this Act may be expended for any 

10 Federal contract for an amount in excess of $1,000,000, un11 less the contractor agrees not to— 

12 (1) enter into any agreement with any of its em13 ployees or independent contractors that requires, as a 

14 condition of employment, that the employee or inde15 pendent contractor agree to resolve through arbitra16 tion any claim under title VII of the Civil Rights Act 

17 of 1964 or any tort related to or arising out of sexual 

18 assault or harassment, including assault and battery, 

19 intentional infliction of emotional distress, false im20 prisonment, or negligent hiring, supervision, or reten21 tion; or 

22 (2) take any action to enforce any provision of 

23 an existing agreement with an employee or inde24 pendent contractor that mandates that the employee 

25 or independent contractor resolve through arbitration 
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1 any claim under title VII of the Civil Rights Act of 

2 1964 or any tort related to or arising out of sexual 

3 assault or harassment, including assault and battery, 

4 intentional infliction of emotional distress, false im5 prisonment, or negligent hiring, supervision, or reten6 tion. 

7 (b) None of the funds appropriated or otherwise made 

8 available by this Act may be expended for any Federal con9 tract unless the contractor certifies that it requires each cov10 ered subcontractor to agree not to enter into, and not to 

11 take any action to enforce any provision of, any agreement 

12 as described in paragraphs (1) and (2) of subsection (a), 

13 with respect to any employee or independent contractor per14 forming work related to such subcontract. For purposes of 

15 this subsection, a ‘‘covered subcontractor’’ is an entity that 

16 has a subcontract in excess of $1,000,000 on a contract sub17 ject to subsection (a). 

18 (c) The prohibitions in this section do not apply with 

19 respect to a contractor’s or subcontractor’s agreements with 

20 employees or independent contractors that may not be en21 forced in a court of the United States. 

22 (d) The Secretary of Defense may waive the applica23 tion of subsection (a) or (b) to a particular contractor or 

24 subcontractor for the purposes of a particular contract or 

25 subcontract if the Secretary or the Deputy Secretary per-
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1 sonally determines that the waiver is necessary to avoid 

2 harm to national security interests of the United States, 

3 and that the term of the contract or subcontract is not 

4 longer than necessary to avoid such harm. The determina5 tion shall set forth with specificity the grounds for the waiv6 er and for the contract or subcontract term selected, and 

7 shall state any alternatives considered in lieu of a waiver 

8 and the reasons each such alternative would not avoid harm 

9 to national security interests of the United States. The Sec10 retary of Defense shall transmit to Congress, and simulta11 neously make public, any determination under this sub12 section not less than 15 business days before the contract 

13 or subcontract addressed in the determination may be 

14 awarded. 

15 (INCLUDING TRANSFER OF FUNDS)

16 SEC. 1190. From within the funds appropriated for 

17 operation and maintenance for the Defense Health Program 

18 in this Act, up to $115,519,000, shall be available for trans19 fer to the Joint Department of Defense-Department of Vet20 erans Affairs Medical Facility Demonstration Fund in ac21 cordance with the provisions of section 1704 of the National 

22 Defense Authorization Act for Fiscal Year 2010, Public Law 

23 111–84: Provided, That for purposes of section 1704(b), the 

24 facility operations funded are operations of the integrated 

25 Captain James A. Lovell Federal Health Care Center, con-
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1 sisting of the North Chicago Veterans Affairs Medical Cen2 ter, the Navy Ambulatory Care Center, and supporting fa3 cilities designated as a combined Federal medical facility 

4 as described by section 706 of Public Law 110–417: Pro5 vided further, That additional funds may be transferred 

6 from funds appropriated for operation and maintenance for 

7 the Defense Health Program to the Joint Department of De8 fense-Department of Veterans Affairs Medical Facility 

9 Demonstration Fund upon written notification by the Sec10 retary of Defense to the Committees on Appropriations of 

11 the House of Representatives and the Senate. 

12 SEC. 1191. None of the funds appropriated or other13 wise made available by this Act may be used by the Depart14 ment of Defense or a component thereof in contravention 

15 of the provisions of section 130h of title 10, United States 

16 Code. 

17 SEC. 1192. Appropriations available to the Depart18 ment of Defense may be used for the purchase of heavy and 

19 light armored vehicles for the physical security of personnel 

20 or for force protection purposes up to a limit of $450,000 

21 per vehicle, notwithstanding price or other limitations ap22 plicable to the purchase of passenger carrying vehicles. 

23 (INCLUDING TRANSFER OF FUNDS)

24 SEC. 1193. Upon a determination by the Director of 

25 National Intelligence that such action is necessary and in 
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1 the national interest, the Director may, with the approval 

2 of the Office of Management and Budget, transfer not to 

3 exceed $1,500,000,000 of the funds made available in this 

4 Act for the National Intelligence Program: Provided, That 

5 such authority to transfer may not be used unless for higher 

6 priority items, based on unforeseen intelligence require7 ments, than those for which originally appropriated and 

8 in no case where the item for which funds are requested 

9 has been denied by the Congress: Provided further, That a 

10 request for multiple reprogrammings of funds using author11 ity provided in this section shall be made prior to June 

12 30, 2017. 

13 SEC. 1194. None of the funds appropriated or other14 wise made available in this or any other Act may be used 

15 to transfer, release, or assist in the transfer or release to 

16 or within the United States, its territories, or possessions 

17 Khalid Sheikh Mohammed or any other detainee who— 

18 (1) is not a United States citizen or a member 

19 of the Armed Forces of the United States; and 

20 (2) is or was held on or after June 24, 2009, at 

21 United States Naval Station, Guanta ́namo Bay, 

22 Cuba, by the Department of Defense. 

23 SEC. 1195. (a) None of the funds appropriated or oth24 erwise made available in this or any other Act may be used 

25 to construct, acquire, or modify any facility in the United 
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1 States, its territories, or possessions to house any individual 

2 described in subsection (c) for the purposes of detention or 

3 imprisonment in the custody or under the effective control 

4 of the Department of Defense. 

5 (b) The prohibition in subsection (a) shall not apply 

6 to any modification of facilities at United States Naval 

7 Station, Guanta ́namo Bay, Cuba. 

8 (c) An individual described in this subsection is any 

9 individual who, as of June 24, 2009, is located at United 

10 States Naval Station, Guanta ́namo Bay, Cuba, and who— 

11 (1) is not a citizen of the United States or a 

12 member of the Armed Forces of the United States; and 

13 (2) is— 

14 (A) in the custody or under the effective 

15 control of the Department of Defense; or 

16 (B) otherwise under detention at United 

17 States Naval Station, Guanta ́namo Bay, Cuba. 

18 SEC. 1196. None of the funds appropriated or other19 wise made available in this Act may be used to transfer 

20 any individual detained at United States Naval Station 

21 Guanta ́namo Bay, Cuba, to the custody or control of the 

22 individual’s country of origin, any other foreign country, 

23 or any other foreign entity except in accordance with sec24 tion 1034 of the National Defense Authorization Act for Fis25 cal Year 2016 (Public Law 114–92) and section 1034 of 
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1 the National Defense Authorization Act for Fiscal Year 

2 2017 (Public Law 114–328). 

3 SEC. 1197. None of the funds made available by this 

4 Act may be used in contravention of the War Powers Reso5 lution (50 U.S.C. 1541 et seq.). 

6 SEC. 1198. (a) None of the funds appropriated or oth7 erwise made available by this or any other Act may be used 

8 by the Secretary of Defense, or any other official or officer 

9 of the Department of Defense, to enter into a contract, 

10 memorandum of understanding, or cooperative agreement 

11 with, or make a grant to, or provide a loan or loan guar12 antee to Rosoboronexport or any subsidiary of 

13 Rosoboronexport. 

14 (b) The Secretary of Defense may waive the limitation 

15 in subsection (a) if the Secretary, in consultation with the 

16 Secretary of State and the Director of National Intelligence, 

17 determines that it is in the vital national security interest 

18 of the United States to do so, and certifies in writing to 

19 the congressional defense committees that, to the best of the 

20 Secretary’s knowledge: 

21 (1) Rosoboronexport has ceased the transfer of le22 thal military equipment to, and the maintenance of 

23 existing lethal military equipment for, the Govern24 ment of the Syrian Arab Republic; 
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1 (2) The armed forces of the Russian Federation 

2 have withdrawn from Crimea, other than armed 

3 forces present on military bases subject to agreements 

4 in force between the Government of the Russian Fed5 eration and the Government of Ukraine; and 

6 (3) Agents of the Russian Federation have ceased 

7 taking active measures to destabilize the control of the 

8 Government of Ukraine over eastern Ukraine. 

9 (c) The Inspector General of the Department of Defense 

10 shall conduct a review of any action involving 

11 Rosoboronexport with respect to a waiver issued by the Sec12 retary of Defense pursuant to subsection (b), and not later 

13 than 90 days after the date on which such a waiver is issued 

14 by the Secretary of Defense, the Inspector General shall sub15 mit to the congressional defense committees a report con16 taining the results of the review conducted with respect to 

17 such waiver. 

18 SEC. 1199. None of the funds made available in this 

19 Act may be used for the purchase or manufacture of a flag 

20 of the United States unless such flags are treated as covered 

21 items under section 2533a(b) of title 10, United States 

22 Code. 

23 SEC. 1200. (a) Of the funds appropriated in this Act 

24 for the Department of Defense, amounts may be made avail25 able, under such regulations as the Secretary of Defense 
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1 may prescribe, to local military commanders appointed by 

2 the Secretary, or by an officer or employee designated by 

3 the Secretary, to provide at their discretion ex gratia pay4 ments in amounts consistent with subsection (d) of this sec5 tion for damage, personal injury, or death that is incident 

6 to combat operations of the Armed Forces in a foreign coun7 try. 

8 (b) An ex gratia payment under this section may be 

9 provided only if— 

10 (1) the prospective foreign civilian recipient is 

11 determined by the local military commander to be 

12 friendly to the United States; 

13 (2) a claim for damages would not be compen14 sable under chapter 163 of title 10, United States 

15 Code (commonly known as the ‘‘Foreign Claims 

16 Act’’); and 

17 (3) the property damage, personal injury, or 

18 death was not caused by action by an enemy. 

19 (c) NATURE OF PAYMENTS.—Any payments provided 

20 under a program under subsection (a) shall not be consid21 ered an admission or acknowledgement of any legal obliga22 tion to compensate for any damage, personal injury, or 

23 death. 

24 (d) AMOUNT OF PAYMENTS.—If the Secretary of De25 fense determines a program under subsection (a) to be ap-
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1 propriate in a particular setting, the amounts of payments, 

2 if any, to be provided to civilians determined to have suf3 fered harm incident to combat operations of the Armed 

4 Forces under the program should be determined pursuant 

5 to regulations prescribed by the Secretary and based on an 

6 assessment, which should include such factors as cultural 

7 appropriateness and prevailing economic conditions. 

8 (e) LEGAL ADVICE.—Local military commanders shall 

9 receive legal advice before making ex gratia payments under 

10 this subsection. The legal advisor, under regulations of the 

11 Department of Defense, shall advise on whether an ex gratia 

12 payment is proper under this section and applicable De13 partment of Defense regulations. 

14 (f) WRITTEN RECORD.—A written record of any ex 

15 gratia payment offered or denied shall be kept by the local 

16 commander and on a timely basis submitted to the appro17 priate office in the Department of Defense as determined 

18 by the Secretary of Defense. 

19 (g) REPORT.—The Secretary of Defense shall report to 

20 the congressional defense committees on an annual basis the 

21 efficacy of the ex gratia payment program including the 

22 number of types of cases considered, amounts offered, the 

23 response from ex gratia payment recipients, and any rec24 ommended modifications to the program. 
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1 SEC. 1201. None of the funds available in this Act to 

2 the Department of Defense, other than appropriations made 

3 for necessary or routine refurbishments, upgrades or main4 tenance activities, shall be used to reduce or to prepare to 

5 reduce the number of deployed and non-deployed strategic 

6 delivery vehicles and launchers below the levels set forth in 

7 the report submitted to Congress in accordance with section 

8 1042 of the National Defense Authorization Act for Fiscal 

9 Year 2012. 

10 SEC. 1202. The Secretary of Defense shall post grant 

11 awards on a public Website in a searchable format. 

12 SEC. 1203. None of the funds made available by this 

13 Act may be used to fund the performance of a flight dem14 onstration team at a location outside of the United States: 

15 Provided, That this prohibition applies only if a perform16 ance of a flight demonstration team at a location within 

17 the United States was canceled during the current fiscal 

18 year due to insufficient funding. 

19 SEC. 1204. None of the funds made available by this 

20 Act may be used by the National Security Agency to— 

21 (1) conduct an acquisition pursuant to section 

22 702 of the Foreign Intelligence Surveillance Act of 

23 1978 for the purpose of targeting a United States per24 son; or 
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1 (2) acquire, monitor, or store the contents (as 

2 such term is defined in section 2510(8) of title 18, 

3 United States Code) of any electronic communication 

4 of a United States person from a provider of elec5 tronic communication services to the public pursuant 

6 to section 501 of the Foreign Intelligence Surveillance 

7 Act of 1978. 

8 SEC. 1205. None of the funds made available by this 

9 Act may be obligated or expended to implement the Arms 

10 Trade Treaty until the Senate approves a resolution of rati11 fication for the Treaty. 

12 SEC. 1206. None of the funds made available in this 

13 or any other Act may be used to pay the salary of any 

14 officer or employee of any agency funded by this Act who 

15 approves or implements the transfer of administrative re16 sponsibilities or budgetary resources of any program, 

17 project, or activity financed by this Act to the jurisdiction 

18 of another Federal agency not financed by this Act unless 

19 explicity provided for in a Defense Appropriations Act: 

20 Provided, That this limitation shall not apply to transfers 

21 of funds expressly provided for in Defense Appropriations 

22 Acts, or provisions of Acts providing supplemental appro23 priations for the Department of Defense. 

24 SEC. 1207. None of the funds made available in this 

25 Act may be obligated for activities authorized under section 
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•HR 1892 EAH 

1 1208 of the Ronald W. Reagan National Defense Authoriza2 tion Act for Fiscal Year 2005 (Public Law 112–81; 125 

3 Stat. 1621) to initiate support for, or expand support to, 

4 foreign forces, irregular forces, groups, or individuals unless 

5 the congressional defense committees are notified in accord6 ance with the direction contained in the classified annex 

7 accompanying this Act, not less than 15 days before initi8 ating such support: Provided, That none of the funds made 

9 available in this Act may be used under section 1208 for 

10 any activity that is not in support of an ongoing military 

11 operation being conducted by United States Special Oper12 ations Forces to combat terrorism: Provided further, That 

13 the Secretary of Defense may waive the prohibitions in this 

14 section if the Secretary determines that such waiver is re15 quired by extraordinary circumstances and, by not later 

16 than 72 hours after making such waiver, notifies the con17 gressional defense committees of such waiver. 

18 SEC. 1208. None of the funds made available by this 

19 Act may be used with respect to Iraq in contravention of 

20 the War Powers Resolution (50 U.S.C. 1541 et seq.), includ21 ing for the introduction of United States armed forces into 

22 hostilities in Iraq, into situations in Iraq where imminent 

23 involvement in hostilities is clearly indicated by the cir24 cumstances, or into Iraqi territory, airspace, or waters 

25 while equipped for combat, in contravention of the congres-
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1 sional consultation and reporting requirements of sections 

2 3 and 4 of such Resolution (50 U.S.C. 1542 and 1543). 

3 SEC. 1209. None of the funds provided in this Act for 

4 the T–AO Fleet Oiler or the Towing, Salvage, and Rescue 

5 Ship programs shall be used to award a new contract that 

6 provides for the acquisition of the following components un7 less those components are manufactured in the United 

8 States: Auxiliary equipment (including pumps) for ship9 board services; propulsion equipment (including engines, 

10 reduction gears, and propellers); shipboard cranes; and 

11 spreaders for shipboard cranes. 

12 SEC. 1210. The amount appropriated in title II of this 

13 Act for ‘‘Operation and Maintenance, Army’’ is hereby re14 duced by $75,000,000 to reflect excess cash balances in De15 partment of Defense Working Capital Funds. 

16 SEC. 1211. Notwithstanding any other provision of 

17 this Act, to reflect savings due to lower than anticipated 

18 fuel costs, the total amount appropriated in title II of this 

19 Act is hereby reduced by $1,007,267,000. 

20 SEC. 1212. None of the funds made available by this 

21 Act may be used for Government Travel Charge Card ex22 penses by military or civilian personnel of the Department 

23 of Defense for gaming, or for entertainment that includes 

24 topless or nude entertainers or participants, as prohibited 

25 by Department of Defense FMR, Volume 9, Chapter 3 and 
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1 Department of Defense Instruction 1015.10 (enclosure 3, 

2 14a and 14b). 

3 SEC. 1213. None of the funds made available by this 

4 Act may be used to propose, plan for, or execute a new or 

5 additional Base Realignment and Closure (BRAC) round. 

6 SEC. 1214. Of the amounts appropriated in this Act 

7 for ‘‘Operation and Maintenance, Navy’’, $289,255,000, to 

8 remain available until expended, may be used for any pur9 poses related to the National Defense Reserve Fleet estab10 lished under section 11 of the Merchant Ship Sales Act of 

11 1946 (50 U.S.C. 4405): Provided, That such amounts are 

12 available for reimbursements to the Ready Reserve Force, 

13 Maritime Administration account of the United States De14 partment of Transportation for programs, projects, activi15 ties, and expenses related to the National Defense Reserve 

16 Fleet. 

17 SEC. 1215. None of the funds made available by this 

18 Act for the Joint Surveillance Target Attack Radar System 

19 recapitalization program may be obligated or expended for 

20 pre-milestone B activities after March 31, 2018, except for 

21 source selection and other activities necessary to enter the 

22 engineering and manufacturing development phase. 

23 SEC. 1216. None of the funds made available by this 

24 Act may be used to carry out the closure or realignment 
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1 of the United States Naval Station, Guanta ́namo Bay, 

2 Cuba. 

3 (INCLUDING TRANSFER OF FUNDS)

4 SEC. 1217. Additional readiness funds made available 

5 in title II of this Act for ‘‘Operation and Maintenance, 

6 Army’’, ‘‘Operation and Maintenance, Navy’’, ‘‘Operation 

7 and Maintenance, Marine Corps’’, and ‘‘Operation and 

8 Maintenance, Air Force’’ may be transferred to and merged 

9 with any appropriation of the Department of Defense for 

10 activities related to the Zika virus in order to provide 

11 health support for the full range of military operations and 

12 sustain the health of the members of the Armed Forces, civil13 ian employees of the Department of Defense, and their fami14 lies, to include: research and development, disease surveil15 lance, vaccine development, rapid detection, vector controls 

16 and surveillance, training, and outbreak response: Pro17 vided, That the authority provided in this section is subject 

18 to the same terms and conditions as the authority provided 

19 in section 8005 of this Act. 

20 SEC. 1218. (a) None of the funds made available in 

21 this Act may be used to maintain or establish a computer 

22 network unless such network is designed to block access to 

23 pornography websites. 

24 (b) Nothing in subsection (a) shall limit the use of 

25 funds necessary for any Federal, State, tribal, or local law 
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1 enforcement agency or any other entity carrying out crimi2 nal investigations, prosecution, or adjudication activities, 

3 or for any activity necessary for the national defense, in4 cluding intelligence activities. 

5 SEC. 1219. Notwithstanding any other provision of 

6 law, any transfer of funds appropriated or otherwise made 

7 available by this Act to the Global Engagement Center pur8 suant to section 1287 of the National Defense Authorization 

9 Act for Fiscal Year 2017 (Public Law 114–328) shall be 

10 made in accordance with section 8005 or 9002 of this Act, 

11 as applicable. 

12 SEC. 1220. No amounts credited or otherwise made 

13 available in this or any other Act to the Department of De14 fense Acquisition Workforce Development Fund may be 

15 transferred to: 

16 (1) the Rapid Prototyping Fund established 

17 under section 804(d) of the National Defense Author18 ization Act for Fiscal Year 2016 (10 U.S.C. 2302 

19 note); or 

20 (2) credited to a military-department specific 

21 fund established under section 804(d)(2) of the Na22 tional Defense Authorization Act for Fiscal Year 2016 

23 (as amended by section 897 of the National Defense 

24 Authorization Act for Fiscal Year 2017). 
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1 (INCLUDING TRANSFER FUND)

2 SEC. 1221. In addition to amounts provided elsewhere 

3 in this Act for military personnel pay, including active 

4 duty, reserve and National Guard personnel, $206,400,000 

5 is hereby appropriated to the Department of Defense and 

6 made available for transfer only to military personnel ac7 counts: Provided, That the transfer authority provided 

8 under this heading is in addition to any other transfer au9 thority provided elsewhere in this Act. 

10 SEC. 1222. In addition to amounts provided elsewhere 

11 in this Act, there is appropriated $235,000,000, for an ad12 ditional amount for ‘‘Operation and Maintenance, Defense13 Wide’’, to remain available until expended: Provided, That 

14 such funds shall only be available to the Secretary of De15 fense, acting through the Office of Economic Adjustment of 

16 the Department of Defense, or for transfer to the Secretary 

17 of Education, notwithstanding any other provision of law, 

18 to make grants, conclude cooperative agreements, or supple19 ment other Federal funds to construct, renovate, repair, or 

20 expand elementary and secondary public schools on mili21 tary installations in order to address capacity or facility 

22 condition deficiencies at such schools: Provided further, 

23 That in making such funds available, the Office of Eco24 nomic Adjustment or the Secretary of Education shall give 

25 priority consideration to those military installations with 
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1 schools having the most serious capacity or facility condi2 tion deficiencies as determined by the Secretary of Defense: 

3 Provided further, That as a condition of receiving funds 

4 under this section a local educational agency or State shall 

5 provide a matching share as described in the notice titled 

6 ‘‘Department of Defense Program for Construction, Renova7 tion, Repair or Expansion of Public Schools Located on 

8 Military Installations’’ published by the Department of De9 fense in the Federal Register on September 9, 2011 (76 Fed. 

10 Reg. 55883 et seq.): Provided further, That these provisions 

11 apply to funds provided under this section, and to funds 

12 previously provided by Congress to construct, renovate, re13 pair, or expand elementary and secondary public schools 

14 on military installations in order to address capacity or 

15 facility condition deficiencies at such schools to the extent 

16 such funds remain unobligated on the date of enactment of 

17 this section. 

18 SEC. 1223. None of the funds made available by this 

19 Act may be used to carry out the changes to the Joint Travel 

20 Regulations of the Department of Defense described in the 

21 memorandum of the Per Diem Travel and Transportation 

22 Allowance Committee titled ‘‘UTD/CTD for MAP 118–13/ 

23 CAP 118–13 - Flat Rate Per Diem for Long Term TDY’’ 

24 and dated October 1, 2014. 
119 

•HR 1892 EAH 

1 SEC. 1224. In carrying out the program described in 

2 the memorandum on the subject of ‘‘Policy for Assisted Re3 productive Services for the Benefit of Seriously or Severely 

4 Ill/Injured (Category II or III) Active Duty Service Mem5 bers’’ issued by the Assistant Secretary of Defense for 

6 Health Affairs on April 3, 2012, and the guidance issued 

7 to implement such memorandum, the Secretary of Defense 

8 shall apply such policy and guidance, except that— 

9 (1) the limitation on periods regarding embryo 

10 cryopreservation and storage set forth in part III(G) 

11 and in part IV(H) of such memorandum shall not 

12 apply; and 

13 (2) the term ‘‘assisted reproductive technology’’ 

14 shall include embryo cryopreservation and storage 

15 without limitation on the duration of such 

16 cryopreservation and storage. 

17 TITLE IX 

18 OVERSEAS CONTINGENCY OPERATIONS/GLOBAL 

19 WAR ON TERRORISM 

20 MILITARY PERSONNEL 

21 MILITARY PERSONNEL, ARMY

22 For an additional amount for ‘‘Military Personnel, 

23 Army’’, $2,635,317,000: Provided, That such amount is des24 ignated by the Congress for Overseas Contingency Oper25 ations/Global War on Terrorism pursuant to section 
120 

•HR 1892 EAH 

1 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

2 Deficit Control Act of 1985. 

3 MILITARY PERSONNEL, NAVY

4 For an additional amount for ‘‘Military Personnel, 

5 Navy’’, $377,857,000: Provided, That such amount is des6 ignated by the Congress for Overseas Contingency Oper7 ations/Global War on Terrorism pursuant to section 

8 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

9 Deficit Control Act of 1985. 

10 MILITARY PERSONNEL, MARINE CORPS

11 For an additional amount for ‘‘Military Personnel, 

12 Marine Corps’’, $103,800,000: Provided, That such amount 

13 is designated by the Congress for Overseas Contingency Op14 erations/Global War on Terrorism pursuant to section 

15 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

16 Deficit Control Act of 1985. 

17 MILITARY PERSONNEL, AIR FORCE

18 For an additional amount for ‘‘Military Personnel, 

19 Air Force’’, $912,779,000: Provided, That such amount is 

20 designated by the Congress for Overseas Contingency Oper21 ations/Global War on Terrorism pursuant to section 

22 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

23 Deficit Control Act of 1985. 
121 

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1 RESERVE PERSONNEL, ARMY

2 For an additional amount for ‘‘Reserve Personnel, 

3 Army’’, $24,942,000: Provided, That such amount is des4 ignated by the Congress for Overseas Contingency Oper5 ations/Global War on Terrorism pursuant to section 

6 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

7 Deficit Control Act of 1985. 

8 RESERVE PERSONNEL, NAVY

9 For an additional amount for ‘‘Reserve Personnel, 

10 Navy’’, $9,091,000: Provided, That such amount is des11 ignated by the Congress for Overseas Contingency Oper12 ations/Global War on Terrorism pursuant to section 

13 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

14 Deficit Control Act of 1985. 

15 RESERVE PERSONNEL, MARINE CORPS

16 For an additional amount for ‘‘Reserve Personnel, Ma17 rine Corps’’, $2,328,000: Provided, That such amount is 

18 designated by the Congress for Overseas Contingency Oper19 ations/Global War on Terrorism pursuant to section 

20 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

21 Deficit Control Act of 1985. 

22 RESERVE PERSONNEL, AIR FORCE

23 For an additional amount for ‘‘Reserve Personnel, Air 

24 Force’’, $20,569,000: Provided, That such amount is des25 ignated by the Congress for Overseas Contingency Oper-
122 

•HR 1892 EAH 

1 ations/Global War on Terrorism pursuant to section 

2 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

3 Deficit Control Act of 1985. 

4 NATIONAL GUARD PERSONNEL, ARMY

5 For an additional amount for ‘‘National Guard Per6 sonnel, Army’’, $184,589,000: Provided, That such amount 

7 is designated by the Congress for Overseas Contingency Op8 erations/Global War on Terrorism pursuant to section 

9 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

10 Deficit Control Act of 1985. 

11 NATIONAL GUARD PERSONNEL, AIR FORCE

12 For an additional amount for ‘‘National Guard Per13 sonnel, Air Force’’, $5,004,000: Provided, That such 

14 amount is designated by the Congress for Overseas Contin15 gency Operations/Global War on Terrorism pursuant to sec16 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer17 gency Deficit Control Act of 1985. 

18 MILITARY PERSONNEL, NATIONAL DEFENSE RESTORATION

19 FUND

20 (INCLUDING TRANSFER OF FUNDS)

21 In addition to amounts provided elsewhere in this Act, 

22 there is appropriated $1,000,000,000, for the ‘‘Military Per23 sonnel, National Defense Restoration Fund’’: Provided, 

24 That such funds provided under this heading shall only be 

25 available for programs, projects and activities necessary to 
123 

•HR 1892 EAH 

1 implement the 2018 National Defense Strategy: Provided 

2 further, That such funds shall not be available for transfer 

3 until 30 days after the Secretary has submitted, and the 

4 congressional defense committees have approved, the pro5 posed allocation plan for the use of such funds to implement 

6 such strategy: Provided further, That such allocation plan 

7 shall include a detailed justification for the use of such 

8 funds and a description of how such investments are nec9 essary to implement the strategy: Provided further, That the 

10 Secretary of Defense may transfer these funds only to mili11 tary personnel accounts: Provided further, That the funds 

12 transferred shall be merged with and shall be available for 

13 the same purposes and for the same time period, as the ap14 propriation to which transferred: Provided further, That 

15 none of the funds made available under this heading may 

16 be transferred to any program, project, or activity specifi17 cally limited or denied by this Act: Provided further, That 

18 the transfer authority provided under this heading is in ad19 dition to any other transfer authority available to the De20 partment of Defense: Provided further, That such amount 

21 is designated by the Congress for Overseas Contingency Op22 erations/Global War on Terrorism pursuant to section 

23 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

24 Deficit Control Act of 1985. 
124 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE 

2 OPERATION AND MAINTENANCE, ARMY

3 For an additional amount for ‘‘Operation and Mainte4 nance, Army’’, $16,126,403,000: Provided, That such 

5 amount is designated by the Congress for Overseas Contin6 gency Operations/Global War on Terrorism pursuant to sec7 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer8 gency Deficit Control Act of 1985. 

9 OPERATION AND MAINTENANCE, NAVY

10 For an additional amount for ‘‘Operation and Mainte11 nance, Navy’’, $5,875,015,000, of which up to $161,885,000 

12 may be transferred to the Coast Guard ‘‘Operating Ex13 penses’’ account: Provided, That such amount is designated 

14 by the Congress for Overseas Contingency Operations/Glob15 al War on Terrorism pursuant to section 251(b)(2)(A)(ii) 

16 of the Balanced Budget and Emergency Deficit Control Act 

17 of 1985. 

18 OPERATION AND MAINTENANCE, MARINE CORPS

19 For an additional amount for ‘‘Operation and Mainte20 nance, Marine Corps’’, $1,116,640,000: Provided, That such 

21 amount is designated by the Congress for Overseas Contin22 gency Operations/Global War on Terrorism pursuant to sec23 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer24 gency Deficit Control Act of 1985. 
125 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, AIR FORCE

2 For an additional amount for ‘‘Operation and Mainte3 nance, Air Force’’, $10,266,295,000: Provided, That such 

4 amount is designated by the Congress for Overseas Contin5 gency Operations/Global War on Terrorism pursuant to sec6 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer7 gency Deficit Control Act of 1985. 

8 OPERATION AND MAINTENANCE, DEFENSE-WIDE

9 For an additional amount for ‘‘Operation and Mainte10 nance, Defense-Wide’’, $6,944,201,000: Provided, That of 

11 the funds provided under this heading, not to exceed 

12 $900,000,000, to remain available until September 30, 

13 2019, shall be for payments to reimburse key cooperating 

14 nations for logistical, military, and other support, includ15 ing access, provided to United States military and stability 

16 operations in Afghanistan and to counter the Islamic State 

17 of Iraq and the Levant: Provided further, That such reim18 bursement payments may be made in such amounts as the 

19 Secretary of Defense, with the concurrence of the Secretary 

20 of State, and in consultation with the Director of the Office 

21 of Management and Budget, may determine, based on docu22 mentation determined by the Secretary of Defense to ade23 quately account for the support provided, and such deter24 mination is final and conclusive upon the accounting offi25 cers of the United States, and 15 days following notification 
126 

•HR 1892 EAH 

1 to the appropriate congressional committees: Provided fur2 ther, That funds provided under this heading may be used 

3 for the purpose of providing specialized training and pro4 curing supplies and specialized equipment and providing 

5 such supplies and loaning such equipment on a non-reim6 bursable basis to coalition forces supporting United States 

7 military and stability operations in Afghanistan and to 

8 counter the Islamic State of Iraq and the Levant, and 15 

9 days following notification to the appropriate congressional 

10 committees: Provided further, That funds provided under 

11 this heading may be used to support the Government of Jor12 dan, in such amounts as the Secretary of Defense may de13 termine, to enhance the ability of the armed forces of Jordan 

14 to increase or sustain security along its borders, upon 15 

15 days prior written notification to the congressional defense 

16 committees outlining the amounts intended to be provided 

17 and the nature of the expenses incurred: Provided further, 

18 That of the funds provided under this heading, not to exceed 

19 $750,000,000, to remain available until September 30, 

20 2019, shall be available to provide support and assistance 

21 to foreign security forces or other groups or individuals to 

22 conduct, support, or facilitate counterterrorism, crisis re23 sponse, or other Department of Defense security cooperation 

24 programs: Provided further, That such amount is des25 ignated by the Congress for Overseas Contingency Oper-
127 

•HR 1892 EAH 

1 ations/Global War on Terrorism pursuant to section 

2 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

3 Deficit Control Act of 1985. 

4 OPERATION AND MAINTENANCE, ARMY RESERVE

5 For an additional amount for ‘‘Operation and Mainte6 nance, Army Reserve’’, $24,699,000: Provided, That such 

7 amount is designated by the Congress for Overseas Contin8 gency Operations/Global War on Terrorism pursuant to sec9 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer10 gency Deficit Control Act of 1985. 

11 OPERATION AND MAINTENANCE, NAVY RESERVE

12 For an additional amount for ‘‘Operation and Mainte13 nance, Navy Reserve’’, $23,980,000: Provided, That such 

14 amount is designated by the Congress for Overseas Contin15 gency Operations/Global War on Terrorism pursuant to sec16 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer17 gency Deficit Control Act of 1985. 

18 OPERATION AND MAINTENANCE, MARINE CORPS RESERVE

19 For an additional amount for ‘‘Operation and Mainte20 nance, Marine Corps Reserve’’, $3,367,000: Provided, That 

21 such amount is designated by the Congress for Overseas 

22 Contingency Operations/Global War on Terrorism pursu23 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

24 Emergency Deficit Control Act of 1985. 
128 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, AIR FORCE RESERVE

2 For an additional amount for ‘‘Operation and Mainte3 nance, Air Force Reserve’’, $58,523,000: Provided, That 

4 such amount is designated by the Congress for Overseas 

5 Contingency Operations/Global War on Terrorism pursu6 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

7 Emergency Deficit Control Act of 1985. 

8 OPERATION AND MAINTENANCE, ARMY NATIONAL GUARD

9 For an additional amount for ‘‘Operation and Mainte10 nance, Army National Guard’’, $108,111,000: Provided, 

11 That such amount is designated by the Congress for Over12 seas Contingency Operations/Global War on Terrorism pur13 suant to section 251(b)(2)(A)(ii) of the Balanced Budget 

14 and Emergency Deficit Control Act of 1985. 

15 OPERATION AND MAINTENANCE, AIR NATIONAL GUARD

16 For an additional amount for ‘‘Operation and Mainte17 nance, Air National Guard’’, $15,400,000: Provided, That 

18 such amount is designated by the Congress for Overseas 

19 Contingency Operations/Global War on Terrorism pursu20 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

21 Emergency Deficit Control Act of 1985. 
129 

•HR 1892 EAH 

1 OPERATION AND MAINTENANCE, NATIONAL DEFENSE

2 RESTORATION FUND

3 (INCLUDING TRANSFER OF FUNDS)

4 In addition to amounts provided elsewhere in this Act, 

5 there is appropriated $2,000,000,000, for the ‘‘Operation 

6 and Maintenance, National Defense Restoration Fund’’: 

7 Provided, That such funds provided under this heading 

8 shall only be available for programs, projects and activities 

9 necessary to implement the 2018 National Defense Strategy: 

10 Provided further, That such funds shall not be available for 

11 transfer until 30 days after the Secretary has submitted, 

12 and the congressional defense committees have approved, the 

13 proposed allocation plan for the use of such funds to imple14 ment such strategy: Provided further, That such allocation 

15 plan shall include a detailed justification for the use of such 

16 funds and a description of how such investments are nec17 essary to implement the strategy: Provided further, That the 

18 Secretary of Defense may transfer these funds only to oper19 ation and maintenance accounts: Provided further, That the 

20 funds transferred shall be merged with and shall be avail21 able for the same purposes and for the same time period, 

22 as the appropriation to which transferred: Provided further, 

23 That none of the funds made available under this heading 

24 may be transferred to any program, project, or activity spe25 cifically limited or denied by this Act: Provided further, 
130 

•HR 1892 EAH 

1 That the transfer authority provided under this heading is 

2 in addition to any other transfer authority available to the 

3 Department of Defense: Provided further, That such amount 

4 is designated by the Congress for Overseas Contingency Op5 erations/Global War on Terrorism pursuant to section 

6 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

7 Deficit Control Act of 1985. 

8 AFGHANISTAN SECURITY FORCES FUND

9 For the ‘‘Afghanistan Security Forces Fund’’, 

10 $4,937,515,000 (reduced by $12,000,000), to remain avail11 able until September 30, 2019: Provided, That such funds 

12 shall be available to the Secretary of Defense, notwith13 standing any other provision of law, for the purpose of al14 lowing the Commander, Combined Security Transition 

15 Command—Afghanistan, or the Secretary’s designee, to 

16 provide assistance, with the concurrence of the Secretary of 

17 State, to the security forces of Afghanistan, including the 

18 provision of equipment, supplies, services, training, facility 

19 and infrastructure repair, renovation, construction, and 

20 funding: Provided further, That the Secretary of Defense 

21 may obligate and expend funds made available to the De22 partment of Defense in this title for additional costs associ23 ated with existing projects previously funded with amounts 

24 provided under the heading ‘‘Afghanistan Infrastructure 

25 Fund’’ in prior Acts: Provided further, That such costs shall 
131 

•HR 1892 EAH 

1 be limited to contract changes resulting from inflation, 

2 market fluctuation, rate adjustments, and other necessary 

3 contract actions to complete existing projects, and associ4 ated supervision and administration costs and costs for de5 sign during construction: Provided further, That the Sec6 retary may not use more than $50,000,000 under the au7 thority provided in this section: Provided further, That the 

8 Secretary shall notify in advance such contract changes and 

9 adjustments in annual reports to the congressional defense 

10 committees: Provided further, That the authority to provide 

11 assistance under this heading is in addition to any other 

12 authority to provide assistance to foreign nations: Provided 

13 further, That contributions of funds for the purposes pro14 vided herein from any person, foreign government, or inter15 national organization may be credited to this Fund, to re16 main available until expended, and used for such purposes: 

17 Provided further, That the Secretary of Defense shall notify 

18 the congressional defense committees in writing upon the 

19 receipt and upon the obligation of any contribution, delin20 eating the sources and amounts of the funds received and 

21 the specific use of such contributions: Provided further, That 

22 the Secretary of Defense shall, not fewer than 15 days prior 

23 to obligating from this appropriation account, notify the 

24 congressional defense committees in writing of the details 

25 of any such obligation: Provided further, That the Secretary 
132 

•HR 1892 EAH 

1 of Defense shall notify the congressional defense committees 

2 of any proposed new projects or transfer of funds between 

3 budget sub-activity groups in excess of $20,000,000: Pro4 vided further, That the United States may accept equip5 ment procured using funds provided under this heading in 

6 this or prior Acts that was transferred to the security forces 

7 of Afghanistan and returned by such forces to the United 

8 States: Provided further, That equipment procured using 

9 funds provided under this heading in this or prior Acts, 

10 and not yet transferred to the security forces of Afghanistan 

11 or transferred to the security forces of Afghanistan and re12 turned by such forces to the United States, may be treated 

13 as stocks of the Department of Defense upon written notifi14 cation to the congressional defense committees: Provided 

15 further, That of the funds provided under this heading, not 

16 less than $10,000,000 shall be for recruitment and retention 

17 of women in the Afghanistan National Security Forces, and 

18 the recruitment and training of female security personnel: 

19 Provided further, That such amount is designated by the 

20 Congress for Overseas Contingency Operations/Global War 

21 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

22 Balanced Budget and Emergency Deficit Control Act of 

23 1985. 
133 

•HR 1892 EAH 

1 COUNTER-ISIL TRAIN AND EQUIP FUND

2 For the ‘‘Counter-Islamic State of Iraq and the Levant 

3 Train and Equip Fund’’, $1,769,000,000, to remain avail4 able until September 30, 2019: Provided, That such funds 

5 shall be available to the Secretary of Defense in coordina6 tion with the Secretary of State, to provide assistance, in7 cluding training; equipment; logistics support, supplies, 

8 and services; stipends; infrastructure repair and renova9 tion; and sustainment, to foreign security forces, irregular 

10 forces, groups, or individuals participating, or preparing 

11 to participate in activities to counter the Islamic State of 

12 Iraq and the Levant, and their affiliated or associated 

13 groups: Provided further, That these funds may be used in 

14 such amounts as the Secretary of Defense may determine 

15 to enhance the border security of nations adjacent to conflict 

16 areas including Jordan, Lebanon, Egypt, and Tunisia re17 sulting from actions of the Islamic State of Iraq and the 

18 Levant: Provided further, That amounts made available 

19 under this heading shall be available to provide assistance 

20 only for activities in a country designated by the Secretary 

21 of Defense, in coordination with the Secretary of State, as 

22 having a security mission to counter the Islamic State of 

23 Iraq and the Levant, and following written notification to 

24 the congressional defense committees of such designation: 

25 Provided further, That the Secretary of Defense shall ensure 
134 

•HR 1892 EAH 

1 that prior to providing assistance to elements of any forces 

2 or individuals, such elements or individuals are appro3 priately vetted, including at a minimum, assessing such ele4 ments for associations with terrorist groups or groups asso5 ciated with the Government of Iran; and receiving commit6 ments from such elements to promote respect for human 

7 rights and the rule of law: Provided further, That the Sec8 retary of Defense shall, not fewer than 15 days prior to obli9 gating from this appropriation account, notify the congres10 sional defense committees in writing of the details of any 

11 such obligation: Provided further, That the Secretary of De12 fense may accept and retain contributions, including assist13 ance in-kind, from foreign governments, including the Gov14 ernment of Iraq and other entities, to carry out assistance 

15 authorized under this heading: Provided further, That con16 tributions of funds for the purposes provided herein from 

17 any foreign government or other entity may be credited to 

18 this Fund, to remain available until expended, and used 

19 for such purposes: Provided further, That the Secretary of 

20 Defense may waive a provision of law relating to the acqui21 sition of items and support services or sections 40 and 40A 

22 of the Arms Export Control Act (22 U.S.C. 2780 and 2785) 

23 if the Secretary determines that such provision of law would 

24 prohibit, restrict, delay or otherwise limit the provision of 

25 such assistance and a notice of and justification for such 
135 

•HR 1892 EAH 

1 waiver is submitted to the congressional defense committees, 

2 the Committees on Appropriations and Foreign Relations 

3 of the Senate and the Committees on Appropriations and 

4 Foreign Affairs of the House of Representatives: Provided 

5 further, That the United States may accept equipment pro6 cured using funds provided under this heading, or under 

7 the heading, ‘‘Iraq Train and Equip Fund’’ in prior Acts, 

8 that was transferred to security forces, irregular forces, or 

9 groups participating, or preparing to participate in activi10 ties to counter the Islamic State of Iraq and the Levant 

11 and returned by such forces or groups to the United States, 

12 may be treated as stocks of the Department of Defense upon 

13 written notification to the congressional defense committees: 

14 Provided further, That equipment procured using funds 

15 provided under this heading, or under the heading, ‘‘Iraq 

16 Train and Equip Fund’’ in prior Acts, and not yet trans17 ferred to security forces, irregular forces, or groups partici18 pating, or preparing to participate in activities to counter 

19 the Islamic State of Iraq and the Levant may be treated 

20 as stocks of the Department of Defense when determined by 

21 the Secretary to no longer be required for transfer to such 

22 forces or groups and upon written notification to the con23 gressional defense committees: Provided further, That the 

24 Secretary of Defense shall provide quarterly reports to the 

25 congressional defense committees on the use of funds pro-
136 

•HR 1892 EAH 

1 vided under this heading, including, but not limited to, the 

2 number of individuals trained, the nature and scope of sup3 port and sustainment provided to each group or individual, 

4 the area of operations for each group, and the contributions 

5 of other countries, groups, or individuals: Provided further, 

6 That such amount is designated by the Congress for Over7 seas Contingency Operations/ Global War on Terrorism 

8 pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 

9 and Emergency Deficit Control Act of 1985. 

10 PROCUREMENT 

11 AIRCRAFT PROCUREMENT, ARMY

12 For an additional amount for ‘‘Aircraft Procurement, 

13 Army’’, $424,686,000, to remain available until September 

14 30, 2020: Provided, That such amount is designated by the 

15 Congress for Overseas Contingency Operations/Global War 

16 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

17 Balanced Budget and Emergency Deficit Control Act of 

18 1985. 

19 MISSILE PROCUREMENT, ARMY

20 For an additional amount for ‘‘Missile Procurement, 

21 Army’’, $557,583,000, to remain available until September 

22 30, 2020: Provided, That such amount is designated by the 

23 Congress for Overseas Contingency Operations/Global War 

24 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
137 

•HR 1892 EAH 

1 Balanced Budget and Emergency Deficit Control Act of 

2 1985. 

3 PROCUREMENT OF WEAPONS AND TRACKED COMBAT

4 VEHICLES, ARMY

5 For an additional amount for ‘‘Procurement of Weap6 ons and Tracked Combat Vehicles, Army’’, $1,191,139,000, 

7 to remain available until September 30, 2020: Provided, 

8 That such amount is designated by the Congress for Over9 seas Contingency Operations/Global War on Terrorism pur10 suant to section 251(b)(2)(A)(ii) of the Balanced Budget 

11 and Emergency Deficit Control Act of 1985. 

12 PROCUREMENT OF AMMUNITION, ARMY

13 For an additional amount for ‘‘Procurement of Am14 munition, Army’’, $193,436,000, to remain available until 

15 September 30, 2020: Provided, That such amount is des16 ignated by the Congress for Overseas Contingency Oper17 ations/Global War on Terrorism pursuant to section 

18 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

19 Deficit Control Act of 1985. 

20 OTHER PROCUREMENT, ARMY

21 For an additional amount for ‘‘Other Procurement, 

22 Army’’, $405,575,000, to remain available until September 

23 30, 2020: Provided, That such amount is designated by the 

24 Congress for Overseas Contingency Operations/Global War 

25 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
138 

•HR 1892 EAH 

1 Balanced Budget and Emergency Deficit Control Act of 

2 1985. 

3 AIRCRAFT PROCUREMENT, NAVY

4 For an additional amount for ‘‘Aircraft Procurement, 

5 Navy’’, $157,300,000, to remain available until September 

6 30, 2020: Provided, That such amount is designated by the 

7 Congress for Overseas Contingency Operations/Global War 

8 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

9 Balanced Budget and Emergency Deficit Control Act of 

10 1985. 

11 WEAPONS PROCUREMENT, NAVY

12 For an additional amount for ‘‘Weapons Procurement, 

13 Navy’’, $130,994,000, to remain available until September 

14 30, 2020: Provided, That such amount is designated by the 

15 Congress for Overseas Contingency Operations/Global War 

16 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

17 Balanced Budget and Emergency Deficit Control Act of 

18 1985. 

19 PROCUREMENT OF AMMUNITION, NAVY AND MARINE

20 CORPS

21 For an additional amount for ‘‘Procurement of Am22 munition, Navy and Marine Corps’’, $223,843,000, to re23 main available until September 30, 2020: Provided, That 

24 such amount is designated by the Congress for Overseas 

25 Contingency Operations/Global War on Terrorism pursu-
139 

•HR 1892 EAH 

1 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

2 Emergency Deficit Control Act of 1985. 

3 OTHER PROCUREMENT, NAVY

4 For an additional amount for ‘‘Other Procurement, 

5 Navy’’, $207,984,000, to remain available until September 

6 30, 2020: Provided, That such amount is designated by the 

7 Congress for Overseas Contingency Operations/Global War 

8 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

9 Balanced Budget and Emergency Deficit Control Act of 

10 1985. 

11 PROCUREMENT, MARINE CORPS

12 For an additional amount for ‘‘Procurement, Marine 

13 Corps’’, $64,071,000, to remain available until September 

14 30, 2020: Provided, That such amount is designated by the 

15 Congress for Overseas Contingency Operations/Global War 

16 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

17 Balanced Budget and Emergency Deficit Control Act of 

18 1985. 

19 AIRCRAFT PROCUREMENT, AIR FORCE

20 For an additional amount for ‘‘Aircraft Procurement, 

21 Air Force’’, $510,836,000, to remain available until Sep22 tember 30, 2020: Provided, That such amount is designated 

23 by the Congress for Overseas Contingency Operations/Glob24 al War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
140 

•HR 1892 EAH 

1 of the Balanced Budget and Emergency Deficit Control Act 

2 of 1985. 

3 MISSILE PROCUREMENT, AIR FORCE

4 For an additional amount for ‘‘Missile Procurement, 

5 Air Force’’, $381,700,000, to remain available until Sep6 tember 30, 2020: Provided, That such amount is designated 

7 by the Congress for Overseas Contingency Operations/Glob8 al War on Terrorism pursuant to section 251(b)(2)(A)(ii) 

9 of the Balanced Budget and Emergency Deficit Control Act 

10 of 1985. 

11 SPACE PROCUREMENT, AIR FORCE

12 For an additional amount for ‘‘Space Procurement, 

13 Air Force’’, $2,256,000, to remain available until Sep14 tember 30, 2020: Provided, That such amount is designated 

15 by the Congress for Overseas Contingency Operations/Glob16 al War on Terrorism pursuant to section 251(b)(2)(A)(ii) 

17 of the Balanced Budget and Emergency Deficit Control Act 

18 of 1985. 

19 PROCUREMENT OF AMMUNITION, AIR FORCE

20 For an additional amount for ‘‘Procurement of Am21 munition, Air Force’’, $501,509,000, to remain available 

22 until September 30, 2020: Provided, That such amount is 

23 designated by the Congress for Overseas Contingency Oper24 ations/Global War on Terrorism pursuant to section 
141 

•HR 1892 EAH 

1 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

2 Deficit Control Act of 1985. 

3 OTHER PROCUREMENT, AIR FORCE

4 For an additional amount for ‘‘Other Procurement, 

5 Air Force’’, $3,998,887,000, to remain available until Sep6 tember 30, 2020: Provided, That such amount is designated 

7 by the Congress for Overseas Contingency Operations/Glob8 al War on Terrorism pursuant to section 251(b)(2)(A)(ii) 

9 of the Balanced Budget and Emergency Deficit Control Act 

10 of 1985. 

11 PROCUREMENT, DEFENSE-WIDE

12 For an additional amount for ‘‘Procurement, Defense13 Wide’’, $510,741,000, to remain available until September 

14 30, 2020: Provided, That such amount is designated by the 

15 Congress for Overseas Contingency Operations/Global War 

16 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

17 Balanced Budget and Emergency Deficit Control Act of 

18 1985. 

19 NATIONAL GUARD AND RESERVE EQUIPMENT ACCOUNT

20 For procurement of rotary-wing aircraft; combat, tac21 tical and support vehicles; other weapons; and other pro22 curement items for the reserve components of the Armed 

23 Forces, $1,000,000,000, to remain available for obligation 

24 until September 30, 2020: Provided, That the Chiefs of Na25 tional Guard and Reserve components shall, not later than 
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1 30 days after enactment of this Act, individually submit 

2 to the congressional defense committees the modernization 

3 priority assessment for their respective National Guard or 

4 Reserve component: Provided further, That none of the 

5 funds made available by this paragraph may be used to 

6 procure manned fixed wing aircraft, or procure or modify 

7 missiles, munitions, or ammunition: Provided further, That 

8 such amount is designated by the Congress for Overseas 

9 Contingency Operations/Global War on Terrorism pursu10 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

11 Emergency Deficit Control Act of 1985. 

12 PROCUREMENT, NATIONAL DEFENSE RESTORATION FUND

13 (INCLUDING TRANSFER OF FUNDS)

14 In addition to amounts provided elsewhere in this Act, 

15 there is appropriated $6,000,000,000, for the ‘‘Procurement, 

16 National Defense Restoration Fund’’: Provided, That such 

17 funds provided under this heading shall only be available 

18 for programs, projects and activities necessary to implement 

19 the 2018 National Defense Strategy: Provided further, That 

20 such funds shall not be available for transfer until 30 days 

21 after the Secretary has submitted, and the congressional de22 fense committees have approved, the proposed allocation 

23 plan for the use of such funds to implement such strategy: 

24 Provided further, That such allocation plan shall include 

25 a detailed justification for the use of such funds and a de-
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•HR 1892 EAH 

1 scription of how such investments are necessary to imple2 ment the strategy: Provided further, That the Secretary of 

3 Defense may transfer these funds only to procurement ac4 counts: Provided further, That the funds transferred shall 

5 be merged with and shall be available for the same purposes 

6 and for the same time period, as the appropriation to which 

7 transferred: Provided further, That none of the funds made 

8 available under this heading may be transferred to any pro9 gram, project, or activity specifically limited or denied by 

10 this Act: Provided further, That the transfer authority pro11 vided under this heading is in addition to any other trans12 fer authority available to the Department of Defense: Pro13 vided further, That such amount is designated by the Con14 gress for Overseas Contingency Operations/Global War on 

15 Terrorism pursuant to section 251(b)(2)(A)(ii) of the Bal16 anced Budget and Emergency Deficit Control Act of 1985. 

17 RESEARCH, DEVELOPMENT, TEST AND 

18 EVALUATION 

19 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, ARMY

20 For an additional amount for ‘‘Research, Develop21 ment, Test and Evaluation, Army’’, $119,368,000 (in22 creased by $6,000,000), to remain available until September 

23 30, 2019: Provided, That such amount is designated by the 

24 Congress for Overseas Contingency Operations/Global War 

25 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
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•HR 1892 EAH 

1 Balanced Budget and Emergency Deficit Control Act of 

2 1985. 

3 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, NAVY

4 For an additional amount for ‘‘Research, Develop5 ment, Test and Evaluation, Navy’’, $124,865,000, to re6 main available until September 30, 2019: Provided, That 

7 such amount is designated by the Congress for Overseas 

8 Contingency Operations/Global War on Terrorism pursu9 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

10 Emergency Deficit Control Act of 1985. 

11 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, AIR

12 FORCE

13 For an additional amount for ‘‘Research, Develop14 ment, Test and Evaluation, Air Force’’, $144,508,000, to 

15 remain available until September 30, 2019: Provided, That 

16 such amount is designated by the Congress for Overseas 

17 Contingency Operations/Global War on Terrorism pursu18 ant to section 251(b)(2)(A)(ii) of the Balanced Budget and 

19 Emergency Deficit Control Act of 1985. 

20 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, 

21 DEFENSE-WIDE

22 For an additional amount for ‘‘Research, Develop23 ment, Test and Evaluation, Defense-Wide’’, $226,096,000, 

24 to remain available until September 30, 2019: Provided, 

25 That such amount is designated by the Congress for Over-
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•HR 1892 EAH 

1 seas Contingency Operations/Global War on Terrorism pur2 suant to section 251(b)(2)(A)(ii) of the Balanced Budget 

3 and Emergency Deficit Control Act of 1985. 

4 RESEARCH, DEVELOPMENT, TEST AND EVALUATION, 

5 NATIONAL DEFENSE RESTORATION FUND

6 (INCLUDING TRANSFER OF FUNDS)

7 In addition to amounts provided elsewhere in this Act, 

8 there is appropriated $1,000,000,000, for the ‘‘Research, De9 velopment, Test and Evaluation, National Defense Restora10 tion Fund’’: Provided, That such funds provided under this 

11 heading shall only be available for programs, projects and 

12 activities necessary to implement the 2018 National Defense 

13 Strategy: Provided further, That such funds shall not be 

14 available for transfer until 30 days after the Secretary has 

15 submitted, and the congressional defense committees have 

16 approved, the proposed allocation plan for the use of such 

17 funds to implement such strategy: Provided further, That 

18 such allocation plan shall include a detailed justification 

19 for the use of such funds and a description of how such 

20 investments are necessary to implement the strategy: Pro21 vided further, That the Secretary of Defense may transfer 

22 these funds only to research, development, test and evalua23 tion accounts: Provided further, That the funds transferred 

24 shall be merged with and shall be available for the same 

25 purposes and for the same time period, as the appropriation 
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•HR 1892 EAH 

1 to which transferred: Provided further, That none of the 

2 funds made available under this heading may be trans3 ferred to any program, project, or activity specifically lim4 ited or denied by this Act: Provided further, That the trans5 fer authority provided under this heading is in addition 

6 to any other transfer authority available to the Department 

7 of Defense: Provided further, That such amount is des8 ignated by the Congress for Overseas Contingency Oper9 ations/Global War on Terrorism pursuant to section 

10 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

11 Deficit Control Act of 1985. 

12 REVOLVING AND MANAGEMENT FUNDS 

13 DEFENSE WORKING CAPITAL FUNDS

14 For an additional amount for ‘‘Defense Working Cap15 ital Funds’’, $148,956,000: Provided, That such amount is 

16 designated by the Congress for Overseas Contingency Oper17 ations/Global War on Terrorism pursuant to section 

18 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

19 Deficit Control Act of 1985. 

20 OTHER DEPARTMENT OF DEFENSE PROGRAMS 

21 DEFENSE HEALTH PROGRAM

22 For an additional amount for ‘‘Defense Health Pro23 gram’’, $395,805,000, which shall be for operation and 

24 maintenance: Provided, That such amount is designated by 

25 the Congress for Overseas Contingency Operations/Global 
147 

•HR 1892 EAH 

1 War on Terrorism pursuant to section 251(b)(2)(A)(ii) of 

2 the Balanced Budget and Emergency Deficit Control Act 

3 of 1985. 

4 DRUG INTERDICTION AND COUNTER-DRUG ACTIVITIES, 

5 DEFENSE

6 For an additional amount for ‘‘Drug Interdiction and 

7 Counter-Drug Activities, Defense’’, $196,300,000: Provided, 

8 That such amount is designated by the Congress for Over9 seas Contingency Operations/Global War on Terrorism pur10 suant to section 251(b)(2)(A)(ii) of the Balanced Budget 

11 and Emergency Deficit Control Act of 1985. 

12 JOINT IMPROVISED-THREAT DEFEAT FUND

13 (INCLUDING TRANSFER OF FUNDS)

14 For the ‘‘Joint Improvised-Threat Defeat Fund’’, 

15 $483,058,000, to remain available until September 30, 

16 2020: Provided, That such funds shall be available to the 

17 Secretary of Defense, notwithstanding any other provision 

18 of law, for the purpose of allowing the Director of the Joint 

19 Improvised-Threat Defeat Organization to investigate, de20 velop and provide equipment, supplies, services, training, 

21 facilities, personnel and funds to assist United States forces 

22 in the defeat of improvised explosive devices: Provided fur23 ther, That the Secretary of Defense may transfer funds pro24 vided herein to appropriations for military personnel; oper25 ation and maintenance; procurement; research, develop-
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1 ment, test and evaluation; and defense working capital 

2 funds to accomplish the purpose provided herein: Provided 

3 further, That this transfer authority is in addition to any 

4 other transfer authority available to the Department of De5 fense: Provided further, That the Secretary of Defense shall, 

6 not fewer than 5 days prior to making transfers from this 

7 appropriation, notify the congressional defense committees 

8 in writing of the details of any such transfer: Provided fur9 ther, That such amount is designated by the Congress for 

10 Overseas Contingency Operations/Global War on Terrorism 

11 pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 

12 and Emergency Deficit Control Act of 1985. 

13 OFFICE OF THE INSPECTOR GENERAL

14 For an additional amount for the ‘‘Office of the Inspec15 tor General’’, $24,692,000: Provided, That such amount is 

16 designated by the Congress for Overseas Contingency Oper17 ations/Global War on Terrorism pursuant to section 

18 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

19 Deficit Control Act of 1985. 

20 GENERAL PROVISIONS—THIS TITLE 

21 SEC. 1301. Notwithstanding any other provision of 

22 law, funds made available in this title are in addition to 

23 amounts appropriated or otherwise made available for the 

24 Department of Defense for fiscal year 2018. 
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1 (INCLUDING TRANSFER OF FUNDS)

2 SEC. 1302. Upon the determination of the Secretary 

3 of Defense that such action is necessary in the national in4 terest, the Secretary may, with the approval of the Office 

5 of Management and Budget, transfer up to $2,500,000,000 

6 between the appropriations or funds made available to the 

7 Department of Defense in this title: Provided, That the Sec8 retary shall notify the Congress promptly of each transfer 

9 made pursuant to the authority in this section: Provided 

10 further, That the authority provided in this section is in 

11 addition to any other transfer authority available to the 

12 Department of Defense and is subject to the same terms and 

13 conditions as the authority provided in section 8005 of this 

14 Act. 

15 SEC. 1303. Supervision and administration costs and 

16 costs for design during construction associated with a con17 struction project funded with appropriations available for 

18 operation and maintenance or the ‘‘Afghanistan Security 

19 Forces Fund’’ provided in this Act and executed in direct 

20 support of overseas contingency operations in Afghanistan, 

21 may be obligated at the time a construction contract is 

22 awarded: Provided, That, for the purpose of this section, 

23 supervision and administration costs and costs for design 

24 during construction include all in-house Government costs. 
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1 SEC. 1304. From funds made available in this title, 

2 the Secretary of Defense may purchase for use by military 

3 and civilian employees of the Department of Defense in the 

4 United States Central Command area of responsibility: 

5 (1) passenger motor vehicles up to a limit of 

6 $75,000 per vehicle; and 

7 (2) heavy and light armored vehicles for the 

8 physical security of personnel or for force protection 

9 purposes up to a limit of $450,000 per vehicle, not10 withstanding price or other limitations applicable to 

11 the purchase of passenger carrying vehicles. 

12 SEC. 1305. Not to exceed $5,000,000 of the amounts 

13 appropriated by this title under the heading ‘‘Operation 

14 and Maintenance, Army’’ may be used, notwithstanding 

15 any other provision of law, to fund the Commanders’ Emer16 gency Response Program (CERP), for the purpose of ena17 bling military commanders in Afghanistan to respond to 

18 urgent, small-scale, humanitarian relief and reconstruction 

19 requirements within their areas of responsibility: Provided, 

20 That each project (including any ancillary or related ele21 ments in connection with such project) executed under this 

22 authority shall not exceed $2,000,000: Provided further, 

23 That not later than 45 days after the end of each 6 months 

24 of the fiscal year, the Secretary of Defense shall submit to 

25 the congressional defense committees a report regarding the 
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•HR 1892 EAH 

1 source of funds and the allocation and use of funds during 

2 that 6-month period that were made available pursuant to 

3 the authority provided in this section or under any other 

4 provision of law for the purposes described herein: Provided 

5 further, That, not later than 30 days after the end of each 

6 fiscal year quarter, the Army shall submit to the congres7 sional defense committees quarterly commitment, obliga8 tion, and expenditure data for the CERP in Afghanistan: 

9 Provided further, That, not less than 15 days before making 

10 funds available pursuant to the authority provided in this 

11 section or under any other provision of law for the purposes 

12 described herein for a project with a total anticipated cost 

13 for completion of $500,000 or more, the Secretary shall sub14 mit to the congressional defense committees a written notice 

15 containing each of the following: 

16 (1) The location, nature and purpose of the pro17 posed project, including how the project is intended to 

18 advance the military campaign plan for the country 

19 in which it is to be carried out. 

20 (2) The budget, implementation timeline with 

21 milestones, and completion date for the proposed 

22 project, including any other CERP funding that has 

23 been or is anticipated to be contributed to the comple24 tion of the project. 
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•HR 1892 EAH 

1 (3) A plan for the sustainment of the proposed 

2 project, including the agreement with either the host 

3 nation, a non-Department of Defense agency of the 

4 United States Government or a third-party contrib5 utor to finance the sustainment of the activities and 

6 maintenance of any equipment or facilities to be pro7 vided through the proposed project. 

8 SEC. 1306. Funds available to the Department of De9 fense for operation and maintenance may be used, notwith10 standing any other provision of law, to provide supplies, 

11 services, transportation, including airlift and sealift, and 

12 other logistical support to allied forces participating in a 

13 combined operation with the armed forces of the United 

14 States and coalition forces supporting military and sta15 bility operations in Afghanistan and to counter the Islamic 

16 State of Iraq and the Levant: Provided, That the Secretary 

17 of Defense shall provide quarterly reports to the congres18 sional defense committees regarding support provided under 

19 this section. 

20 SEC. 1307. None of the funds appropriated or other21 wise made available by this or any other Act shall be obli22 gated or expended by the United States Government for a 

23 purpose as follows: 
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•HR 1892 EAH 

1 (1) To establish any military installation or base 

2 for the purpose of providing for the permanent sta3 tioning of United States Armed Forces in Iraq. 

4 (2) To exercise United States control over any 

5 oil resource of Iraq. 

6 (3) To establish any military installation or base 

7 for the purpose of providing for the permanent sta8 tioning of United States Armed Forces in Afghani9 stan. 

10 SEC. 1308. None of the funds made available in this 

11 Act may be used in contravention of the following laws en12 acted or regulations promulgated to implement the United 

13 Nations Convention Against Torture and Other Cruel, In14 human or Degrading Treatment or Punishment (done at 

15 New York on December 10, 1984): 

16 (1) Section 2340A of title 18, United States 

17 Code. 

18 (2) Section 2242 of the Foreign Affairs Reform 

19 and Restructuring Act of 1998 (division G of Public 

20 Law 105–277; 112 Stat. 2681–822; 8 U.S.C. 1231 

21 note) and regulations prescribed thereto, including 

22 regulations under part 208 of title 8, Code of Federal 

23 Regulations, and part 95 of title 22, Code of Federal 

24 Regulations. 
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•HR 1892 EAH 

1 (3) Sections 1002 and 1003 of the Department of 

2 Defense, Emergency Supplemental Appropriations to 

3 Address Hurricanes in the Gulf of Mexico, and Pan4 demic Influenza Act, 2006 (Public Law 109–148). 

5 SEC. 1309. None of the funds provided for the ‘‘Afghan6 istan Security Forces Fund’’ (ASFF) may be obligated 

7 prior to the approval of a financial and activity plan by 

8 the Afghanistan Resources Oversight Council (AROC) of the 

9 Department of Defense: Provided, That the AROC must ap10 prove the requirement and acquisition plan for any service 

11 requirements in excess of $50,000,000 annually and any 

12 non-standard equipment requirements in excess of 

13 $100,000,000 using ASFF: Provided further, That the De14 partment of Defense must certify to the congressional de15 fense committees that the AROC has convened and approved 

16 a process for ensuring compliance with the requirements in 

17 the preceding proviso and accompanying report language 

18 for the ASFF. 

19 SEC. 1310. Funds made available in this title to the 

20 Department of Defense for operation and maintenance may 

21 be used to purchase items having an investment unit cost 

22 of not more than $250,000: Provided, That, upon deter23 mination by the Secretary of Defense that such action is 

24 necessary to meet the operational requirements of a Com25 mander of a Combatant Command engaged in contingency 
155 

•HR 1892 EAH 

1 operations overseas, such funds may be used to purchase 

2 items having an investment item unit cost of not more than 

3 $500,000. 

4 SEC. 1311. Up to $500,000,000 of funds appropriated 

5 by this Act for the Defense Security Cooperation Agency 

6 in ‘‘Operation and Maintenance, Defense-Wide’’ may be 

7 used to provide assistance to the Government of Jordan to 

8 support the armed forces of Jordan and to enhance security 

9 along its borders. 

10 SEC. 1312. None of the funds made available by this 

11 Act under the heading ‘‘Counter-ISIL Train and Equip 

12 Fund’’ may be used to procure or transfer man-portable air 

13 defense systems. 

14 SEC. 1313. For the ‘‘Ukraine Security Assistance Ini15 tiative’’, $150,000,000 is hereby appropriated, to remain 

16 available until September 30, 2018: Provided, That such 

17 funds shall be available to the Secretary of Defense, in co18 ordination with the Secretary of State, to provide assist19 ance, including training; equipment; lethal weapons of a 

20 defensive nature; logistics support, supplies and services; 

21 sustainment; and intelligence support to the military and 

22 national security forces of Ukraine, and for replacement of 

23 any weapons or defensive articles provided to the Govern24 ment of Ukraine from the inventory of the United States: 

25 Provided further, That the Secretary of Defense shall, not 
156 

•HR 1892 EAH 

1 less than 15 days prior to obligating funds provided under 

2 this heading, notify the congressional defense committees in 

3 writing of the details of any such obligation: Provided fur4 ther, That the United States may accept equipment pro5 cured using funds provided under this heading in this or 

6 prior Acts that was transferred to the security forces of 

7 Ukraine and returned by such forces to the United States: 

8 Provided further, That equipment procured using funds 

9 provided under this heading in this or prior Acts, and not 

10 yet transferred to the military or National Security Forces 

11 of Ukraine or returned by such forces to the United States, 

12 may be treated as stocks of the Department of Defense upon 

13 written notification to the congressional defense committees: 

14 Provided further, That amounts made available by this sec15 tion are designated by the Congress for Overseas Contin16 gency Operations/Global War on Terrorism pursuant to sec17 tion 251(b)(2)(A)(ii) of the Balanced Budget and Emer18 gency Deficit Control Act of 1985. 

19 SEC. 1314. Funds appropriated in this title shall be 

20 available for replacement of funds for items provided to the 

21 Government of Ukraine from the inventory of the United 

22 States to the extent specifically provided for in section 9013 

23 of this Act. 

24 SEC. 1315. None of the funds made available by this 

25 Act under section 9013 for ‘‘Assistance and Sustainment 
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•HR 1892 EAH 

1 to the Military and National Security Forces of Ukraine’’ 

2 may be used to procure or transfer man-portable air defense 

3 systems. 

4 SEC. 1316. (a) None of the funds appropriated or oth5 erwise made available by this Act under the heading ‘‘Oper6 ation and Maintenance, Defense-Wide’’ for payments under 

7 section 1233 of Public Law 110–181 for reimbursement to 

8 the Government of Pakistan may be made available unless 

9 the Secretary of Defense, in coordination with the Secretary 

10 of State, certifies to the congressional defense committees 

11 that the Government of Pakistan is— 

12 (1) cooperating with the United States in 

13 counterterrorism efforts against the Haqqani Network, 

14 the Quetta Shura Taliban, Lashkar e-Tayyiba, Jaish15 e-Mohammed, Al Qaeda, and other domestic and for16 eign terrorist organizations, including taking steps to 

17 end support for such groups and prevent them from 

18 basing and operating in Pakistan and carrying out 

19 cross border attacks into neighboring countries; 

20 (2) not supporting terrorist activities against 

21 United States or coalition forces in Afghanistan, and 

22 Pakistan’s military and intelligence agencies are not 

23 intervening extra-judicially into political and judicial 

24 processes in Pakistan; 
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•HR 1892 EAH 

1 (3) dismantling improvised explosive device 

2 (IED) networks and interdicting precursor chemicals 

3 used in the manufacture of IEDs; 

4 (4) preventing the proliferation of nuclear-re5 lated material and expertise; 

6 (5) implementing policies to protect judicial 

7 independence and due process of law; 

8 (6) issuing visas in a timely manner for United 

9 States visitors engaged in counterterrorism efforts and 

10 assistance programs in Pakistan; and 

11 (7) providing humanitarian organizations access 

12 to detainees, internally displaced persons, and other 

13 Pakistani civilians affected by the conflict. 

14 (b) The Secretary of Defense, in coordination with the 

15 Secretary of State, may waive the restriction in subsection 

16 (a) on a case-by-case basis by certifying in writing to the 

17 congressional defense committees that it is in the national 

18 security interest to do so: Provided, That if the Secretary 

19 of Defense, in coordination with the Secretary of State, ex20 ercises such waiver authority, the Secretaries shall report 

21 to the congressional defense committees on both the justifica22 tion for the waiver and on the requirements of this section 

23 that the Government of Pakistan was not able to meet: Pro24 vided further, That such report may be submitted in classi25 fied form if necessary. 
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•HR 1892 EAH 

1 (INCLUDING TRANSFER OF FUNDS)

2 SEC. 1317. In addition to amounts otherwise made 

3 available in this Act, $500,000,000 is hereby appropriated 

4 to the Department of Defense and made available for trans5 fer only to the operation and maintenance, military per6 sonnel, and procurement accounts, to improve the intel7 ligence, surveillance, and reconnaissance capabilities of the 

8 Department of Defense: Provided, That the transfer author9 ity provided in this section is in addition to any other 

10 transfer authority provided elsewhere in this Act: Provided 

11 further, That not later than 30 days prior to exercising the 

12 transfer authority provided in this section, the Secretary 

13 of Defense shall submit a report to the congressional defense 

14 committees on the proposed uses of these funds: Provided 

15 further, That the funds provided in this section may not 

16 be transferred to any program, project, or activity specifi17 cally limited or denied by this Act: Provided further, That 

18 amounts made available by this section are designated by 

19 the Congress for Overseas Contingency Operations/Global 

20 War on Terrorism pursuant to section 251(b)(2)(A)(ii) of 

21 the Balanced Budget and Emergency Deficit Control Act 

22 of 1985: Provided further, That the authority to provide 

23 funding under this section shall terminate on September 30, 

24 2018. 
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•HR 1892 EAH 

1 SEC. 1318. None of the funds made available by this 

2 Act may be used with respect to Syria in contravention of 

3 the War Powers Resolution (50 U.S.C. 1541 et seq.), includ4 ing for the introduction of United States armed or military 

5 forces into hostilities in Syria, into situations in Syria 

6 where imminent involvement in hostilities is clearly indi7 cated by the circumstances, or into Syrian territory, air8 space, or waters while equipped for combat, in contraven9 tion of the congressional consultation and reporting require10 ments of sections 3 and 4 of that law (50 U.S.C. 1542 and 

11 1543). 

12 (RESCISSIONS)

13 SEC. 1319. Of the funds appropriated in Department 

14 of Defense Appropriations Acts, the following funds are 

15 hereby rescinded from the following accounts and programs 

16 in the specified amounts: Provided, That such amounts are 

17 designated by the Congress for Overseas Contingency Oper18 ations/Global War on Terrorism pursuant to section 

19 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

20 Deficit Control Act of 1985: 

21 ‘‘Other Procurement, Air Force’’, 2017/2019, 

22 $25,100,000; 

23 ‘‘Afghanistan Security Forces Fund’’, 2017/2018, 

24 $100,000,000; and 
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•HR 1892 EAH 

1 ‘‘Counter-ISIL Train and Equip Fund’’, 2017/ 

2 2018, $112,513,000. 

3 ‘‘Operation and Maintenance, Defense-Wide, 

4 DSCA Coalition Support Fund’’, 2017/2018, 

5 $350,000,000. 

6 SEC. 1320. Each amount designated in this Act by the 

7 Congress for Overseas Contingency Operations/Global War 

8 on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 

9 Balanced Budget and Emergency Deficit Control Act of 

10 1985 shall be available only if the President subsequently 

11 so designates all such amounts and transmits such designa12 tions to the Congress. 

13 SEC. 1321. (a) Not later than 30 days after the date 

14 of the enactment of this Act, the President shall submit to 

15 Congress a report on the United States strategy to defeat 

16 Al-Qaeda, the Taliban, the Islamic State of Iraq and Syria 

17 (ISIS), and their associated forces and co-belligerents. 

18 (b) The report required under subsection (a) shall in19 clude the following: 

20 (1) An analysis of the adequacy of the existing 

21 legal framework to accomplish the strategy described 

22 in subsection (a), particularly with respect to the Au23 thorization for Use of Military Force (Public Law 

24 107–40; 50 U.S.C. 1541 note) and the Authorization 
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•HR 1892 EAH 

1 for Use of Military Force Against Iraq Resolution of 

2 2002 (Public Law 107–243; 50 U.S.C. 1541 note). 

3 (2) An analysis of the budgetary resources nec4 essary to accomplish the strategy described in sub5 section (a). 

6 (c) Not later than 30 days after the date on which the 

7 President submits to the appropriate congressional commit8 tees the report required by subsection (a), the Secretary of 

9 State and the Secretary of Defense shall testify at any hear10 ing held by any of the appropriate congressional committees 

11 on the report and to which the Secretary is invited. 

12 (d) In this section, the term ‘‘appropriate congres13 sional committees’’ means— 

14 (1) the Committee on Foreign Relations and the 

15 Committee on Armed Services of the Senate; and 

16 (2) the Committee on Foreign Affairs and the 

17 Committee on Armed Services of the House of Rep18 resentatives. 

19 SEC. 1322. (a) In addition to amounts provided else20 where in this Act, there is hereby appropriated 

21 $1,184,112,000, for the following accounts and programs in 

22 the specified amounts for costs associated with Operation 

23 Freedom’s Sentinel: 

24 (1) ‘‘Military Personnel, Army’’, $48,377,000; 
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•HR 1892 EAH 

1 (2) ‘‘Military Personnel, Marine Corps’’, 

2 $179,000; 

3 (3) ‘‘Military Personnel, Air Force’’, $1,340,000; 

4 (4) ‘‘Operation and Maintenance, Army’’, 

5 $872,491,000; 

6 (5) ‘‘Operation and Maintenance, Navy’’, 

7 $76,274,000; 

8 (6) ‘‘Operation and Maintenance, Marine 

9 Corps’’, $24,734,000; 

10 (7) ‘‘Operation and Maintenance, Defense-Wide’’, 

11 $81,164,000; 

12 (8) ‘‘Procurement of Ammunition, Navy and 

13 Marine Corps’’, $10,853,000, to remain available 

14 until September 30, 2020; 

15 (9) ‘‘Other Procurement, Navy’’, $31,500,000, to 

16 remain available until September 30, 2020; and 

17 (10) ‘‘Research, Development, Test and Evalua18 tion, Navy’’, $37,200,000, to remain available until 

19 September 30, 2019. 

20 (b) Amounts provided pursuant to this section are 

21 hereby designated by the Congress for Overseas Contingency 

22 Operations/Global War on Terrorism pursuant to section 

23 251(b)(2)(A)(ii) of the Balanced Budget and Emergency 

24 Deficit Control Act of 1985. 
164 

•HR 1892 EAH 

1 TITLE X—ADDITIONAL GENERAL PROVISIONS 

2 REFERENCES TO REPORT

3 SEC. 1401. Any reference to a ‘‘report accompanying 

4 this Act’’ contained in this Act shall be treated as a ref5 erence to House Report 115–219. Such report shall apply 

6 for purposes of determining the allocation of funds provided 

7 by, and the implementation of, this Act. 

8 SPENDING REDUCTION ACCOUNT

9 SEC. 1402. $0. 

10 SEC. 1403. None of the funds appropriated or other11 wise made available under the heading ‘‘Afghanistan Secu12 rity Forces Fund’’ may be used to procure uniforms for the 

13 Afghan National Army. 

14 SEC. 1404. None of the funds made available in this 

15 Act may be used for the closure of a biosafety level 4 labora16 tory. 

17 SEC. 1405. None of the funds made available by this 

18 Act may be used to provide arms, training, or other assist19 ance to the Azov Battalion. 

20 SEC. 1406. None of the finds made available by this 

21 Act may be used to purchase heavy water from Iran. 

22 SEC. 1407. None of the funds appropriated by this Act 

23 may be used to plan for, begin, continue, complete, process, 

24 or approve a public-private competition under the Office 

25 of Management and Budget Circular A-76. 
165 

•HR 1892 EAH 

1 SEC. 1408. Notwithstanding any other provision of 

2 law, with respect to the revised security category (as that 

3 term is defined in section 250(c)(4)(D) of the Balanced 

4 Budget and Emergency Deficit Control Act of 1985), any 

5 sequestration order issued under such Act for fiscal year 

6 2018 shall have no force or effect. 

7 This division may be cited as the ‘‘Department of De8 fense Appropriations Act, 2018’’. 

9 DIVISION D—MISCELLANEOUS 

10 SEC. 1501. (a) Section 1240B of the Food Security Act 

11 of 1985 (16 U.S.C. 3839aa-2) is amended by striking sub12 section (a) and inserting the following: 

13 ‘‘(a) ESTABLISHMENT.—During each of the 2002 

14 through 2019 fiscal years, the Secretary shall provide pay15 ments to producers that enter into contracts with the Sec16 retary under the program.’’. 

17 (b) Section 1241 of the Food Security Act of 1985 (16 

18 U.S.C. 3841) is amended— 

19 (1) in subsection (a)— 

20 (A) in the matter preceding paragraph (1), 

21 by striking ‘‘2018’’ and inserting ‘‘2018 (and fis22 cal year 2019 in the case of the program speci23 fied in paragraph (5))’’; and 
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1 (B) in paragraph (5)(E), by striking ‘‘fiscal 

2 year 2018’’ and inserting ‘‘each of fiscal years 

3 2018 through 2019’’; and 

4 (2) in subsection (b), by striking ‘‘2018’’ and in5 serting ‘‘2018 (and fiscal year 2019 in the case of the 

6 program specified in subsection (a)(5))’’. 

7 DIVISION E—TAX MATTERS 

8 SEC. 1601. REPEAL OF SHIFT IN TIME OF PAYMENT OF COR9 PORATE ESTIMATED TAXES. 

10 The Trade Preferences Extension Act of 2015 is 

11 amended by striking section 803 (relating to time for pay12 ment of corporate estimated taxes). 

13 DIVISION F—HEALTH 

14 PROVISIONS 

15 SEC. 2100. SHORT TITLE. 

16 This division may be cited as the ‘‘Strengthening and 

17 Underpinning the Safety-net to Aid Individuals Needing 

18 Care Act of 2018’’ or the ‘‘SUSTAIN Care Act of 2018’’. 

19 TITLE I—MEDICARE EXTENDERS 

20 AND RELATED POLICIES 

21 Subtitle A—Medicare Part A 

22 SEC. 2101. EXTENSION OF THE MEDICARE-DEPENDENT 

23 HOSPITAL (MDH) PROGRAM. 

24 (a) IN GENERAL.—Section 1886(d)(5)(G) of the Social 

25 Security Act (42 U.S.C. 1395ww(d)(5)(G)) is amended— 
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1 (1) in clause (i), by striking ‘‘October 1, 2017’’ 

2 and inserting ‘‘October 1, 2019’’; 

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

4 2017’’ and inserting ‘‘October 1, 2019’’; and 

5 (3) in clause (iv)— 

6 (A) by amending subclause (I) to read as 

7 follows: 

8 ‘‘(I) that— 

9 ‘‘(aa) is located in a rural 

10 area; or 

11 ‘‘(bb) for discharges occur12 ring on or after October 1, 2017, 

13 is located in a State with no 

14 rural area (as defined in para15 graph (2)(D)) and satisfies any of 

16 the criteria in subclause (I), (II), 

17 (III), or (IV) of paragraph 

18 (8)(E)(ii),’’; and 

19 (B) by adding at the end, after and below 

20 subclause (IV), the following flush sentence: 

21 ‘‘For purposes of applying subclause (II) of paragraph 

22 (8)(E)(ii) under subclause (I)(bb), such subclause (II) shall 

23 be applied by inserting ‘as of January 1, 2018,’ after ‘such 

24 State’ each place it appears.’’. 

25 (b) CONFORMING AMENDMENTS.— 
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1 (1) EXTENSION OF TARGET AMOUNT.—Section 

2 1886(b)(3)(D) of the Social Security Act (42 U.S.C. 

3 1395ww(b)(3)(D)) is amended— 

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

5 striking ‘‘October 1, 2017’’ and inserting ‘‘Octo6 ber 1, 2019’’; and 

7 (B) in clause (iv), by striking ‘‘through fis8 cal year 2017’’ and inserting ‘‘through fiscal 

9 year 2019’’. 

10 (2) PERMITTING HOSPITALS TO DECLINE RE11 CLASSIFICATION.—Section 13501(e)(2) of the Omni12 bus Budget Reconciliation Act of 1993 (42 U.S.C. 

13 1395ww note) is amended by striking ‘‘through fiscal 

14 year 2017’’ and inserting ‘‘through fiscal year 2019’’. 

15 SEC. 2102. EXTENSION OF INCREASED INPATIENT HOS16 PITAL PAYMENT ADJUSTMENT FOR CERTAIN 

17 LOW-VOLUME HOSPITALS. 

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

19 U.S.C. 1395ww(d)(12)) is amended— 

20 (1) in subparagraph (B), in the matter pre21 ceding clause (i), by striking ‘‘fiscal year 2018’’ and 

22 inserting ‘‘fiscal year 2020’’; 

23 (2) in subparagraph (C)(i), by striking ‘‘fiscal 

24 years 2011 through 2017’’ and inserting ‘‘fiscal years 

25 2011 through 2019’’ each place it appears; and 
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1 (3) in subparagraph (D), by striking ‘‘fiscal 

2 years 2011 through 2017’’ and inserting ‘‘fiscal years 

3 2011 through 2019’’. 

4 SEC. 2103. STUDIES RELATING TO HOSPITAL PROGRAMS 

5 PAID OUTSIDE OF PROSPECTIVE PAYMENT 

6 SYSTEMS. 

7 (a) MEDPAC REPORT.—Using data from hospital 

8 programs with respect to which hospitals receive payment 

9 outside of the prospective payment systems under sections 

10 1833 and 1886 of the Social Security Act (42 U.S.C. 1395l; 

11 42 U.S.C. 1395ww) (such programs referred to in this sub12 section as ‘‘PPS carve-out programs’’) or other data, as 

13 available, not later than June 30, 2019, the Medicare Pay14 ment Advisory Commission shall submit to Congress a re15 port that evaluates and recommends changes to PPS carve16 out programs, including with respect to amendments made 

17 by sections 2101 and 2102 of this Act, sections 1814, 1820, 

18 1886(d)(5)(D)(iii), and 1115(A) of the Social Security Act, 

19 and such other sections of title XVIII of the Social Security 

20 Act deemed appropriate. To the extent feasible, such report 

21 shall make recommendations on a payment methodology 

22 under the Medicare program for hospital payments, includ23 ing with respect to PPS carve-out programs, that differs 

24 from the payment methodology applicable to such programs 

25 as of September 30, 2017. 
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1 (b) MEDPAC RECOMMENDATIONS FOR POSSIBLE AL2 TERNATIVE PAYMENTS.—Not later than 2 years after the 

3 date by which the Secretary of Health and Human Services 

4 has collected 2 years of data under sections 1886(d)(5)(G) 

5 and 1886(d)(12) of the Social Security Act (42 U.S.C. 

6 1395ww(d)(5)(G); 42 U.S.C. 1395ww(d)(12)), as extended 

7 pursuant to sections 2101 and 2102 of this Act, the Medi8 care Payment Advisory Commission shall submit to Con9 gress a report, including— 

10 (1) recommendations on payments, including a 

11 technical prototype for payments for PPS carve-out 

12 programs, if warranted; 

13 (2) recommendations, if any, on which Medicare 

14 fee-for-service regulations for hospital payments under 

15 title XVIII of the Social Security Act should be al16 tered (such as the critical access hospital 96-hour 

17 rule); 

18 (3) an analysis of the impact of the rec19 ommended payments described in paragraph (1) on 

20 Medicare beneficiary cost-sharing, access to care, and 

21 choice of setting; 

22 (4) a projection of any potential reduction in ex23 penditures under title XVIII of the Social Security 

24 Act that may be attributable to the application of the 

25 recommended payments described in paragraph (1); 
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1 (5) a review of the value of hospitals partici2 pating in PPS carve-out programs collecting and re3 porting to the Secretary standardized patient assess4 ment data with respect to inpatient hospital services; 

5 (6) the types of rural hospital classifications and 

6 payment methodologies under the Medicare program, 

7 including information on each special payment struc8 ture such as eligibility criteria, and any areas of 

9 overlap between such special payment programs; 

10 (7) Medicare spending on each PPS carve-out 

11 program; 

12 (8) the financial aspects of hospitals partici13 pating in such PPS carve-out programs, such as the 

14 share of discharges under the Medicare and Medicaid 

15 programs; and 

16 (9) whether such payment programs are empiri17 cally justified to support Medicare beneficiary access 

18 to care. 

19 SEC. 2104. EXTENSION OF HOME HEALTH RURAL ADD-ON. 

20 (a) EXTENSION.— 

21 (1) IN GENERAL.—Section 421 of the Medicare 

22 Prescription Drug, Improvement, and Modernization 

23 Act of 2003 (Public Law 108–173; 117 Stat. 2283; 42 

24 U.S.C. 1395fff note), as amended by section 5201(b) 

25 of the Deficit Reduction Act of 2005 (Public Law 
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1 109–171; 120 Stat. 46), section 3131(c) of the Patient 

2 Protection and Affordable Care Act (Public Law 111– 

3 148; 124 Stat. 428), and section 210 of the Medicare 

4 Access and CHIP Reauthorization Act of 2015 (Pub5 lic Law 114–10; 129 Stat. 151) is amended— 

6 (A) in subsection (a), by striking ‘‘January 

7 1, 2018’’ and inserting ‘‘January 1, 2019’’ each 

8 place it appears; 

9 (B) by redesignating subsections (b) and (c) 

10 as subsections (c) and (d), respectively; 

11 (C) in each of subsections (c) and (d), as so 

12 redesignated, by striking ‘‘subsection (a)’’ and 

13 inserting ‘‘subsection (a) or (b)’’; and 

14 (D) by inserting after subsection (a) the fol15 lowing new subsection: 

16 ‘‘(b) SUBSEQUENT TEMPORARY INCREASE.— 

17 ‘‘(1) IN GENERAL.—The Secretary shall increase 

18 the payment amount otherwise made under such sec19 tion 1895 for home health services furnished in a 

20 county (or equivalent area) in a rural area (as de21 fined in such section 1886(d)(2)(D)) that, as deter22 mined by the Secretary— 

23 ‘‘(A) is in the highest quartile of all coun24 ties (or equivalent areas) based on the number of 

25 Medicare home health episodes furnished per 100 
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1 individuals who are entitled to, or enrolled for, 

2 benefits under part A of title XVIII of the Social 

3 Security Act or enrolled for benefits under part 

4 B of such title (but not enrolled in a plan under 

5 part C of such title)— 

6 ‘‘(i) in the case of episodes and visits 

7 ending during 2019, by 1.5 percent; and 

8 ‘‘(ii) in the case of episodes and visits 

9 ending during 2020, by 0.5 percent; 

10 ‘‘(B) has a population density of 6 individ11 uals or fewer per square mile of land area and 

12 is not described in subparagraph (A)— 

13 ‘‘(i) in the case of episodes and visits 

14 ending during 2019, by 4 percent; 

15 ‘‘(ii) in the case of episodes and visits 

16 ending during 2020, by 3 percent; 

17 ‘‘(iii) in the case of episodes and visits 

18 ending during 2021, by 2 percent; and 

19 ‘‘(iv) in the case of episodes and visits 

20 ending during 2022, by 1 percent; and 

21 ‘‘(C) is not described in either subpara22 graph (A) or (B)— 

23 ‘‘(i) in the case of episodes and visits 

24 ending during 2019, by 3 percent; 
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1 ‘‘(ii) in the case of episodes and visits 

2 ending during 2020, by 2 percent; and 

3 ‘‘(iii) in the case of episodes and visits 

4 ending during 2021, by 1 percent. 

5 ‘‘(2) RULES FOR DETERMINATIONS.— 

6 ‘‘(A) NO SWITCHING.—For purposes of this 

7 subsection, the determination by the Secretary as 

8 to which subparagraph of paragraph (1) applies 

9 to a county (or equivalent area) shall be made 

10 a single time and shall apply for the duration 

11 of the period to which this subsection applies. 

12 ‘‘(B) UTILIZATION.—In determining which 

13 counties (or equivalent areas) are in the highest 

14 quartile under paragraph (1)(A), the following 

15 rules shall apply: 

16 ‘‘(i) The Secretary shall use data from 

17 2015. 

18 ‘‘(ii) The Secretary shall exclude data 

19 from the territories (and the territories shall 

20 not be described in such paragraph). 

21 ‘‘(iii) The Secretary may exclude data 

22 from counties (or equivalent areas) in rural 

23 areas with a low volume of home health epi24 sodes (and if data is so excluded with re25 spect to a county (or equivalent area), such 
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1 county (or equivalent area) shall not be de2 scribed in such paragraph). 

3 ‘‘(C) POPULATION DENSITY.—In deter4 mining population density under paragraph 

5 (1)(B), the Secretary shall use data from the 

6 2010 decennial Census. 

7 ‘‘(3) LIMITATIONS ON REVIEW.—There shall be 

8 no administrative or judicial review under section 

9 1869, section 1878, or otherwise of determinations 

10 under paragraph (1).’’. 

11 (2) REQUIREMENT TO SUBMIT COUNTY DATA ON

12 CLAIM FORM.—Section 1895(c) of the Social Security 

13 Act (42 U.S.C. 1395fff(c)) is amended— 

14 (A) in paragraph (1), by striking ‘‘and’’ at 

15 the end; 

16 (B) in paragraph (2), by striking the period 

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

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

19 paragraph: 

20 ‘‘(3) in the case of home health services furnished 

21 on or after January 1, 2019, the claim contains the 

22 code for the county (or equivalent area) in which the 

23 home health service was furnished.’’. 

24 (b) OIG REVIEW.—The Office of the Inspector General 

25 shall submit to Congress, not later than January 1, 2020, 
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1 and annually thereafter through January 1, 2024, a report 

2 containing— 

3 (1) an analysis of payments made under section 

4 1895 of the Social Security Act (42 U.S.C. 1395fff) 

5 increased under section 421 of the Medicare Prescrip6 tion Drug, Improvement, and Modernization Act of 

7 2003 (Public Law 108–173; 117 Stat. 2283; 42 

8 U.S.C. 1395fff note), as amended by section 5201(b) 

9 of the Deficit Reduction Act of 2005 (Public Law 

10 109–171; 120 Stat. 46), section 3131(c) of the Patient 

11 Protection and Affordable Care Act (Public Law 111– 

12 148; 124 Stat. 428), section 210 of the Medicare Ac13 cess and CHIP Reauthorization Act of 2015 (Public 

14 Law 114–10; 129 Stat. 151), and subsection (a); and 

15 (2) a recommendation on whether such payments 

16 should continue to be made based on county data. 

17 Subtitle B—Medicare Part B 

18 SEC. 2111. GROUND AMBULANCE SERVICES COST REPORT19 ING REQUIREMENT. 

20 (a) IN GENERAL.—Section 1121 of the Social Security 

21 Act (42 U.S.C. 1320a) is amended— 

22 (1) in subsection (a)— 

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

24 inserting ‘‘Subject to subsection (d), for the pur25 poses of’’; 
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1 (B) by inserting ‘‘suppliers of ground am2 bulance services,’’ after ‘‘health maintenance or3 ganizations,’’; and 

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

5 by adding the following new sentence: ‘‘Not later 

6 than December 31, 2019, the Secretary shall 

7 modify the uniform reporting systems for pro8 viders of services with respect to ground ambu9 lance services to ensure that such systems con10 tain information similar (as determined by the 

11 Secretary) to information required under the 

12 uniform reporting system for suppliers of ground 

13 ambulance services.’’; and 

14 (2) by adding at the end the following new sub15 section: 

16 ‘‘(d) In the case of a provider or supplier of ground 

17 ambulance services, the Secretary may modify the require18 ments for the inclusion of any data element specified in 

19 subsection (a) in reports made in accordance with the uni20 form reporting system established under this section with 

21 respect to such services for such provider or supplier.’’. 

22 (b) SUSPENSION OF PAYMENT FOR GROUND AMBU23 LANCE SERVICES; DEEMING CERTAIN PAYMENTS OVERPAY24 MENTS.—Section 1834(l) of the Social Security Act (42 
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1 U.S.C. 1395m(l)) is amended by adding at the end the fol2 lowing new paragraph: 

3 ‘‘(17) REQUIREMENT TO SUBMIT COST REPORT

4 AND AUTHORITY TO SUSPEND PAYMENTS AND DEEM

5 CERTAIN PAYMENTS OVERPAYMENTS FOR GROUND AM6 BULANCE SERVICES.— 

7 ‘‘(A) IN GENERAL.—With respect to ground 

8 ambulance services furnished by a supplier of 

9 such services during cost reporting periods (as 

10 defined in subparagraph (I)) beginning on or 

11 after January 1, 2020, such supplier shall make 

12 reports to the Secretary of information described 

13 in section 1121(a) in accordance with the uni14 form reporting system established under such sec15 tion for such suppliers and, as may be required 

16 by the Secretary, of any of the information de17 scribed in subparagraph (B). 

18 ‘‘(B) ADDITIONAL INFORMATION.—The Sec19 retary may, with respect to a supplier of ground 

20 ambulance services, require the following infor21 mation (to be reported to the extent practicable 

22 under the uniform reporting system established 

23 under section 1121(a) for such suppliers): 

24 ‘‘(i) Whether the supplier is part of an 

25 emergency services department, a govern-
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1 mental organization, or another type of en2 tity (as described by the Secretary). 

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

4 during which the supplier is available for 

5 furnishing ground ambulance services. 

6 ‘‘(iii) The average number of volunteer 

7 hours a week used by the supplier. 

8 ‘‘(C) SUSPENSION OF PAYMENT.—Subject to 

9 subparagraph (E), in the case that the Secretary 

10 determines that a supplier of ground ambulance 

11 services has not made to the Secretary a timely 

12 report described in subparagraph (A) with re13 spect to a cost reporting period beginning on or 

14 after January 1, 2020, and before January 1, 

15 2022, the Secretary may suspend payments 

16 made under this subsection, in whole or in part, 

17 to such supplier until the Secretary determines 

18 that such supplier has made such a report. 

19 ‘‘(D) DEEMING CERTAIN PAYMENTS OVER20 PAYMENTS.—Subject to subparagraphs (E) and 

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

22 that a supplier of ground ambulance services has 

23 not made to the Secretary a complete, accurate, 

24 and timely report described in subparagraph (A) 

25 with respect to a cost reporting period beginning 
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1 on or after January 1, 2022, the Secretary may 

2 either— 

3 ‘‘(i) deem payments made under this 

4 subsection to such supplier for such period 

5 to be overpayments and recoup such over6 payments; or 

7 ‘‘(ii) suspend payments made under 

8 this subsection to such supplier for such pe9 riod. 

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

11 shall establish a process whereby a supplier of 

12 ground ambulance services may request a delay 

13 in making a report described in subparagraph 

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

15 reason of significant hardship (as determined by 

16 the Secretary). 

17 ‘‘(F) AUTHORITY TO MODIFY COST REPORT18 ING ELEMENTS AND ENFORCEMENT.—Not earlier 

19 than January 1, 2024, the Secretary may pro20 vide that subparagraph (D) no longer applies to 

21 suppliers of ground ambulance services or a cat22 egory of such suppliers after— 

23 ‘‘(i) taking into account the rec24 ommendation of the Medicare Payment Ad25 visory Commission in the most recent report 
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1 available to the Secretary submitted under 

2 section 2111(g) of the SUSTAIN Care Act 

3 of 2018 whether cost reports made by sup4 pliers or a category of suppliers (as speci5 fied for purposes of the report submitted 

6 under such section) of ground ambulance 

7 services should be required or modified; and 

8 ‘‘(ii) undertaking notice and comment 

9 rulemaking. 

10 ‘‘(G) AUDIT OF COST REPORTS.—The Sec11 retary shall audit reports described in subpara12 graph (A) made with respect to cost reporting 

13 periods beginning on or after January 1, 2021. 

14 ‘‘(H) APPEALS.—The Secretary shall estab15 lish a process whereby a supplier of ground am16 bulance services may appeal a determination de17 scribed in subparagraph (C) or (D) made with 

18 respect to a cost report required to be made by 

19 such supplier under subparagraph (A). 

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

21 term ‘cost reporting period’ means, with respect 

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

23 January 1 of such year.’’. 

24 (c) STAKEHOLDER FEEDBACK.— 
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1 (1) IN GENERAL.—The Secretary of Health and 

2 Human Services shall implement the provisions of 

3 this section, including the amendments made by this 

4 section, through notice and comment rulemaking and 

5 seek input from stakeholders. 

6 (2) NONAPPLICATION OF PAPERWORK REDUCTION

7 ACT.—Chapter 35 of title 44, United States Code, 

8 shall not apply with respect to— 

9 (A) the development and implementation of 

10 the uniform reporting system required under sec11 tion 1121(a) of the Social Security Act (42 

12 U.S.C. 1320a(a)) for suppliers of ground ambu13 lance services and reports required to be made 

14 under section 1834(l)(17) of such Act (42 U.S.C. 

15 1395m(l)(17)); and 

16 (B) the modification of the uniform report17 ing systems under such section 1121(a) of such 

18 Act for providers of such services and reports re19 quired to be made under section 1861(v)(1)(F) of 

20 such Act (42 U.S.C. 1395x(v)(1)(F)). 

21 (d) IMPLEMENTATION RESOURCES.—In addition to 

22 funds otherwise available, there are appropriated to the 

23 Centers for Medicare & Medicaid Services Program Man24 agement Account from the Federal Hospital Insurance 

25 Trust Fund under section 1817 of the Social Security Act 
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1 (42 U.S.C. 1395i) $8,000,000 and from the Federal Supple2 mentary Medical Insurance Trust Fund under section 1841 

3 of such Act (42 U.S.C. 1395t) $137,000,000 (of which not 

4 less than $15,000,000 shall be used to fulfill the auditing 

5 requirement under section 1834(l)(17)(G) of such Act, as 

6 added by subsection (b) of this section) to carry out the pro7 visions of this section, including the amendments made by 

8 this section, to remain available through December 31, 

9 2022. Of the amounts appropriated under the previous sen10 tence, the Secretary shall use such sums as may be necessary 

11 to hire not less than 2 full-time employees for purposes of 

12 carrying out such provisions, including such amendments. 

13 (e) EXTENSION OF RURAL ADD-ON PAYMENTS.—Sec14 tion 1834(l) of the Social Security Act (42. U.S.C. 

15 1395m(l)) is amended— 

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

17 and inserting ‘‘2023’’; and 

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

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

20 (f) SENSE OF CONGRESS.—It is the sense of Congress 

21 that— 

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

23 ambulance services with respect to a cost reporting 

24 period beginning before January 1, 2022, may not 

25 contain complete and accurate information on ground 
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1 ambulance services furnished during such a period by 

2 the supplier; and 

3 (2) the Secretary should take into account only 

4 the timeliness of such a report made with respect to 

5 such a period when determining whether to suspend 

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

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

8 (g) GROUND AMBULANCE SERVICES COST REPORTING

9 STUDY.— 

10 (1) IN GENERAL.—Not later than March 15, 

11 2023, and as determined necessary by the Medicare 

12 Payment Advisory Commission thereafter, such Com13 mission shall assess and submit to Congress a report 

14 on cost reports of suppliers and providers of ground 

15 ambulance services carried out in accordance with 

16 sections 1121(a) and 1834(l) of the Social Security 

17 Act (42 U.S.C. 1320a(a), 1395m(l)), the adequacy of 

18 payments for such services made under section 

19 1834(l) of such Act, and geographic variations in the 

20 cost of providing such services. 

21 (2) CONTENTS.—The report described in para22 graph (1) shall contain the following: 

23 (A) An analysis of cost report data sub24 mitted in accordance with such sections. 
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1 (B) An analysis of any burden on providers 

2 and suppliers of such services associated with re3 porting such data. 

4 (C) A recommendation on whether or not 

5 cost reports of ground ambulance services made 

6 by suppliers or a category of suppliers (as speci7 fied by the Secretary) of such services, or the 

8 ground ambulance portion of cost reports made 

9 by providers of such services, should be required 

10 or modified, taking into account the analyses de11 scribed in subparagraphs (A) and (B). 

12 SEC. 2112. EXTENSION OF WORK GPCI FLOOR. 

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

14 U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu15 ary 1, 2018’’ and inserting ‘‘January 1, 2020’’. 

16 SEC. 2113. REPEAL OF MEDICARE PAYMENT CAP FOR THER17 APY SERVICES; REPLACEMENT WITH LIMITA18 TION TO ENSURE APPROPRIATE THERAPY. 

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

20 1395l(g)) is amended— 

21 (1) in paragraph (1)— 

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

23 and (5)’’ and inserting ‘‘(A) Subject to para24 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 not 

5 apply to expenses incurred with respect to serv6 ices furnished after December 31, 2017.’’; and 

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

8 subparagraph: 

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

10 or a subsequent year, in the case of physical therapy serv11 ices of the type described in section 1861(p), speech-lan12 guage pathology services of the type described in such sec13 tion through the application of section 1861(ll)(2), and 

14 physical therapy services and speech-language pathology 

15 services of such type which are furnished by a physician 

16 or as incident to physicians’ services, with respect to ex17 penses incurred in any calendar year, any amount that is 

18 more than the amount specified in paragraph (2) for the 

19 year shall not be considered as incurred expenses for pur20 poses of subsections (a) and (b) unless the applicable re21 quirements of paragraph (7) are met.’’; 

22 (2) in paragraph (3)— 

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

24 and (5)’’ and inserting ‘‘(A) Subject to para25 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 not 

5 apply to expenses incurred with respect to serv6 ices furnished after December 31, 2017.’’; and 

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

8 subparagraph:. 

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

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

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

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

13 which are furnished by a physician or as incident to physi14 cians’ services), with respect to expenses incurred in any 

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

16 specified in paragraph (2) for the year shall not be consid17 ered as incurred expenses for purposes of subsections (a) 

18 and (b) unless the applicable requirements of paragraph (7) 

19 are met.’’; 

20 (3) in paragraph (5)— 

21 (A) by redesignating subparagraph (D) as 

22 paragraph (8) and moving such paragraph to 

23 immediately follow paragraph (7), as added by 

24 paragraph (4) of this section; and 
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1 (B) in subparagraph (E)(iv), by inserting 

2 ‘‘, except as such process is applied under para3 graph (7)(B)’’ before the period at the end; and 

4 (4) by adding at the end the following new para5 graph: 

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

7 with respect to services described in such paragraphs, the 

8 requirements described in this paragraph are as follows: 

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

10 The claim for such services contains an appropriate 

11 modifier (such as the KX modifier described in para12 graph (5)(B)) indicating that such services are medi13 cally necessary as justified by appropriate docu14 mentation in the medical record involved. 

15 ‘‘(B) TARGETED MEDICAL REVIEW FOR CERTAIN

16 SERVICES ABOVE THRESHOLD.— 

17 ‘‘(i) IN GENERAL.—In the case where ex18 penses that would be incurred for such services 

19 would exceed the threshold described in clause 

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

21 the process for medical review implemented 

22 under paragraph (5)(E). 

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

24 this clause for— 

25 ‘‘(I) a year before 2028, is $3,000; 
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1 ‘‘(II) 2028, is the amount specified in 

2 subclause (I) increased by the percentage in3 crease in the MEI (as defined in section 

4 1842(i)(3)) for 2028; and 

5 ‘‘(III) a subsequent year, is the amount 

6 specified in this clause for the preceding 

7 year increased by the percentage increase in 

8 the MEI (as defined in section 1842(i)(3)) 

9 for such subsequent year; 

10 except that if an increase under subclause (II) or 

11 (III) for a year is not a multiple of $10, it shall 

12 be rounded to the nearest multiple of $10. 

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

14 clause (ii) shall be applied separately— 

15 ‘‘(I) for physical therapy services and 

16 speech-language pathology services; and 

17 ‘‘(II) for occupational therapy services. 

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

19 out this subparagraph, the Secretary shall pro20 vide for the transfer, from the Federal Supple21 mentary Medical Insurance Trust Fund under 

22 section 1841 to the Centers for Medicare & Med23 icaid Services Program Management Account, of 

24 $5,000,000 for each fiscal year beginning with 

25 fiscal year 2018, to remain available until ex-
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1 pended. Such funds may not be used by a con2 tractor under section 1893(h) for medical reviews 

3 under this subparagraph.’’. 

4 Subtitle C—Miscellaneous 

5 SEC. 2121. PROVIDING CONTINUED ACCESS TO MEDICARE 

6 ADVANTAGE SPECIAL NEEDS PLANS FOR VUL7 NERABLE POPULATIONS. 

8 (a) EXTENSION.—Section 1859(f)(1) of the Social Se9 curity Act (42 U.S.C. 1395w–28(f)(1)) is amended by strik10 ing ‘‘and for periods before January 1, 2019’’. 

11 (b) INCREASED INTEGRATION OF DUAL SNPS.— 

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

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

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

15 the following new subparagraph: 

16 ‘‘(F) The plan meets the requirements ap17 plicable under paragraph (8).’’; and 

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

19 paragraph: 

20 ‘‘(8) INCREASED INTEGRATION OF DUAL SNPS.— 

21 ‘‘(A) DESIGNATED CONTACT.—The Sec22 retary, acting through the Federal Coordinated 

23 Health Care Office established under section 

24 2602 of Public Law 111–148, shall serve as a 

25 dedicated point of contact for States to address 
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1 misalignments that arise with the integration of 

2 specialized MA plans for special needs individ3 uals described in subsection (b)(6)(B)(ii) under 

4 this paragraph and, consistent with such role, 

5 shall establish— 

6 ‘‘(i) a uniform process for dissemi7 nating to State Medicaid agencies informa8 tion under this title impacting contracts be9 tween such agencies and such plans under 

10 this subsection; and 

11 ‘‘(ii) basic resources for States inter12 ested in exploring such plans as a platform 

13 for integration, such as a model contract or 

14 other tools to achieve those goals. 

15 ‘‘(B) UNIFIED GRIEVANCES AND APPEALS

16 PROCESS.— 

17 ‘‘(i) IN GENERAL.—Not later than 

18 April 1, 2020, the Secretary shall establish 

19 procedures, to the extent feasible as deter20 mined by the Secretary, unifying grievances 

21 and appeals procedures under sections 

22 1852(f), 1852(g), 1902(a)(3), 1902(a)(5), 

23 and 1932(b)(4) for items and services pro24 vided by specialized MA plans for special 

25 needs individuals described in subsection 
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1 (b)(6)(B)(ii) under this title and title XIX. 

2 With respect to items and services described 

3 in the preceding sentence, procedures estab4 lished under this clause shall apply in place 

5 of otherwise applicable grievances and ap6 peals procedures. The Secretary shall solicit 

7 comment in developing such procedures 

8 from States, plans, beneficiaries and their 

9 representatives, and other relevant stake10 holders. 

11 ‘‘(ii) PROCEDURES.—The procedures 

12 established under clause (i) shall be in13 cluded in the plan contract under para14 graph (3)(D) and shall— 

15 ‘‘(I) adopt the provisions for the 

16 enrollee that are most protective for the 

17 enrollee and, to the extent feasible as 

18 determined by the Secretary, are com19 patible with unified timeframes and 

20 consolidated access to external review 

21 under an integrated process; 

22 ‘‘(II) take into account differences 

23 in State plans under title XIX to the 

24 extent necessary; 
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1 ‘‘(III) be easily navigable by an 

2 enrollee; and 

3 ‘‘(IV) include the elements de4 scribed in clause (iii), as applicable. 

5 ‘‘(iii) ELEMENTS DESCRIBED.—Both 

6 unified appeals and unified grievance pro7 cedures shall include, as applicable, the fol8 lowing elements described in this clause: 

9 ‘‘(I) Single written notification of 

10 all applicable grievances and appeal 

11 rights under this title and title XIX. 

12 For purposes of this subparagraph, the 

13 Secretary may waive the requirements 

14 under section 1852(g)(1)(B) when the 

15 specialized MA plan covers items or 

16 services under this part or under title 

17 XIX. 

18 ‘‘(II) Single pathways for resolu19 tion of any grievance or appeal related 

20 to a particular item or service pro21 vided by specialized MA plans for spe22 cial needs individuals described in sub23 section (b)(6)(B)(ii) under this title 

24 and title XIX. 
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1 ‘‘(III) Notices written in plain 

2 language and available in a language 

3 and format that is accessible to the en4 rollee, including in non-English lan5 guages that are prevalent in the service 

6 area of the specialized MA plan. 

7 ‘‘(IV) Unified timeframes for 

8 grievances and appeals processes, such 

9 as an individual’s filing of a grievance 

10 or appeal, a plan’s acknowledgment 

11 and resolution of a grievance or ap12 peal, and notification of decisions with 

13 respect to a grievance or appeal. 

14 ‘‘(V) Requirements for how the 

15 plan must process, track, and resolve 

16 grievances and appeals, to ensure bene17 ficiaries are notified on a timely basis 

18 of decisions that are made throughout 

19 the grievance or appeals process and 

20 are able to easily determine the status 

21 of a grievance or appeal. 

22 ‘‘(iv) CONTINUATION OF BENEFITS

23 PENDING APPEAL.—The unified procedures 

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

25 benefits under parts A and B and title XIX 
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1 subject to appeal under such procedures, in2 corporate provisions under current law and 

3 implementing regulations that provide con4 tinuation of benefits pending appeal under 

5 this title and title XIX. 

6 ‘‘(C) REQUIREMENT FOR UNIFIED GRIEV7 ANCES AND APPEALS.—For 2021 and subsequent 

8 years, the contract of a specialized MA plan for 

9 special needs individuals described in subsection 

10 (b)(6)(B)(ii) with a State Medicaid agency 

11 under paragraph (3)(D) shall require the use of 

12 unified grievances and appeals procedures as de13 scribed in subparagraph (B). 

14 ‘‘(D) REQUIREMENTS FOR INTEGRATION.— 

15 ‘‘(i) IN GENERAL.—For 2021 and sub16 sequent years, a specialized MA plan for 

17 special needs individuals described in sub18 section (b)(6)(B)(ii) shall meet one or more 

19 of the following requirements, to the extent 

20 permitted under State law, for integration 

21 of benefits under this title and title XIX: 

22 ‘‘(I) The specialized MA plan 

23 must meet the requirements of con24 tracting with the State Medicaid agen25 cy described in paragraph (3)(D) in 
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1 addition to coordinating long-term 

2 services and supports or behavioral 

3 health services, or both, by meeting an 

4 additional minimum set of require5 ments determined by the Secretary 

6 through the Federal Coordinated 

7 Health Care Office established under 

8 section 2602 of the Patient Protection 

9 and Affordable Care Act based on 

10 input from stakeholders, such as noti11 fying the State in a timely manner of 

12 hospitalizations, emergency room vis13 its, and hospital or nursing home dis14 charges of enrollees, assigning one pri15 mary care provider for each enrollee, 

16 or sharing data that would benefit the 

17 coordination of items and services 

18 under this title and the State plan 

19 under title XIX. Such minimum set of 

20 requirements must be included in the 

21 contract of the specialized MA plan 

22 with the State Medicaid agency under 

23 such paragraph. 

24 ‘‘(II) The specialized MA plan 

25 must meet the requirements of a fully 
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1 integrated plan described in section 

2 1853(a)(1)(B)(iv)(II) (other than the 

3 requirement that the plan have similar 

4 average levels of frailty, as determined 

5 by the Secretary, as the PACE pro6 gram), or enter into a capitated con7 tract with the State Medicaid agency 

8 to provide long-term services and sup9 ports or behavioral health services, or 

10 both. 

11 ‘‘(III) In the case of a specialized 

12 MA plan that is offered by a parent or13 ganization that is also the parent orga14 nization of a Medicaid managed care 

15 organization providing long term serv16 ices and supports or behavioral services 

17 under a contract under section 

18 1903(m), the parent organization must 

19 assume clinical and financial responsi20 bility for benefits provided under this 

21 title and title XIX with respect to any 

22 individual who is enrolled in both the 

23 specialized MA plan and the Medicaid 

24 managed care organization. 
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1 ‘‘(ii) SUSPENSION OF ENROLLMENT

2 FOR FAILURE TO MEET REQUIREMENTS

3 DURING INITIAL PERIOD.—During the pe4 riod of plan years 2021 through 2025, if the 

5 Secretary determines that a specialized MA 

6 plan for special needs individuals described 

7 in subsection (b)(6)(B)(ii) has failed to 

8 comply with clause (i), the Secretary may 

9 provide for the application against the 

10 Medicare Advantage organization offering 

11 the plan of the remedy described in section 

12 1857(g)(2)(B) in the same manner as the 

13 Secretary may apply such remedy, and in 

14 accordance with the same procedures as 

15 would apply, in the case of an MA organi16 zation determined by the Secretary to have 

17 engaged in conduct described in section 

18 1857(g)(1). If the Secretary applies such 

19 remedy to a Medicare Advantage organiza20 tion under the preceding sentence, the orga21 nization shall submit to the Secretary (at a 

22 time, and in a form and manner, specified 

23 by the Secretary) information describing 

24 how the plan will come into compliance 

25 with clause (i). 
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1 ‘‘(E) STUDY AND REPORT TO CONGRESS.— 

2 ‘‘(i) IN GENERAL.—Not later than Jan3 uary 1, 2022, and, subject to clause (iii), bi4 ennially thereafter through 2032, the Medi5 care Payment Advisory Commission estab6 lished under section 1805, in consultation 

7 with the Medicaid and CHIP Payment and 

8 Access Commission established under section 

9 1900, shall conduct (and submit to the Sec10 retary and the Committees on Ways and 

11 Means and Energy and Commerce of the 

12 House of Representatives and the Committee 

13 on Finance of the Senate a report on) a 

14 study to determine how specialized MA 

15 plans for special needs individuals described 

16 in subsection (b)(6)(B)(ii) perform among 

17 each other based on data from Healthcare 

18 Effectiveness Data and Information Set 

19 (HEDIS) quality measures, reported on the 

20 plan level, as required under section 

21 1852(e)(3) (or such other measures or data 

22 sources that are available and appropriate, 

23 such as encounter data and Consumer As24 sessment of Healthcare Providers and Sys25 tems data, as specified by such Commissions 
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1 as enabling an accurate evaluation under 

2 this subparagraph). Such study shall in3 clude, as feasible, the following comparison 

4 groups of specialized MA plans for special 

5 needs individuals described in subsection 

6 (b)(6)(B)(ii): 

7 ‘‘(I) A comparison group of such 

8 plans that are described in subpara9 graph (D)(i)(I). 

10 ‘‘(II) A comparison group of such 

11 plans that are described in subpara12 graph (D)(i)(II). 

13 ‘‘(III) A comparison group of 

14 such plans operating within the Fi15 nancial Alignment Initiative dem16 onstration for the period for which 

17 such plan is so operating and the dem18 onstration is in effect, and, in the case 

19 that an integration option that is not 

20 with respect to specialized MA plans 

21 for special needs individuals is estab22 lished after the conclusion of the dem23 onstration involved. 
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1 ‘‘(IV) A comparison group of such 

2 plans that are described in subpara3 graph (D)(i)(III). 

4 ‘‘(V) A comparison group of MA 

5 plans, as feasible, not described in a 

6 previous subclause of this clause, with 

7 respect to the performance of such 

8 plans for enrollees who are special 

9 needs individuals described in sub10 section (b)(6)(B)(ii). 

11 ‘‘(ii) DISCRETIONARY ADDITIONAL RE12 PORTS.—Beginning with 2033 and every 

13 five years thereafter, the Medicare Payment 

14 Advisory Commission, in consultation with 

15 the Medicaid and CHIP Payment and Ac16 cess Commission shall, at the discretion of 

17 the Secretary, conduct a study described in 

18 clause (i).’’. 

19 (2) CONFORMING AMENDMENT TO RESPONSIBIL20 ITIES OF FEDERAL COORDINATED HEALTH CARE OF21 FICE.—Section 2602(d) of Public Law 111–148 (42 

22 U.S.C. 1315b(d)) is amended by adding at the end the 

23 following new paragraphs: 

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

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

2 to the integration of specialized MA plans for special 

3 needs individuals described in subsection (b)(6)(B)(ii) 

4 of such section. 

5 ‘‘(7) To be responsible, subject to the final ap6 proval of the Secretary, for developing regulations 

7 and guidance related to the implementation of a uni8 fied grievance and appeals process as described in 

9 subparagraphs (B) and (C) of section 1859(f)(8) of 

10 the Social Security Act (42 U.S.C. 1395w–28(f)(8)). 

11 ‘‘(8) To be responsible, subject to the final ap12 proval of the Secretary, for developing regulations 

13 and guidance related to the integration or alignment 

14 of policy and oversight under the Medicare program 

15 under title XVIII of such Act and the Medicaid pro16 gram under title XIX of such Act regarding special17 ized MA plans for special needs individuals described 

18 in subsection (b)(6)(B)(ii) of such section 1859.’’. 

19 (c) IMPROVEMENTS TO SEVERE OR DISABLING CHRON20 IC CONDITION SNPS.— 

21 (1) CARE MANAGEMENT REQUIREMENTS.—Sec22 tion 1859(f)(5) of the Social Security Act (42 U.S.C. 

23 1395w–28(f)(5)) is amended— 

24 (A) by striking ‘‘ALL SNPS.—The require25 ments’’ and inserting ‘‘ALL SNPS.— 
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1 ‘‘(A) IN GENERAL.—Subject to subpara2 graph (B), the requirements’’; 

3 (B) by redesignating subparagraphs (A) 

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

5 indenting appropriately; and 

6 (C) in clause (ii), as redesignated by sub7 paragraph (B), by redesignating clauses (i) 

8 through (iii) as subclauses (I) through (III), re9 spectively, and indenting appropriately; and 

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

11 subparagraph: 

12 ‘‘(B) IMPROVEMENTS TO CARE MANAGE13 MENT REQUIREMENTS FOR SEVERE OR DIS14 ABLING CHRONIC CONDITION SNPS.—For 2020 

15 and subsequent years, in the case of a specialized 

16 MA plan for special needs individuals described 

17 in subsection (b)(6)(B)(iii), the requirements de18 scribed in this paragraph include the following: 

19 ‘‘(i) The interdisciplinary team under 

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

21 of providers with demonstrated expertise, 

22 including training in an applicable spe23 cialty, in treating individuals similar to the 

24 targeted population of the plan. 
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1 ‘‘(ii) Requirements developed by the 

2 Secretary to provide face-to-face encounters 

3 with individuals enrolled in the plan not 

4 less frequently than on an annual basis. 

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

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

7 results of the initial assessment and annual 

8 reassessment under clause (ii)(I) of such 

9 subparagraph of each individual enrolled in 

10 the plan are addressed in the individual’s 

11 individualized care plan under clause 

12 (ii)(II) of such subparagraph. 

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

14 and approval of such model of care, the Sec15 retary shall take into account whether the 

16 plan fulfilled the previous year’s goals (as 

17 required under the model of care). 

18 ‘‘(v) The Secretary shall establish a 

19 minimum benchmark for each element of the 

20 model of care of a plan. The Secretary shall 

21 only approve a plan’s model of care under 

22 this paragraph if each element of the model 

23 of care meets the minimum benchmark ap24 plicable under the preceding sentence.’’. 
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1 (2) REVISIONS TO THE DEFINITION OF A SEVERE

2 OR DISABLING CHRONIC CONDITIONS SPECIALIZED

3 NEEDS INDIVIDUAL.— 

4 (A) IN GENERAL.—Section 

5 1859(b)(6)(B)(iii) of the Social Security Act (42 

6 U.S.C. 1395w–28(b)(6)(B)(iii)) is amended— 

7 (i) by striking ‘‘who have’’ and insert8 ing ‘‘who— 

9 ‘‘(I) before January 1, 2022, 

10 have’’; 

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

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

13 and inserting ‘‘; and’’; and 

14 (iii) by adding at the end the following 

15 new subclause: 

16 ‘‘(II) on or after January 1, 2022, 

17 have one or more comorbid and medi18 cally complex chronic conditions that 

19 is life threatening or significantly lim20 its overall health or function, have a 

21 high risk of hospitalization or other 

22 adverse health outcomes, and require 

23 intensive care coordination and that is 

24 listed under subsection (f)(9)(A).’’. 
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1 (B) PANEL OF CLINICAL ADVISORS.—Sec2 tion 1859(f) of the Social Security Act (42 

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

4 (b), is amended by adding at the end the fol5 lowing new paragraph: 

6 ‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION OF

7 THE DEFINITION OF A SEVERE OR DISABLING CHRON8 IC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.— 

9 ‘‘(A) IN GENERAL.—Not later than Decem10 ber 31, 2020, and every 5 years thereafter, sub11 ject to subparagraphs (B) and (C), the Secretary 

12 shall convene a panel of clinical advisors to es13 tablish and update a list of conditions that meet 

14 each of the following criteria: 

15 ‘‘(i) Conditions that meet the defini16 tion of a severe or disabling chronic condi17 tion under subsection (b)(6)(B)(iii) on or 

18 after January 1, 2022. 

19 ‘‘(ii) Conditions that require prescrip20 tion drugs, providers, and models of care 

21 that are unique to the specific population of 

22 enrollees in a specialized MA plan for spe23 cial needs individuals described in such sub24 section on or after such date and— 
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1 ‘‘(I) as a result of access to, and 

2 enrollment in, such a specialized MA 

3 plan for special needs individuals, in4 dividuals with such condition would 

5 have a reasonable expectation of slow6 ing or halting the progression of the 

7 disease, improving health outcomes and 

8 decreasing overall costs for individuals 

9 diagnosed with such condition com10 pared to available options of care other 

11 than through such a specialized MA 

12 plan for special needs individuals; or 

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

14 general population of beneficiaries 

15 under this title or a disproportionally 

16 high per-beneficiary cost under this 

17 title. 

18 ‘‘(B) INCLUSION OF CERTAIN CONDITIONS.— 

19 The conditions listed under subparagraph (A) 

20 shall include HIV/AIDS, end stage renal disease, 

21 and chronic and disabling mental illness. 

22 ‘‘(C) REQUIREMENT.—In establishing and 

23 updating the list under subparagraph (A), the 

24 panel shall take into account the availability of 

25 varied benefits, cost-sharing, and supplemental 
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1 benefits under the model described in paragraph 

2 (2) of section 1859(h), including the expansion 

3 under paragraph (1) of such section.’’. 

4 (d) QUALITY MEASUREMENT AT THE PLAN LEVEL FOR

5 SNPS AND DETERMINATION OF FEASABILITY OF QUALITY

6 MEASUREMENT AT THE PLAN LEVEL FOR ALL MA 

7 PLANS.—Section 1853(o) of the Social Security Act (42 

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

9 following new paragraphs: 

10 ‘‘(6) QUALITY MEASUREMENT AT THE PLAN

11 LEVEL FOR SNPS.— 

12 ‘‘(A) IN GENERAL.—Subject to subpara13 graph (B), the Secretary may require reporting 

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

15 under this subsection, quality measures at the 

16 plan level for specialized MA plans for special 

17 needs individuals instead of at the contract level. 

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

19 quality measurement at the plan level under this 

20 paragraph, the Secretary shall— 

21 ‘‘(i) take into consideration the min22 imum number of enrollees in a specialized 

23 MA plan for special needs individuals in 

24 order to determine if a statistically signifi-
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1 cant or valid measurement of quality at the 

2 plan level is possible under this paragraph; 

3 ‘‘(ii) take into consideration the im4 pact of such application on plans that serve 

5 a disproportionate number of individuals 

6 dually eligible for benefits under this title 

7 and under title XIX; 

8 ‘‘(iii) if quality measures are reported 

9 at the plan level, ensure that MA plans are 

10 not required to provide duplicative informa11 tion; and 

12 ‘‘(iv) ensure that such reporting does 

13 not interfere with the collection of encounter 

14 data submitted by MA organizations or the 

15 administration of any changes to the pro16 gram under this part as a result of the col17 lection of such data. 

18 ‘‘(C) APPLICATION.—If the Secretary ap19 plies quality measurement at the plan level 

20 under this paragraph— 

21 ‘‘(i) such quality measurement may in22 clude Medicare Health Outcomes Survey 

23 (HOS), Healthcare Effectiveness Data and 

24 Information Set (HEDIS), Consumer As25 sessment of Healthcare Providers and Sys-
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1 tems (CAHPS) measures and quality meas2 ures under part D; and 

3 ‘‘(ii) the Secretary shall consider ap4 plying administrative actions, such as rem5 edies described in section 1857(g)(2), at the 

6 plan level. 

7 ‘‘(7) DETERMINATION OF FEASIBILITY OF QUAL8 ITY MEASUREMENT AT THE PLAN LEVEL FOR ALL MA

9 PLANS.— 

10 ‘‘(A) DETERMINATION OF FEASIBILITY.— 

11 The Secretary shall determine the feasibility of 

12 requiring reporting of data under section 1852(e) 

13 for, and applying under this subsection, quality 

14 measures at the plan level for all MA plans 

15 under this part. 

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

17 making a determination under subparagraph 

18 (A), the Secretary shall consider requiring such 

19 reporting and applying such quality measures at 

20 the plan level as described in such subpara21 graph’’. 

22 (e) GAO STUDY AND REPORT ON STATE-LEVEL INTE23 GRATION BETWEEN DUAL SNPS AND MEDICAID.— 

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

25 United States (in this subsection referred to as the 
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1 ‘‘Comptroller General’’) shall conduct a study on 

2 State-level integration between specialized MA plans 

3 for special needs individuals described in subsection 

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

5 Act (42 U.S.C. 1395w–28) and the Medicaid program 

6 under title XIX of such Act (42 U.S.C. 1396 et seq.). 

7 Such study shall include an analysis of the following: 

8 (A) The characteristics of States in which 

9 the State agency responsible for administering 

10 the State plan under such title XIX has a con11 tract with such a specialized MA plan and that 

12 delivers long-term services and supports under 

13 the State plan under such title XIX through a 

14 managed care program, including the require15 ments under such State plan with respect to 

16 long-term services and supports. 

17 (B) The types of such specialized MA plans, 

18 which may include the following: 

19 (i) A plan described in section 

20 1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 

21 1395w–23(a)(1)(B)(iv)(II)). 

22 (ii) A plan that meets the requirements 

23 described in subsection (f)(3)(D) of such sec24 tion 1859. 
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1 (iii) A plan described in clause (ii) 

2 that also meets additional requirements es3 tablished by the State. 

4 (C) The characteristics of individuals en5 rolled in such specialized MA plans. 

6 (D) As practicable, the following with re7 spect to State programs for the delivery of long8 term services and supports under such title XIX 

9 through a managed care program: 

10 (i) Which populations of individuals 

11 are eligible to receive such services and sup12 ports. 

13 (ii) Whether all such services and sup14 ports are provided on a capitated basis or 

15 if any of such services and supports are 

16 carved out and provided through fee17 forservice. 

18 (E) As practicable, how the availability and 

19 variation of integration arrangements of such 

20 specialized MA plans offered in States affects 

21 spending, service delivery options, access to com22 munity-based care, and utilization of care. 

23 (F) The efforts of State Medicaid programs 

24 to transition dually-eligible beneficiaries receiv25 ing long-term services and supports (LTSS) 
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1 from institutional settings to home and commu2 nity-based settings and related financial impacts 

3 of such transitions. 

4 (G) Barriers and opportunities for making 

5 further progress on dual integration, as well as 

6 recommendations for legislation or administra7 tive action to expedite or refine pathways toward 

8 fully integrated care. 

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

10 date of the enactment of this Act, the Comptroller 

11 General shall submit to Congress a report containing 

12 the results of the study conducted under paragraph 

13 (1), together with recommendations for such legisla14 tion and administrative action as the Comptroller 

15 General determines appropriate. 

16 SEC. 2122. EXTENSION OF CERTAIN MIPPA FUNDING PROVI17 SIONS; STATE HEALTH INSURANCE ASSIST18 ANCE PROGRAM REPORTING REQUIREMENTS. 

19 (a) FUNDING EXTENSIONS.—Section 119 of the Medi20 care Improvements for Patients and Providers Act of 2008 

21 (42 U.S.C. 1395b–3 note) is amended— 

22 (1) in subsection (a)(1)(B)— 

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

24 end; 
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1 (B) in clause (vii), by striking the period at 

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

3 (C) by inserting after clause (vii) the fol4 lowing new clause: 

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

6 and 2019, of $13,000,000.’’; 

7 (2) in subsection (b)(1)(B)— 

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

9 end; 

10 (B) in clause (vii), by striking the period at 

11 the end and inserting ‘‘; and’’; and 

12 (C) by inserting after clause (vii) the fol13 lowing new clause: 

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

15 and 2019, of $7,500,000.’’; 

16 (3) in subsection (c)(1)(B)— 

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

18 end; 

19 (B) in clause (vii), by striking the period at 

20 the end and inserting ‘‘; and’’; and 

21 (C) by inserting after clause (vii) the fol22 lowing new clause: 

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

24 and 2019, of $5,000,000.’’; and 

25 (4) in subsection (d)(2)— 
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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 at 

4 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 and 2019, of $12,000,000.’’. 

9 (b) STATE HEALTH INSURANCE ASSISTANCE PRO10 GRAM REPORTING REQUIREMENTS.—Beginning not later 

11 than April 1, 2019, and biennially thereafter, the Agency 

12 for Community Living shall electronically post on its 

13 website the following information, with respect to grants to 

14 States for State health insurance assistance programs, (such 

15 information to be presented by State and by entity receiv16 ing funds from the State to carry out such a program fund17 ed by such grant): 

18 (1) The amount of Federal funding provided to 

19 each such State for such program for the period in20 volved and the amount of Federal funding provided 

21 by each such State for such program to each such en22 tity for the period involved. 

23 (2) Information as the Secretary may specify, 

24 with respect to such programs carried out through 
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1 such grants, consistent with the terms and conditions 

2 for receipt of such grants. 

3 SEC. 2123. EXTENSION OF FUNDING FOR QUALITY MEAS4 URE ENDORSEMENT, INPUT, AND SELECTION; 

5 REPORTING REQUIREMENTS. 

6 (a) IN GENERAL.—Section 1890(d) of the Social Secu7 rity Act (42 U.S.C. 1395aaa(d)) is amended— 

8 (1) in paragraph (2), by adding at the end the 

9 following new sentence: ‘‘Any of such amounts re10 maining available as of the date of the enactment of 

11 the SUSTAIN Care Act of 2018 shall be used only for 

12 purposes under this section that are purposes other 

13 than funding a contract entered into under subsection 

14 (a).’’; and 

15 (2) by adding at the end the following new para16 graph: 

17 ‘‘(3) For purposes of carrying out this section, 

18 the Secretary shall provide for the transfer, from the 

19 Federal Hospital Insurance Trust Fund under section 

20 1817 and the Federal Supplemental Medical Insur21 ance Trust Fund under 1841, in such proportion as 

22 Secretary deems appropriate, to the Centers for Medi23 care & Medicaid Services Program Management Ac24 count of $7,500,000 for each of fiscal years 2018 and 

25 2019. Of the amount transferred under the previous 
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1 sentence for a fiscal year, there shall be used for the 

2 purpose of funding a contract entered into under sub3 section (a) with respect to carrying out section 1890A 

4 (other than subsections (e) and (f)) for such fiscal 

5 year an amount that is not less than the amount used 

6 for such purpose for fiscal year 2017.’’. 

7 (b) ANNUAL REPORT BY SECRETARY TO CONGRESS.— 

8 Section 1890 of the Social Security Act (42 U.S.C. 

9 1395aaa) is amended by adding at the end the following 

10 new subsection: 

11 ‘‘(e) ANNUAL REPORT BY SECRETARY TO CON12 GRESS.—By not later than March 1 of each year (beginning 

13 with 2018), the Secretary shall submit to Congress a report 

14 containing the following: 

15 ‘‘(1) A comprehensive plan that identifies the 

16 quality measurement needs of programs and initia17 tives of the Secretary and provides a strategy for 

18 using the work performed by the entity with a con19 tract under subsection (a) and the work of any other 

20 entity the Secretary has contracted with to perform 

21 work associated with this section or section 1890A to 

22 help meet those needs, specifically with respect to the 

23 programs under this title and title XIX. 

24 ‘‘(2) The amount of mandatory funding provided 

25 under subsection (d) for purposes of carrying out this 
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1 section and section 1890A that has been obligated by 

2 the Secretary, the amount of funding provided that 

3 has been expended, and the amount of funding pro4 vided that remains unobligated. 

5 ‘‘(3) A description of how the funds provided 

6 that are obligated have been allocated, including how 

7 much of that funding has been allocated for work per8 formed by the Secretary, the entity with a contract 

9 under subsection (a), and any other entity the Sec10 retary has contracted with to perform work related to 

11 this section or section 1890A, respectively. 

12 ‘‘(4) A description of the activities for which the 

13 obligated funds have been or will be used, including 

14 any activities performed by the Secretary, task orders, 

15 specific projects, and activities assigned to the entity 

16 with a contract under subsection (a), and task orders, 

17 specific projects, and activities assigned to any other 

18 entity the Secretary has contracted with to perform 

19 work related to carrying out this section or section 

20 1890A. 

21 ‘‘(5) The amount of funding allocated to each of 

22 the activities described in paragraph (4). 

23 ‘‘(6) Estimates for, and descriptions of, obliga24 tions and expenditures that the Secretary anticipates 

25 will be needed in the succeeding two year period to 
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1 carry out each of the quality measurement activities 

2 required under this section and section 1890A, includ3 ing any obligations that will require funds to be ex4 pended in a future year.’’. 

5 (c) REVISIONS TO ANNUAL REPORT FROM CON6 SENSUS-BASED ENTITY TO CONGRESS AND THE SEC7 RETARY.— 

8 (1) IN GENERAL.—Section 1890(b)(5)(A) of the 

9 Social Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is 

10 amended— 

11 (A) by redesignating clauses (i) through (vi) 

12 as subclauses (I) through (VI), respectively, and 

13 moving the margins accordingly; 

14 (B) in the matter preceding subclause (I), 

15 as redesignated by clause (i), by striking ‘‘con16 taining a description of—’’ and inserting ‘‘con17 taining the following: 

18 ‘‘(i) A description of—’’; and 

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

20 clauses: 

21 ‘‘(ii) An itemization of financial infor22 mation for the fiscal year ending September 

23 30 of the preceding year, including— 

24 ‘‘(I) annual revenues of the entity 

25 (including any government funding, 
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1 private sector contributions, grants, 

2 membership revenues, and investment 

3 revenue); 

4 ‘‘(II) annual expenses of the enti5 ty (including grants paid, benefits 

6 paid, salaries or other compensation, 

7 fundraising expenses, and overhead 

8 costs); and 

9 ‘‘(III) a breakdown of the amount 

10 awarded per contracted task order and 

11 the specific projects funded in each task 

12 order assigned to the entity. 

13 ‘‘(iii) Any updates or modifications of 

14 internal policies and procedures of the enti15 ty as they relate to the duties of the entity 

16 under this section, including— 

17 ‘‘(I) specifically identifying any 

18 modifications to the disclosure of inter19 ests and conflicts of interests for com20 mittees, work groups, task forces, and 

21 advisory panels of the entity; and 

22 ‘‘(II) information on external 

23 stakeholder participation in the duties 

24 of the entity under this section (includ25 ing complete rosters for all committees, 
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•HR 1892 EAH 

1 work groups, task forces, and advisory 

2 panels funded through government con3 tracts, descriptions of relevant interests 

4 and any conflicts of interest for mem5 bers of all committees, work groups, 

6 task forces, and advisory panels, and 

7 the total percentage by health care sec8 tor of all convened committees, work 

9 groups, task forces, and advisory pan10 els.’’. 

11 (2) EFFECTIVE DATE.—The amendments made 

12 by this subsection shall apply to reports submitted for 

13 years beginning with 2018. 

14 (d) GAO STUDY AND REPORT.— 

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

16 United States shall conduct a study on health care 

17 quality measurement efforts funded under sections 

18 1890 and 1890A of the Social Security Act (42 

19 U.S.C. 1395aaa; 1395aaa–1). Such study shall in20 clude an examination of the following: 

21 (A) The extent to which the Secretary of 

22 Health and Human Services (in this subsection 

23 referred to as the ‘‘Secretary’’) has set and 

24 prioritized objectives to be achieved for each of 
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1 the quality measurement activities required 

2 under such sections 1890 and 1890A. 

3 (B) The efforts that the Secretary has un4 dertaken to meet quality measurement objectives 

5 associated with such sections 1890 and 1890A, 

6 including division of responsibilities for those ef7 forts within the Department of Health and 

8 Human Services and through contracts with a 

9 consensus-based entity under subsection (a) of 

10 such section 1890 (in this subsection referred to 

11 as the ‘‘consensus-based entity’’) and other enti12 ties, and the extent of any overlap among the 

13 work performed by the Secretary, the consensus14 based entity, the Measure Application Partner15 ship (MAP) convened by such entity to provide 

16 input to the Secretary on the selection of quality 

17 and efficiency measures, and any other entities 

18 the Secretary has contracted with to perform 

19 work related to carrying out such sections 1890 

20 and 1890A. 

21 (C) The total amount of mandatory funding 

22 provided to the Secretary for purposes of car23 rying out such sections 1890 and 1890A, the 

24 amount of such funding that has been obligated 
223 

•HR 1892 EAH 

1 by the Secretary, and the amount of such fund2 ing that remains unobligated. 

3 (D) How the obligated funds have been allo4 cated, including how much of the obligated fund5 ing has been allocated for work performed by the 

6 Secretary, the consensus-based entity, and any 

7 other entity the Secretary has contracted with to 

8 perform work related to carrying out such sec9 tions 1890 and 1890A, respectively, and descrip10 tions of such work. 

11 (E) The extent to which the Secretary has 

12 developed a comprehensive and long-term plan to 

13 ensure that it can achieve quality measurement 

14 objectives related to carrying out such sections 

15 1890 and 1890A in a timely manner and with 

16 efficient use of available resources, including the 

17 roles of the consensus-based entity, the Measure 

18 Application Partnership (MAP), and any other 

19 entity the Secretary has contracted with to per20 form work related to such sections 1890 and 

21 1890A in helping the Secretary achieve those ob22 jectives. 

23 (2) REPORT.—Not later than 18 months after the 

24 date of enactment of this Act, the Comptroller General 

25 of the United States shall submit to Congress a report 
224 

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1 containing the results of the study conducted under 

2 paragraph (1), together with recommendations for 

3 such legislation and administrative action as the 

4 Comptroller General determines appropriate. 

5 TITLE II—ADDITIONAL MEDI6 CARE POLICIES RELATING TO 

7 EXTENDERS 

8 SEC. 2201. HOME HEALTH PAYMENT REFORM. 

9 (a) BUDGET NEUTRAL TRANSITION TO A 30-DAY UNIT

10 OF PAYMENT FOR HOME HEALTH SERVICES.—Section 

11 1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) 

12 is amended— 

13 (1) in paragraph (2)— 

14 (A) by striking ‘‘PAYMENT.—In defining’’ 

15 and inserting ‘‘PAYMENT.— 

16 ‘‘(A) IN GENERAL.—In defining’’; and 

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

18 subparagraph: 

19 ‘‘(B) 30-DAY UNIT OF SERVICE.—For pur20 poses of implementing the prospective payment 

21 system with respect to home health units of serv22 ice furnished during a year beginning with 

23 2020, the Secretary shall apply a 30-day unit of 

24 service as the unit of service applied under this 

25 paragraph.’’; 
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1 (2) in paragraph (3)— 

2 (A) in subparagraph (A), by adding at the 

3 end the following new clause: 

4 ‘‘(iv) BUDGET NEUTRALITY FOR 2020.— 

5 With respect to payments for home health 

6 units of service furnished that end during 

7 the 12-month period beginning January 1, 

8 2020, the Secretary shall calculate a stand9 ard prospective payment amount (or 

10 amounts) for 30-day units of service (as de11 scribed in paragraph (2)(B)) for the pro12 spective payment system under this sub13 section. Such standard prospective payment 

14 amount (or amounts) shall be calculated in 

15 a manner such that the estimated aggregate 

16 amount of expenditures under the system 

17 during such period with application of 

18 paragraph (2)(B) is equal to the estimated 

19 aggregate amount of expenditures that oth20 erwise would have been made under the sys21 tem during such period if paragraph (2)(B) 

22 had not been enacted. The previous sentence 

23 shall be applied before (and not affect the 

24 application of) paragraph (3)(B). In calcu25 lating such amount (or amounts), the Sec-
226 

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1 retary shall make assumptions about behav2 ior changes that could occur as a result of 

3 the implementation of paragraph (2)(B) 

4 and the case-mix adjustment factors estab5 lished under paragraph (4)(B) and shall 

6 provide a description of such assumptions 

7 in the notice and comment rulemaking used 

8 to implement this clause.’’; and 

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

10 subparagraph: 

11 ‘‘(D) BEHAVIOR ASSUMPTIONS AND ADJUST12 MENTS.— 

13 ‘‘(i) IN GENERAL.—The Secretary shall 

14 annually determine the impact of dif15 ferences between assumed behavior changes 

16 (as described in paragraph (3)(A)(iv)) and 

17 actual behavior changes on estimated aggre18 gate expenditures under this subsection with 

19 respect to years beginning with 2020 and 

20 ending with 2026. 

21 ‘‘(ii) PERMANENT ADJUSTMENTS.—The 

22 Secretary shall, at a time and in a manner 

23 determined appropriate, through notice and 

24 comment rulemaking, provide for one or 

25 more permanent increases or decreases to 
227 

•HR 1892 EAH 

1 the standard prospective payment amount 

2 (or amounts) for applicable years, on a pro3 spective basis, to offset for such increases or 

4 decreases in estimated aggregate expendi5 tures (as determined under clause (i)). 

6 ‘‘(iii) TEMPORARY ADJUSTMENTS FOR

7 RETROSPECTIVE BEHAVIOR.—The Secretary 

8 shall, at a time and in a manner deter9 mined appropriate, through notice and 

10 comment rulemaking, provide for one or 

11 more temporary increases or decreases to 

12 the payment amount for a unit of home 

13 health services (as determined under para14 graph (4)) for applicable years, on a pro15 spective basis, to offset for such increases or 

16 decreases in estimated aggregate expendi17 tures (as determined under clause (i)). Such 

18 a temporary increase or decrease shall 

19 apply only with respect to the year for 

20 which such temporary increase or decrease 

21 is made, and the Secretary shall not take 

22 into account such a temporary increase or 

23 decrease in computing such amount under 

24 this subsection for a subsequent year.’’; and 

25 (3) in paragraph (4)(B)— 
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1 (A) by striking ‘‘FACTORS.—The Secretary’’ 

2 and inserting ‘‘FACTORS.— 

3 ‘‘(i) IN GENERAL.—The Secretary’’; 

4 and 

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

6 clause: 

7 ‘‘(ii) TREATMENT OF THERAPY

8 THRESHOLDS.—For 2020 and subsequent 

9 years, the Secretary shall eliminate the use 

10 of therapy thresholds (established by the 

11 Secretary) in case mix adjustment factors 

12 established under clause (i) for calculating 

13 payments under the prospective payment 

14 system under this subsection.’’. 

15 (b) TECHNICAL EXPERT PANEL.— 

16 (1) IN GENERAL.—During the period beginning 

17 on January 1, 2018, and ending on December 31, 

18 2018, the Secretary of Health and Human Services 

19 shall hold at least one session of a technical expert 

20 panel, the participants of which shall include home 

21 health providers, patient representatives, and other 

22 relevant stakeholders. The technical expert panel shall 

23 identify and prioritize recommendations with respect 

24 to the prospective payment system for home health 
229 

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1 services under section 1895(b) of the Social Security 

2 Act (42 U.S.C. 1395fff(b)), on the following: 

3 (A) The Home Health Groupings Model, as 

4 described in the proposed rule ‘‘Medicare and 

5 Medicaid Programs; CY 2018 Home Health Pro6 spective Payment System Rate Update and Pro7 posed CY 2019 Case-Mix Adjustment Method8 ology Refinements; Home Health Value-Based 

9 Purchasing Model; and Home Health Quality 

10 Reporting Requirements’’ (82 Fed. Reg. 35294 

11 through 35332 (July 28, 2017)). 

12 (B) Alternative case-mix models to the 

13 Home Health Groupings Model that were sub14 mitted during 2017 as comments in response to 

15 proposed rule making, including patient-focused 

16 factors that consider the risks of hospitalization 

17 and readmission to a hospital, improvement or 

18 maintenance of functionality of individuals to 

19 increase the capacity for self-care, quality of 

20 care, and resource utilization. 

21 (2) INAPPLICABILITY OF FACA.—The provisions 

22 of the Federal Advisory Committee Act (5 U.S.C. 

23 App.) shall not apply to the technical expert panel 

24 under paragraph (1). 
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1 (3) REPORT.—Not later than April 1, 2019, the 

2 Secretary of Health and Human Services shall sub3 mit to the Committee on Ways and Means and the 

4 Committee on Energy and Commerce of the House of 

5 Representatives and the Committee on Finance of the 

6 Senate a report on the recommendations of such panel 

7 described in such paragraph. 

8 (4) NOTICE AND COMMENT RULEMAKING.—Not 

9 later than December 31, 2019, the Secretary of Health 

10 and Human Services shall pursue notice and com11 ment rulemaking on a case-mix system with respect 

12 to the prospective payment system for home health 

13 services under section 1895(b) of the Social Security 

14 Act (42 U.S.C. 1395fff(b)). 

15 (c) REPORTS.— 

16 (1) INTERIM REPORT.—Not later than March 15, 

17 2022, the Medicare Payment Advisory Commission 

18 shall submit to Congress an interim report on the ap19 plication of a 30-day unit of service as the unit of 

20 service applied under section 1895(b)(2) of the Social 

21 Security Act (42 U.S.C. 1395fff(b)(2)), as amended by 

22 subsection (a), including an analysis of the level of 

23 payments provided to home health agencies as com24 pared to the cost of delivering home health services, 
231 

•HR 1892 EAH 

1 and any unintended consequences, including with re2 spect to behavioral changes and quality. 

3 (2) FINAL REPORT.—Not later than March 15, 

4 2026, such Commission shall submit to Congress a 

5 final report on such application and any such con6 sequences. 

7 SEC. 2202. INFORMATION TO SATISFY DOCUMENTATION OF 

8 MEDICARE ELIGIBILITY FOR HOME HEALTH 

9 SERVICES. 

10 (a) PART A.—Section 1814(a) of the Social Security 

11 Act (42 U.S.C. 1395f(a)) is amended by inserting before 

12 ‘‘For purposes of paragraph (2)(C),’’ the following new sen13 tence: ‘‘For purposes of documentation for physician certifi14 cation and recertification made under paragraph (2) on or 

15 after January 1, 2019, and made with respect to home 

16 health services furnished by a home health agency, in addi17 tion to using documentation in the medical record of the 

18 physician who so certifies or the medical record of the acute 

19 or post-acute care facility (in the case that home health 

20 services were furnished to an individual who was directly 

21 admitted to the home health agency from such a facility), 

22 the Secretary may use documentation in the medical record 

23 of the home health agency as supporting material, as appro24 priate to the case involved.’’. 
232 

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1 (b) PART B.—Section 1835(a) of the Social Security 

2 Act (42 U.S.C. 1395n(a)) is amended by inserting before 

3 ‘‘For purposes of paragraph (2)(A),’’ the following new sen4 tence: ‘‘For purposes of documentation for physician certifi5 cation and recertification made under paragraph (2) on or 

6 after January 1, 2019, and made with respect to home 

7 health services furnished by a home health agency, in addi8 tion to using documentation in the medical record of the 

9 physician who so certifies or the medical record of the acute 

10 or post-acute care facility (in the case that home health 

11 services were furnished to an individual who was directly 

12 admitted to the home health agency from such a facility), 

13 the Secretary may use documentation in the medical record 

14 of the home health agency as supporting material, as appro15 priate to the case involved.’’. 

16 SEC. 2203. VOLUNTARY SETTLEMENT OF HOME HEALTH 

17 CLAIMS. 

18 (a) SETTLEMENT PROCESS FOR HOME HEALTH

19 CLAIMS.— 

20 (1) IN GENERAL.—Not later than one year after 

21 the date of enactment of this Act, the Secretary of 

22 Health and Human Services shall establish a settle23 ment process under which a home health agency enti24 tled to an eligible administrative appeal has the op25 tion to enter into a settlement with the Secretary that 
233 

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1 is reached in a manner consistent with the succeeding 

2 paragraphs of this subsection. 

3 (2) PROCESS AND CONSIDERATION OF HOME

4 HEALTH CLAIMS.—A settlement under paragraph (1) 

5 with a home health agency that is with respect to an 

6 eligible administrative appeal may only be reached in 

7 accordance with the following process: 

8 (A) A settlement under such paragraph 

9 with the home health agency shall be with respect 

10 to all claims by such agency, subject to para11 graph (4), that, as of the date of such settlement, 

12 are under an eligible administrative appeal. 

13 (B) For the duration of the settlement proc14 ess with such agency, an eligible administrative 

15 appeal that is with respect to any such claim by 

16 such agency shall be suspended. 

17 (C) Under the settlement process, the Sec18 retary shall determine an aggregate amount to 

19 be paid to the home health agency with respect 

20 to all claims by such agency that are under an 

21 eligible administrative appeal in the following 

22 manner: 

23 (i) The Secretary shall, for purposes of 

24 applying clause (ii) with respect to all set25 tlements under paragraph (1), select a per-
234 

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1 centage. In selecting such percentage, the 

2 Secretary shall consider the percentage used 

3 under the Centers for Medicare & Medicaid 

4 Services hospital appeals settlement that 

5 began on August 29, 2014. 

6 (ii) The Secretary shall, with respect to 

7 each denied claim for such agency that is 

8 under an eligible administrative appeal, 

9 calculate an amount (referred to in this 

10 subparagraph as an ‘‘individual claim 

11 amount’’) by multiplying the net payable 

12 amount for such claim by the percentage se13 lected under clause (i). 

14 (iii) Such aggregate amount with re15 spect to such agency shall be determined by 

16 calculating the total sum of all the indi17 vidual claim amounts calculated under 

18 clause (ii) with respect to such agency. 

19 (3) EFFECT OF PROCESS.— 

20 (A) EFFECT OF SETTLEMENT.— 

21 (i) FURTHER APPEAL.—As part of any 

22 settlement under paragraph (1) between a 

23 home health agency and the Secretary, such 

24 home health agency shall be required to 

25 forego the right to an administrative appeal 
235 

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1 under section 1869 of the Social Security 

2 Act (42 U.S.C. 1395ff) or section 1878 of 

3 such Act (42 U.S.C. 1395oo) (including any 

4 redetermination, reconsideration, hearing, 

5 or review) with respect to any claims for 

6 home health services that are subject to the 

7 settlement. 

8 (ii) JUDICIAL REVIEW.—There shall be 

9 no administrative or judicial review under 

10 such section 1869 or otherwise of a settle11 ment under paragraph (1) and the claims 

12 covered by the settlement. 

13 (B) EFFECT OF NO SETTLEMENT.—In the 

14 event that the process described in paragraph (2) 

15 does not, with respect to a home health agency, 

16 result in a settlement under paragraph (1) with 

17 such agency, any appeal under such section 1869 

18 that is with respect to a claim by such agency 

19 that was suspended pursuant to paragraph 

20 (2)(B) shall resume under such section. 

21 (4) COORDINATION WITH LAW ENFORCEMENT.— 

22 The Secretary of Health and Human Services shall 

23 establish a process to coordinate with appropriate law 

24 enforcement agencies in order to avoid the inadvertent 
236 

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1 settlement of cases that involve fraud or other crimi2 nal activity. 

3 (b) NO ENTITLEMENT TO SETTLEMENT PROCESS.— 

4 Nothing in this section shall be construed as creating an 

5 entitlement to enter into a settlement process established 

6 pursuant to subsection (a). 

7 (c) ELIGIBLE ADMINISTRATIVE APPEAL DEFINED.— 

8 For purposes of this section, the term ‘‘eligible administra9 tive appeal’’ means an appeal under section 1869 of the 

10 Social Security Act (42 U.S.C. 1395ff) (including any rede11 termination, reconsideration, hearing, or review)— 

12 (1) that is with respect to one or more claims 

13 that— 

14 (A) are for home health services that were 

15 furnished on or after January 1, 2011, and be16 fore January 1, 2015; and 

17 (B) were timely filed consistent with section 

18 1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) 

19 or sections 1835(a)(1) and 1842(b)(3) of such Act 

20 (42 U.S.C. 1395n(a)(1), 1395u(b)(3)); and 

21 (2) either— 

22 (A) was timely filed consistent with section 

23 1869 of such Act (42 U.S.C. 1395ff) and is pend24 ing; or 
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1 (B) for which the applicable time frame to 

2 file an appeal has not expired. 

3 (d) CONFORMING AMENDMENT.—Section 1869 of the 

4 Social Security Act (42 U.S.C. 1395ff) is amended by add5 ing at the end the following new subsection: 

6 ‘‘(j) APPLICATION WITH RESPECT TO CERTAIN HOME

7 HEALTH CLAIMS.—For the application of the provisions of 

8 this section with respect to certain claims for home health 

9 services that were furnished on or after January 1, 2011, 

10 and before January 1, 2015, see section 106 of the 

11 Healthcare Extension, Reauthorization, and Opportunities 

12 Act of 2017.’’. 

13 SEC. 2204. EXTENSION OF ENFORCEMENT INSTRUCTION ON 

14 MEDICARE SUPERVISION REQUIREMENTS 

15 FOR OUTPATIENT THERAPEUTIC SERVICES IN 

16 CRITICAL ACCESS AND SMALL RURAL HOS17 PITALS. 

18 Section 1834 of the Social Security Act (42 U.S.C. 

19 1395m) is amended by adding at the end the following new 

20 subsection: 

21 ‘‘(v) EXTENSION OF ENFORCEMENT INSTRUCTION ON

22 SUPERVISION REQUIREMENTS FOR OUTPATIENT THERA23 PEUTIC SERVICES IN CRITICAL ACCESS AND SMALL RURAL

24 HOSPITALS.—For calendar year 2017, the Secretary shall 

25 continue to apply the enforcement instruction described in 
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1 the notice of the Centers for Medicare & Medicaid Services 

2 entitled ‘Enforcement Instruction on Supervision Require3 ments for Outpatient Therapeutic Services in Critical Ac4 cess and Small Rural Hospitals for CY 2013’, dated Novem5 ber 1, 2012 (providing for an exception to the restatement 

6 and clarification under the final rulemaking changes to the 

7 Medicare hospital outpatient prospective payment system 

8 and calendar year 2009 payment rates (published in the 

9 Federal Register on November 18, 2008, 73 Fed. Reg. 68702 

10 through 68704) with respect to requirements for direct su11 pervision by physicians for therapeutic hospital outpatient 

12 services), as previously extended under section 1 of Public 

13 Law 113-198, as amended by section 1 of Public Law 114- 

14 112 and section 16004(a) of the 21st Century Cures Act 

15 (Public Law 114-255).’’. 

16 SEC. 2205. TECHNICAL AMENDMENTS TO PUBLIC LAW 114– 

17 10. 

18 (a) MIPS TRANSITION.—Section 1848 of the Social 

19 Security Act (42 U.S.C. 1395w–4) is amended— 

20 (1) in subsection (q)— 

21 (A) in paragraph (1)— 

22 (i) in subparagraph (B), by striking 

23 ‘‘items and services’’ and inserting ‘‘covered 

24 professional services (as defined in sub25 section (k)(3)(A))’’; and 
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1 (ii) in subparagraph (C)(iv)— 

2 (I) by amending subclause (I) to 

3 read as follows: 

4 ‘‘(I) The minimum number (as 

5 determined by the Secretary) of— 

6 ‘‘(aa) for performance peri7 ods beginning before January 1, 

8 2018, individuals enrolled under 

9 this part who are treated by the 

10 eligible professional for the per11 formance period involved; and 

12 ‘‘(bb) for performance periods 

13 beginning on or after January 1, 

14 2018, individuals enrolled under 

15 this part who are furnished cov16 ered professional services (as de17 fined in subsection (k)(3)(A)) by 

18 the eligible professional for the 

19 performance period involved.’’; 

20 (II) in subclause (II), by striking 

21 ‘‘items and services’’ and inserting 

22 ‘‘covered professional services (as de23 fined in subsection (k)(3)(A))’’; and 

24 (III) by amending subclause (III) 

25 to read as follows: 
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1 ‘‘(III) The minimum amount (as 

2 determined by the Secretary) of— 

3 ‘‘(aa) for performance peri4 ods beginning before January 1, 

5 2018, allowed charges billed by 

6 such professional under this part 

7 for such performance period; and 

8 ‘‘(bb) for performance periods 

9 beginning on or after January 1, 

10 2018, allowed charges for covered 

11 professional services (as defined in 

12 subsection (k)(3)(A)) billed by 

13 such professional for such per14 formance period.’’; 

15 (B) in paragraph (5)(D)— 

16 (i) in clause (i)(I), by inserting ‘‘sub17 ject to clause (iii),’’ after ‘‘clauses (i) and 

18 (ii) of paragraph (2)(A),’’; and 

19 (ii) by adding at the end the following 

20 new clause: 

21 ‘‘(iii) TRANSITION YEARS.—For each of 

22 the second, third, fourth, and fifth years for 

23 which the MIPS applies to payments, the 

24 performance score for the performance cat25 egory described in paragraph (2)(A)(ii) 
241 

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1 shall not take into account the improvement 

2 of the professional involved.’’; 

3 (C) in paragraph (5)(E)— 

4 (i) in clause (i)(I)(bb)— 

5 (I) in the heading by striking 

6 ‘‘FIRST 2 YEARS’’ and inserting 

7 ‘‘FIRST 5 YEARS’’; and 

8 (II) by striking ‘‘the first and sec9 ond years’’ and inserting ‘‘each of the 

10 first through fifth years’’; 

11 (ii) in clause (i)(II)(bb)— 

12 (I) in the heading, by striking ‘‘2

13 YEARS’’ and inserting ‘‘5 YEARS’’; and 

14 (II) by striking the second sen15 tence and inserting the following new 

16 sentences: ‘‘For each of the second, 

17 third, fourth, and fifth years for which 

18 the MIPS applies to payments, not less 

19 than 10 percent and not more than 30 

20 percent of such score shall be based on 

21 performance with respect to the cat22 egory described in clause (ii) of para23 graph (2)(A). Nothing in the previous 

24 sentence shall be construed, with re25 spect to a performance period for a 
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1 year described in the previous sentence, 

2 as preventing the Secretary from bas3 ing 30 percent of such score for such 

4 year with respect to the category de5 scribed in such clause (ii), if the Sec6 retary determines, based on informa7 tion posted under subsection (r)(2)(I) 

8 that sufficient resource use measures 

9 are ready for adoption for use under 

10 the performance category under para11 graph (2)(A)(ii) for such performance 

12 period.’’; 

13 (D) in paragraph (6)(D)— 

14 (i) in clause (i), in the second sentence, 

15 by striking ‘‘Such performance threshold’’ 

16 and inserting ‘‘Subject to clauses (iii) and 

17 (iv), such performance threshold’’; 

18 (ii) in clause (ii)— 

19 (I) in the first sentence, by insert20 ing ‘‘(beginning with 2019 and ending 

21 with 2024)’’ after ‘‘for each year of the 

22 MIPS’’; and 

23 (II) in the second sentence, by in24 serting ‘‘subject to clause (iii),’’ after 

25 ‘‘For each such year,’’; 
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1 (iii) in clause (iii)— 

2 (I) in the heading, by striking ‘‘2’’ 

3 and inserting ‘‘5’’; and 

4 (II) in the first sentence, by strik5 ing ‘‘two years’’ and inserting ‘‘five 

6 years’’; and 

7 (iv) by adding at the end the following 

8 new clause: 

9 ‘‘(iv) ADDITIONAL SPECIAL RULE FOR

10 THIRD, FOURTH AND FIFTH YEARS OF

11 MIPS.—For purposes of determining MIPS 

12 adjustment factors under subparagraph (A), 

13 in addition to the requirements specified in 

14 clause (iii), the Secretary shall increase the 

15 performance threshold with respect to each 

16 of the third, fourth, and fifth years to which 

17 the MIPS applies to ensure a gradual and 

18 incremental transition to the performance 

19 threshold described in clause (i) (as esti20 mated by the Secretary) with respect to the 

21 sixth year to which the MIPS applies.’’; 

22 (E) in paragraph (6)(E)— 

23 (i) by striking ‘‘In the case of items 

24 and services’’ and inserting ‘‘In the case of 
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1 covered professional services (as defined in 

2 subsection (k)(3)(A))’’; and 

3 (ii) by striking ‘‘under this part with 

4 respect to such items and services’’ and in5 serting ‘‘under this part with respect to 

6 such covered professional services’’; and 

7 (F) in paragraph (7), in the first sentence, 

8 by striking ‘‘items and services’’ and inserting 

9 ‘‘covered professional services (as defined in sub10 section (k)(3)(A))’’; 

11 (2) in subsection (r)(2), by adding at the end the 

12 following new subparagraph: 

13 ‘‘(I) INFORMATION.—The Secretary shall, 

14 not later than December 31st of each year (begin15 ning with 2018), post on the Internet website of 

16 the Centers for Medicare & Medicaid Services in17 formation on resource use measures in use under 

18 subsection (q), resource use measures under de19 velopment and the time-frame for such develop20 ment, potential future resource use measure top21 ics, a description of stakeholder engagement, and 

22 the percent of expenditures under part A and 

23 this part that are covered by resource use meas24 ures.’’; and 
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1 (3) in subsection (s)(5)(B), by striking ‘‘section 

2 1833(z)(2)(C)’’ and inserting ‘‘section 1833(z)(3)(D)’’. 

3 (b) PHYSICIAN-FOCUSED PAYMENT MODEL TECHNICAL

4 ADVISORY COMMITTEE PROVISION OF INITIAL PROPOSAL

5 FEEDBACK.—Section 1868(c)(2)(C) of the Social Security 

6 Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as fol7 lows: 

8 ‘‘(C) COMMITTEE REVIEW OF MODELS SUB9 MITTED.—The Committee, on a periodic basis— 

10 ‘‘(i) shall review models submitted 

11 under subparagraph (B); 

12 ‘‘(ii) may provide individuals and 

13 stakeholder entities who submitted such 

14 models with— 

15 ‘‘(I) initial feedback on such mod16 els regarding the extent to which such 

17 models meet the criteria described in 

18 subparagraph (A); and 

19 ‘‘(II) an explanation of the basis 

20 for the feedback provided under sub21 clause (I); and 

22 ‘‘(iii) shall prepare comments and rec23 ommendations regarding whether such mod24 els meet the criteria described in subpara-
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1 graph (A) and submit such comments and 

2 recommendations to the Secretary.’’. 

3 SEC. 2206. REVISED REQUIREMENTS FOR MEDICARE INTEN4 SIVE CARDIAC REHABILITATION PROGRAMS. 

5 (a) IN GENERAL.—Section 1861(eee)(4)(B) of the So6 cial Security Act (42 U.S.C. 1395x(eee)(4)(B)) is amend7 ed— 

8 (1) in clause (v), by striking ‘‘or’’ at the end; 

9 (2) in clause (vi), by striking the period at the 

10 end and inserting a semicolon; and 

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

12 clauses: 

13 ‘‘(vii) stable, chronic heart failure (defined 

14 as patients with left ventricular ejection fraction 

15 of 35 percent or less and New York Heart Asso16 ciation (NYHA) class II to IV symptoms despite 

17 being on optimal heart failure therapy for at 

18 least 6 weeks); or 

19 ‘‘(viii) any additional condition for which 

20 the Secretary has determined that a cardiac re21 habilitation program shall be covered, unless the 

22 Secretary determines, using the same process 

23 used to determine that the condition is covered 

24 for a cardiac rehabilitation program, that such 
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1 coverage is not supported by the clinical evi2 dence.’’. 

3 (b) ENSURING FUTURE SUPERVISION LEVEL PARITY

4 WITH CARDIAC REHABILITATION PROGRAMS.—Section 

5 1861(eee)(4)(A) of the Social Security Act (42 U.S.C. 

6 1395x(eee)(4)(A)) is amended, in the matter preceding 

7 clause (i), by striking ‘‘physician-supervised program (as 

8 described in paragraph (2))’’ and inserting ‘‘program (su9 pervised as described in paragraph (2))’’. 

10 TITLE III—CREATING HIGH11 QUALITY RESULTS AND OUT12 COMES NECESSARY TO IM13 PROVE CHRONIC (CHRONIC) 

14 CARE 

15 Subtitle A—Receiving High Quality 

16 Care in the Home 

17 SEC. 2301. EXTENDING THE INDEPENDENCE AT HOME DEM18 ONSTRATION PROGRAM. 

19 (a) IN GENERAL.—Section 1866E of the Social Secu20 rity Act (42 U.S.C. 1395cc–5) is amended— 

21 (1) in subsection (e)— 

22 (A) in paragraph (1)— 

23 (i) by striking ‘‘An agreement’’ and in24 serting ‘‘Agreements’’; and 
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1 (ii) by striking ‘‘5-year’’ and inserting 

2 ‘‘7-year’’; and 

3 (B) in paragraph (5)— 

4 (i) by striking ‘‘10,000’’ and inserting 

5 ‘‘15,000’’; and 

6 (ii) by adding at the end the following 

7 new sentence: ‘‘An applicable beneficiary 

8 that participates in the demonstration pro9 gram by reason of the increase from 10,000 

10 to 15,000 in the preceding sentence pursu11 ant to the amendment made by section 

12 2301(a)(1)(B) of the SUSTAIN Care Act of 

13 2018 shall be considered in the spending 

14 target estimates under paragraph (1) of 

15 subsection (c) and the incentive payment 

16 calculations under paragraph (2) of such 

17 subsection for the sixth and seventh years of 

18 such program.’’; 

19 (2) in subsection (g), in the first sentence, by in20 serting ‘‘, including, to the extent practicable, with re21 spect to the use of electronic health information sys22 tems, as described in subsection (b)(1)(A)(vi)’’ after 

23 ‘‘under the demonstration program’’; and 
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1 (3) in subsection (i)(1)(A), by striking ‘‘will not 

2 receive an incentive payment for the second of 2’’ and 

3 inserting ‘‘did not achieve savings for the third of 3’’. 

4 (b) EFFECTIVE DATE.—The amendment made by sub5 section (a)(3) shall take effect as if included in the enact6 ment of Public Law 111–148. 

7 SEC. 2302. EXPANDING ACCESS TO HOME DIALYSIS THER8 APY. 

9 (a) IN GENERAL.—Section 1881(b)(3) of the Social Se10 curity Act (42 U.S.C. 1395rr(b)(3)) is amended— 

11 (1) by redesignating subparagraphs (A) and (B) 

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

13 (2) in clause (ii), as redesignated by paragraph 

14 (1), by striking ‘‘on a comprehensive’’ and insert 

15 ‘‘subject to subparagraph (B), on a comprehensive’’; 

16 (3) by striking ‘‘With respect to’’ and inserting 

17 ‘‘(A) With respect to’’; and 

18 (4) by adding at the end the following new sub19 paragraph: 

20 ‘‘(B)(i) For purposes of subparagraph (A)(ii), subject 

21 to clause (ii), an individual determined to have end stage 

22 renal disease receiving home dialysis may choose to receive 

23 monthly end stage renal disease-related clinical assessments 

24 furnished on or after January 1, 2019, via telehealth. 
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1 ‘‘(ii) Clause (i) shall apply to an individual only if 

2 the individual receives a face-to-face clinical assessment, 

3 without the use of telehealth— 

4 ‘‘(I) in the case of the initial 3 months of home 

5 dialysis of such individual, at least monthly; and 

6 ‘‘(II) after such initial 3 months, at least once 

7 every 3 consecutive months.’’. 

8 (b) ORIGINATING SITE REQUIREMENTS.— 

9 (1) IN GENERAL.—Section 1834(m) of the Social 

10 Security Act (42 U.S.C. 1395m(m)) is amended— 

11 (A) in paragraph (4)(C)(ii), by adding at 

12 the end the following new subclauses: 

13 ‘‘(IX) A renal dialysis facility, 

14 but only for purposes of section 

15 1881(b)(3)(B). 

16 ‘‘(X) The home of an individual, 

17 but only for purposes of section 

18 1881(b)(3)(B).’’; and 

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

20 paragraph: 

21 ‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY

22 ESRD-RELATED VISIT.—The geographic requirements 

23 described in paragraph (4)(C)(i) shall not apply with 

24 respect to telehealth services furnished on or after 

25 January 1, 2019, for purposes of section 
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•HR 1892 EAH 

1 1881(b)(3)(B), at an originating site described in 

2 subclause (VI), (IX), or (X) of paragraph (4)(C)(ii).’’. 

3 (2) NO FACILITY FEE IF ORIGINATING SITE FOR

4 HOME DIALYSIS THERAPY IS THE HOME.—Section 

5 1834(m)(2)(B) of the Social Security (42 U.S.C. 

6 1395m(m)(2)(B)) is amended— 

7 (A) by redesignating clauses (i) and (ii) as 

8 subclauses (I) and (II), and indenting appro9 priately; 

10 (B) in subclause (II), as redesignated by 

11 subparagraph (A), by striking ‘‘clause (i) or this 

12 clause’’ and inserting ‘‘subclause (I) or this sub13 clause’’; 

14 (C) by striking ‘‘SITE.—With respect to’’ 

15 and inserting ‘‘SITE.— 

16 ‘‘(i) IN GENERAL.—Subject to clause 

17 (ii), with respect to’’; and 

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

19 clause: 

20 ‘‘(ii) NO FACILITY FEE IF ORIGINATING

21 SITE FOR HOME DIALYSIS THERAPY IS THE

22 HOME.—No facility fee shall be paid under 

23 this subparagraph to an originating site de24 scribed in paragraph (4)(C)(ii)(X).’’. 
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1 (c) CLARIFICATION REGARDING TELEHEALTH PRO2 VIDED TO BENEFICIARIES.—Section 1128A(i)(6) of the So3 cial Security Act (42 U.S.C. 1320a–7a(i)(6)) is amended— 

4 (1) in subparagraph (H), by striking ‘‘or’’ at the 

5 end; 

6 (2) in subparagraph (I), by striking the period 

7 at the end and inserting ‘‘; or’’; and 

8 (3) by adding at the end the following new sub9 paragraph: 

10 ‘‘(J) the provision of telehealth technologies 

11 (as defined by the Secretary) on or after Janu12 ary 1, 2019, by a provider of services or a renal 

13 dialysis facility (as such terms are defined for 

14 purposes of title XVIII) to an individual with 

15 end stage renal disease who is receiving home di16 alysis for which payment is being made under 

17 part B of such title, if— 

18 ‘‘(i) the telehealth technologies are not 

19 offered as part of any advertisement or so20 licitation; 

21 ‘‘(ii) the telehealth technologies are pro22 vided for the purpose of furnishing tele23 health services related to the individual’s 

24 end stage renal disease; and 
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1 ‘‘(iii) the provision of the telehealth 

2 technologies meets any other requirements 

3 set forth in regulations promulgated by the 

4 Secretary.’’. 

5 (d) CONFORMING AMENDMENT.—Section 1881(b)(1) of 

6 the Social Security Act (42 U.S.C. 1395rr(b)(1)) is amend7 ed by striking ‘‘paragraph (3)(A)’’ and inserting ‘‘para8 graph (3)(A)(i)’’. 

9 Subtitle B—Expanding Innovation 

10 and Technology 

11 SEC. 2311. ADAPTING BENEFITS TO MEET THE NEEDS OF 

12 CHRONICALLY ILL MEDICARE ADVANTAGE 

13 ENROLLEES. 

14 Section 1859 of the Social Security Act (42 U.S.C. 

15 1395w–28) is amended by adding at the end the following 

16 new subsection: 

17 ‘‘(h) NATIONAL TESTING OF MEDICARE ADVANTAGE

18 VALUE-BASED INSURANCE DESIGN MODEL.— 

19 ‘‘(1) IN GENERAL.—In implementing the Medi20 care Advantage Value-Based Insurance Design model 

21 that is being tested under section 1115A(b), the Sec22 retary shall revise the testing of the model under such 

23 section to cover, effective not later than January 1, 

24 2020, all States. 
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1 ‘‘(2) TERMINATION AND MODIFICATION PROVI2 SION NOT APPLICABLE UNTIL JANUARY 1, 2022.—The 

3 provisions of section 1115A(b)(3)(B) shall apply to 

4 the Medicare Advantage Value-Based Insurance De5 sign model, including such model as revised under 

6 paragraph (1), beginning January 1, 2022, but shall 

7 not apply to such model, as so revised, prior to such 

8 date. 

9 ‘‘(3) FUNDING.—The Secretary shall allocate 

10 funds made available under section 1115A(f)(1) to de11 sign, implement, and evaluate the Medicare Advan12 tage Value-Based Insurance Design model, as revised 

13 under paragraph (1).’’. 

14 SEC. 2312. EXPANDING SUPPLEMENTAL BENEFITS TO MEET 

15 THE NEEDS OF CHRONICALLY ILL MEDICARE 

16 ADVANTAGE ENROLLEES. 

17 (a) IN GENERAL.—Section 1852(a)(3) of the Social Se18 curity Act (42 U.S.C. 1395w–22(a)(3)) is amended— 

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

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

21 and 

22 (2) by adding at the end the following new sub23 paragraph: 
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1 ‘‘(D) EXPANDING SUPPLEMENTAL BENEFITS

2 TO MEET THE NEEDS OF CHRONICALLY ILL EN3 ROLLEES.— 

4 ‘‘(i) IN GENERAL.—For plan year 2020 

5 and subsequent plan years, in addition to 

6 any supplemental health care benefits other7 wise provided under this paragraph, an MA 

8 plan, including a specialized MA plan for 

9 special needs individuals (as defined in sec10 tion 1859(b)(6)), may provide supplemental 

11 benefits described in clause (ii) to a chron12 ically ill enrollee (as defined in clause (iii)). 

13 ‘‘(ii) SUPPLEMENTAL BENEFITS DE14 SCRIBED.— 

15 ‘‘(I) IN GENERAL.—Supplemental 

16 benefits described in this clause are 

17 supplemental benefits that, with respect 

18 to a chronically ill enrollee, have a rea19 sonable expectation of improving or 

20 maintaining the health or overall func21 tion of the chronically ill enrollee and 

22 may not be limited to being primarily 

23 health related benefits. 

24 ‘‘(II) AUTHORITY TO WAIVE UNI25 FORMITY REQUIREMENTS.—The Sec-
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1 retary may, only with respect to sup2 plemental benefits provided to a chron3 ically ill enrollee under this subpara4 graph, waive the uniformity require5 ments under this part, as determined 

6 appropriate by the Secretary. 

7 ‘‘(iii) CHRONICALLY ILL ENROLLEE

8 DEFINED.—In this subparagraph, the term 

9 ‘chronically ill enrollee’ means an enrollee 

10 in an MA plan that the Secretary deter11 mines— 

12 ‘‘(I) has one or more comorbid 

13 and medically complex chronic condi14 tions that is life threatening or signifi15 cantly limits the overall health or func16 tion of the enrollee; 

17 ‘‘(II) has a high risk of hos18 pitalization or other adverse health 

19 outcomes; and 

20 ‘‘(III) requires intensive care co21 ordination.’’. 

22 (b) GAO STUDY AND REPORT.— 

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

24 United States (in this subsection referred to as the 

25 ‘‘Comptroller General’’) shall conduct a study on sup-
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1 plemental benefits provided to enrollees in Medicare 

2 Advantage plans under part C of title XVIII of the 

3 Social Security Act, including specialized MA plans 

4 for special needs individuals (as defined in section 

5 1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))). 

6 To the extend data are available, such study shall in7 clude an analysis of the following: 

8 (A) The type of supplemental benefits pro9 vided to such enrollees, the total number of en10 rollees receiving each supplemental benefit, and 

11 whether the supplemental benefit is covered by 

12 the standard benchmark cost of the benefit or 

13 with an additional premium. 

14 (B) The frequency in which supplemental 

15 benefits are utilized by such enrollees. 

16 (C) The impact supplemental benefits have 

17 on— 

18 (i) indicators of the quality of care re19 ceived by such enrollees, including overall 

20 health and function of the enrollees; 

21 (ii) the utilization of items and serv22 ices for which benefits are available under 

23 the original Medicare fee-for-service pro24 gram option under parts A and B of such 

25 title XVIII by such enrollees; and 
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1 (iii) the amount of the bids submitted 

2 by Medicare Advantage Organizations for 

3 Medicare Advantage plans under such part 

4 C. 

5 (2) CONSULTATION.—In conducting the study 

6 under paragraph (1), the Comptroller General shall, 

7 as necessary, consult with the Centers for Medicare & 

8 Medicaid Services and Medicare Advantage organiza9 tions offering Medicare Advantage plans. 

10 (3) REPORT.—Not later than 5 years after the 

11 date of the enactment of this Act, the Comptroller 

12 General shall submit to Congress a report containing 

13 the results of the study conducted under paragraph 

14 (1), together with recommendations for such legisla15 tion and administrative action as the Comptroller 

16 General determines appropriate. 

17 SEC. 2313. INCREASING CONVENIENCE FOR MEDICARE AD18 VANTAGE ENROLLEES THROUGH TELE19 HEALTH. 

20 (a) IN GENERAL.—Section 1852 of the Social Security 

21 Act (42 U.S.C. 1395w–22) is amended— 

22 (1) in subsection (a)(1)(B)(i), by inserting ‘‘, 

23 subject to subsection (m),’’ after ‘‘means’’; and 

24 (2) by adding at the end the following new sub25 section: 
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1 ‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH BENE2 FITS.— 

3 ‘‘(1) MA PLAN OPTION.—For plan year 2020 

4 and subsequent plan years, subject to the requirements 

5 of paragraph (3), an MA plan may provide addi6 tional telehealth benefits (as defined in paragraph 

7 (2)) to individuals enrolled under this part. 

8 ‘‘(2) ADDITIONAL TELEHEALTH BENEFITS DE9 FINED.— 

10 ‘‘(A) IN GENERAL.—For purposes of this 

11 subsection and section 1854: 

12 ‘‘(i) DEFINITION.—The term ‘addi13 tional telehealth benefits’ means services— 

14 ‘‘(I) for which benefits are avail15 able under part B, including services 

16 for which payment is not made under 

17 section 1834(m) due to the conditions 

18 for payment under such section; and 

19 ‘‘(II) that are identified for the 

20 year involved by the Secretary as clini21 cally appropriate to furnish using elec22 tronic information and telecommuni23 cations technology when a physician 

24 (as defined in section 1861(r)) or prac25 titioner (described in section 
260 

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1 1842(b)(18)(C)) providing the service 

2 is not at the same location as the plan 

3 enrollee. 

4 ‘‘(ii) EXCLUSION OF CAPITAL AND IN5 FRASTRUCTURE COSTS AND INVEST6 MENTS.—The term ‘additional telehealth 

7 benefits’ does not include capital and infra8 structure costs and investments relating to 

9 such benefits. 

10 ‘‘(B) PUBLIC COMMENT.—Not later than 

11 November 30, 2018, the Secretary shall solicit 

12 comments on— 

13 ‘‘(i) what types of items and services 

14 (including those provided through supple15 mental health care benefits, such as remote 

16 patient monitoring, secure messaging, store 

17 and forward technologies, and other non18 face-to-face communication) should be con19 sidered to be additional telehealth benefits; 

20 and 

21 ‘‘(ii) the requirements for the provision 

22 or furnishing of such benefits (such as licen23 sure, training, and coordination require24 ments). 
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1 ‘‘(3) REQUIREMENTS FOR ADDITIONAL TELE2 HEALTH BENEFITS.—The Secretary shall specify re3 quirements for the provision or furnishing of addi4 tional telehealth benefits, including with respect to the 

5 following: 

6 ‘‘(A) Physician or practitioner qualifica7 tions (other than licensure) and other require8 ments such as specific training. 

9 ‘‘(B) Factors necessary for the coordination 

10 of such benefits with other items and services, in11 cluding those furnished in-person. 

12 ‘‘(C) Such other areas as determined by the 

13 Secretary. 

14 ‘‘(4) ENROLLEE CHOICE.—If an MA plan pro15 vides a service as an additional telehealth benefit (as 

16 defined in paragraph (2))— 

17 ‘‘(A) the MA plan shall also provide access 

18 to such benefit through an in-person visit (and 

19 not only as an additional telehealth benefit); and 

20 ‘‘(B) an individual enrollee shall have dis21 cretion as to whether to receive such service 

22 through the in-person visit or as an additional 

23 telehealth benefit. 

24 ‘‘(5) TREATMENT UNDER MA.—For purposes of 

25 this subsection and section 1854, if a plan provides 
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1 additional telehealth benefits, such additional tele2 health benefits shall be treated as if they were benefits 

3 under the original Medicare fee-for-service program 

4 option. 

5 ‘‘(6) CONSTRUCTION.—Nothing in this subsection 

6 shall be construed as affecting the requirement under 

7 subsection (a)(1) that MA plans provide enrollees 

8 with items and services (other than hospice care) for 

9 which benefits are available under parts A and B, in10 cluding benefits available under section 1834(m).’’. 

11 (b) CLARIFICATION REGARDING INCLUSION IN BID

12 AMOUNT.—Section 1854(a)(6)(A)(ii)(I) of the Social Secu13 rity Act (42 U.S.C. 1395w–24(a)(6)(A)(ii)(I)) is amended 

14 by inserting ‘‘, including, for plan year 2020 and subse15 quent plan years, the provision of additional telehealth ben16 efits as described in section 1852(m)’’ before the semicolon 

17 at the end. 

18 SEC. 2314. PROVIDING ACCOUNTABLE CARE ORGANIZA19 TIONS THE ABILITY TO EXPAND THE USE OF 

20 TELEHEALTH. 

21 (a) IN GENERAL.—Section 1899 of the Social Security 

22 Act (42 U.S.C. 1395jjj) is amended by adding at the end 

23 the following new subsection: 

24 ‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND THE

25 USE OF TELEHEALTH SERVICES.— 
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1 ‘‘(1) IN GENERAL.—In the case of telehealth serv2 ices for which payment would otherwise be made 

3 under this title furnished on or after January 1, 

4 2020, for purposes of this subsection only, the fol5 lowing shall apply with respect to such services fur6 nished by a physician or practitioner participating 

7 in an applicable ACO (as defined in paragraph (2)) 

8 to a Medicare fee-for-service beneficiary assigned to 

9 the applicable ACO: 

10 ‘‘(A) INCLUSION OF HOME AS ORIGINATING

11 SITE.—Subject to paragraph (3), the home of a 

12 beneficiary shall be treated as an originating site 

13 described in section 1834(m)(4)(C)(ii). 

14 ‘‘(B) NO APPLICATION OF GEOGRAPHIC LIM15 ITATION.—The geographic limitation under sec16 tion 1834(m)(4)(C)(i) shall not apply with re17 spect to an originating site described in section 

18 1834(m)(4)(C)(ii) (including the home of a bene19 ficiary under subparagraph (A)), subject to State 

20 licensing requirements. 

21 ‘‘(2) DEFINITIONS.—In this subsection: 

22 ‘‘(A) APPLICABLE ACO.—The term ‘applica23 ble ACO’ means an ACO participating in a 

24 model tested or expanded under section 1115A or 

25 under this section— 
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1 ‘‘(i) that operates under a two-sided 

2 model— 

3 ‘‘(I) described in section 

4 425.600(a) of title 42, Code of Federal 

5 Regulations; or 

6 ‘‘(II) tested or expanded under 

7 section 1115A; and 

8 ‘‘(ii) for which Medicare fee-for-service 

9 beneficiaries are assigned to the ACO using 

10 a prospective assignment method, as deter11 mined appropriate by the Secretary. 

12 ‘‘(B) HOME.—The term ‘home’ means, with 

13 respect to a Medicare fee-for-service beneficiary, 

14 the place of residence used as the home of the 

15 beneficiary. 

16 ‘‘(3) TELEHEALTH SERVICES RECEIVED IN THE

17 HOME.—In the case of telehealth services described in 

18 paragraph (1) where the home of a Medicare fee-for19 service beneficiary is the originating site, the fol20 lowing shall apply: 

21 ‘‘(A) NO FACILITY FEE.—There shall be no 

22 facility fee paid to the originating site under sec23 tion 1834(m)(2)(B). 

24 ‘‘(B) EXCLUSION OF CERTAIN SERVICES.— 

25 No payment may be made for such services that 
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1 are inappropriate to furnish in the home setting 

2 such as services that are typically furnished in 

3 inpatient settings such as a hospital.’’. 

4 (b) STUDY AND REPORT.— 

5 (1) STUDY.— 

6 (A) IN GENERAL.—The Secretary of Health 

7 and Human Services (in this subsection referred 

8 to as the ‘‘Secretary’’) shall conduct a study on 

9 the implementation of section 1899(l) of the So10 cial Security Act, as added by subsection (a). 

11 Such study shall include an analysis of the utili12 zation of, and expenditures for, telehealth serv13 ices under such section. 

14 (B) COLLECTION OF DATA.—The Secretary 

15 may collect such data as the Secretary deter16 mines necessary to carry out the study under 

17 this paragraph. 

18 (2) REPORT.—Not later than January 1, 2026, 

19 the Secretary shall submit to Congress a report con20 taining the results of the study conducted under para21 graph (1), together with recommendations for such 

22 legislation and administrative action as the Secretary 

23 determines appropriate. 
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1 SEC. 2315. EXPANDING THE USE OF TELEHEALTH FOR INDI2 VIDUALS WITH STROKE. 

3 Section 1834(m) of the Social Security Act (42 U.S.C. 

4 1395m(m)), as amended by section 2302(b), is amended— 

5 (1) in paragraph (4)(C)(i), in the matter pre6 ceding subclause (I), by striking ‘‘The term’’ and in7 serting ‘‘Except as provided in paragraph (6), the 

8 term’’; and 

9 (2) by adding at the end the following new para10 graph: 

11 ‘‘(6) TREATMENT OF STROKE TELEHEALTH

12 SERVICES.— 

13 ‘‘(A) NON-APPLICATION OF ORIGINATING

14 SITE REQUIREMENTS.—The requirements de15 scribed in paragraph (4)(C) shall not apply with 

16 respect to telehealth services furnished on or after 

17 January 1, 2021, for purposes of diagnosis, eval18 uation, or treatment of symptoms of an acute 

19 stroke, as determined by the Secretary. 

20 ‘‘(B) INCLUSION OF CERTAIN SITES.—With 

21 respect to telehealth services described in sub22 paragraph (A), the term ‘originating site’ shall 

23 include any hospital (as defined in section 

24 1861(e)) or critical access hospital (as defined in 

25 section 1861(mm)(1)), any mobile stroke unit (as 

26 defined by the Secretary), or any other site deter-
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1 mined appropriate by the Secretary, at which 

2 the eligible telehealth individual is located at the 

3 time the service is furnished via a telecommuni4 cations system. 

5 ‘‘(C) NO ORIGINATING SITE FACILITY FEE

6 FOR NEW SITES.—No facility fee shall be paid 

7 under paragraph (2)(B) to an originating site 

8 with respect to a telehealth service described in 

9 subparagraph (A) if the originating site does not 

10 otherwise meet the requirements for an origi11 nating site under paragraph (4)(C).’’. 

12 Subtitle C—Identifying the 

13 Chronically Ill Population 

14 SEC. 2321. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO 

15 BE PART OF AN ACCOUNTABLE CARE ORGANI16 ZATION. 

17 Section 1899(c) of the Social Security Act (42 U.S.C. 

18 1395jjj(c)) is amended— 

19 (1) by redesignating paragraphs (1) and (2) as 

20 subparagraphs (A) and (B), respectively, and indent21 ing appropriately; 

22 (2) by striking ‘‘ACOS.—The Secretary’’ and in23 serting ‘‘ACOS.— 

24 ‘‘(1) IN GENERAL.—Subject to paragraph (2), the 

25 Secretary’’; and 
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1 (3) by adding at the end the following new para2 graph: 

3 ‘‘(2) PROVIDING FLEXIBILITY.— 

4 ‘‘(A) CHOICE OF PROSPECTIVE ASSIGN5 MENT.—For each agreement period (effective for 

6 agreements entered into or renewed on or after 

7 January 1, 2020), in the case where an ACO es8 tablished under the program is in a Track that 

9 provides for the retrospective assignment of 

10 Medicare fee-for-service beneficiaries to the ACO, 

11 the Secretary shall permit the ACO to choose to 

12 have Medicare fee-for-service beneficiaries as13 signed prospectively, rather than retrospectively, 

14 to the ACO for an agreement period. 

15 ‘‘(B) ASSIGNMENT BASED ON VOLUNTARY

16 IDENTIFICATION BY MEDICARE FEE-FOR-SERVICE

17 BENEFICIARIES.— 

18 ‘‘(i) IN GENERAL.—For performance 

19 year 2018 and each subsequent performance 

20 year, if a system is available for electronic 

21 designation, the Secretary shall permit a 

22 Medicare fee-for-service beneficiary to volun23 tarily identify an ACO professional as the 

24 primary care provider of the beneficiary for 
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1 purposes of assigning such beneficiary to an 

2 ACO, as determined by the Secretary. 

3 ‘‘(ii) NOTIFICATION PROCESS.—The 

4 Secretary shall establish a process under 

5 which a Medicare fee-for-service beneficiary 

6 is— 

7 ‘‘(I) notified of their ability to 

8 make an identification described in 

9 clause (i); and 

10 ‘‘(II) informed of the process by 

11 which they may make and change such 

12 identification. 

13 ‘‘(iii) SUPERSEDING CLAIMS-BASED AS14 SIGNMENT.—A voluntary identification by 

15 a Medicare fee-for-service beneficiary under 

16 this subparagraph shall supersede any 

17 claims-based assignment otherwise deter18 mined by the Secretary.’’. 
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1 Subtitle D—Empowering Individ2 uals and Caregivers in Care De3 livery 

4 SEC. 2331. ELIMINATING BARRIERS TO CARE COORDINA5 TION UNDER ACCOUNTABLE CARE ORGANIZA6 TIONS. 

7 (a) IN GENERAL.—Section 1899 of the Social Security 

8 Act (42 U.S.C. 1395jjj), as amended by section 2314(a), is 

9 amended— 

10 (1) in subsection (b)(2), by adding at the end the 

11 following new subparagraph: 

12 ‘‘(I) An ACO that seeks to operate an ACO 

13 Beneficiary Incentive Program pursuant to sub14 section (m) shall apply to the Secretary at such 

15 time, in such manner, and with such informa16 tion as the Secretary may require.’’; 

17 (2) by adding at the end the following new sub18 section: 

19 ‘‘(m) AUTHORITY TO PROVIDE INCENTIVE PAYMENTS

20 TO BENEFICIARIES WITH RESPECT TO QUALIFYING PRI21 MARY CARE SERVICES.— 

22 ‘‘(1) PROGRAM.— 

23 ‘‘(A) IN GENERAL.—In order to encourage 

24 Medicare fee-for-service beneficiaries to obtain 

25 medically necessary primary care services, an 
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1 ACO participating under this section under a 

2 payment model described in clause (i) or (ii) of 

3 paragraph (2)(B) may apply to establish an 

4 ACO Beneficiary Incentive Program to provide 

5 incentive payments to such beneficiaries who are 

6 furnished qualifying services in accordance with 

7 this subsection. The Secretary shall permit such 

8 an ACO to establish such a program at the Sec9 retary’s discretion and subject to such require10 ments, including program integrity require11 ments, as the Secretary determines necessary. 

12 ‘‘(B) IMPLEMENTATION.—The Secretary 

13 shall implement this subsection on a date deter14 mined appropriate by the Secretary. Such date 

15 shall be no earlier than January 1, 2019, and no 

16 later than January 1, 2020. 

17 ‘‘(2) CONDUCT OF PROGRAM.— 

18 ‘‘(A) DURATION.—Subject to subparagraph 

19 (H), an ACO Beneficiary Incentive Program es20 tablished under this subsection shall be conducted 

21 for such period (of not less than 1 year) as the 

22 Secretary may approve. 

23 ‘‘(B) SCOPE.—An ACO Beneficiary Incen24 tive Program established under this subsection 

25 shall provide incentive payments to all of the fol-
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1 lowing Medicare fee-for-service beneficiaries who 

2 are furnished qualifying services by the ACO: 

3 ‘‘(i) With respect to the Track 2 and 

4 Track 3 payment models described in sec5 tion 425.600(a) of title 42, Code of Federal 

6 Regulations (or in any successor regula7 tion), Medicare fee-for-service beneficiaries 

8 who are preliminarily prospectively or pro9 spectively assigned (or otherwise assigned, 

10 as determined by the Secretary) to the ACO. 

11 ‘‘(ii) With respect to any future pay12 ment models involving two-sided risk, Medi13 care fee-for-service beneficiaries who are as14 signed to the ACO, as determined by the 

15 Secretary. 

16 ‘‘(C) QUALIFYING SERVICE.—For purposes 

17 of this subsection, a qualifying service is a pri18 mary care service, as defined in section 425.20 

19 of title 42, Code of Federal Regulations (or in 

20 any successor regulation), with respect to which 

21 coinsurance applies under part B, furnished 

22 through an ACO by— 

23 ‘‘(i) an ACO professional described in 

24 subsection (h)(1)(A) who has a primary 

25 care specialty designation included in the 
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1 definition of primary care physician under 

2 section 425.20 of title 42, Code of Federal 

3 Regulations (or any successor regulation); 

4 ‘‘(ii) an ACO professional described in 

5 subsection (h)(1)(B); or 

6 ‘‘(iii) a Federally qualified health cen7 ter or rural health clinic (as such terms are 

8 defined in section 1861(aa)). 

9 ‘‘(D) INCENTIVE PAYMENTS.—An incentive 

10 payment made by an ACO pursuant to an ACO 

11 Beneficiary Incentive Program established under 

12 this subsection shall be— 

13 ‘‘(i) in an amount up to $20, with 

14 such maximum amount updated annually 

15 by the percentage increase in the consumer 

16 price index for all urban consumers (United 

17 States city average) for the 12-month period 

18 ending with June of the previous year; 

19 ‘‘(ii) in the same amount for each 

20 Medicare fee-for-service beneficiary described 

21 in clause (i) or (ii) of subparagraph (B) 

22 without regard to enrollment of such a bene23 ficiary in a medicare supplemental policy 

24 (described in section 1882(g)(1)), in a State 

25 Medicaid plan under title XIX or a waiver 
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1 of such a plan, or in any other health in2 surance policy or health benefit plan; 

3 ‘‘(iii) made for each qualifying service 

4 furnished to such a beneficiary described in 

5 clause (i) or (ii) of subparagraph (B) dur6 ing a period specified by the Secretary; and 

7 ‘‘(iv) made no later than 30 days after 

8 a qualifying service is furnished to such a 

9 beneficiary described in clause (i) or (ii) of 

10 subparagraph (B). 

11 ‘‘(E) NO SEPARATE PAYMENTS FROM THE

12 SECRETARY.—The Secretary shall not make any 

13 separate payment to an ACO for the costs, in14 cluding incentive payments, of carrying out an 

15 ACO Beneficiary Incentive Program established 

16 under this subsection. Nothing in this subpara17 graph shall be construed as prohibiting an ACO 

18 from using shared savings received under this 

19 section to carry out an ACO Beneficiary Incen20 tive Program. 

21 ‘‘(F) NO APPLICATION TO SHARED SAVINGS

22 CALCULATION.—Incentive payments made by an 

23 ACO under this subsection shall be disregarded 

24 for purposes of calculating benchmarks, esti-
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1 mated average per capita Medicare expenditures, 

2 and shared savings under this section. 

3 ‘‘(G) REPORTING REQUIREMENTS.—An 

4 ACO conducting an ACO Beneficiary Incentive 

5 Program under this subsection shall, at such 

6 times and in such format as the Secretary may 

7 require, report to the Secretary such information 

8 and retain such documentation as the Secretary 

9 may require, including the amount and fre10 quency of incentive payments made and the 

11 number of Medicare fee-for-service beneficiaries 

12 receiving such payments. 

13 ‘‘(H) TERMINATION.—The Secretary may 

14 terminate an ACO Beneficiary Incentive Pro15 gram established under this subsection at any 

16 time for reasons determined appropriate by the 

17 Secretary. 

18 ‘‘(3) EXCLUSION OF INCENTIVE PAYMENTS.—Any 

19 payment made under an ACO Beneficiary Incentive 

20 Program established under this subsection shall not be 

21 considered income or resources or otherwise taken into 

22 account for purposes of— 

23 ‘‘(A) determining eligibility for benefits or 

24 assistance (or the amount or extent of benefits or 

25 assistance) under any Federal program or under 
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1 any State or local program financed in whole or 

2 in part with Federal funds; or 

3 ‘‘(B) any Federal or State laws relating to 

4 taxation.’’; 

5 (3) in subsection (e), by inserting ‘‘, including 

6 an ACO Beneficiary Incentive Program under sub7 sections (b)(2)(I) and (m)’’ after ‘‘the program’’; and 

8 (4) in subsection (g)(6), by inserting ‘‘or of an 

9 ACO Beneficiary Incentive Program under sub10 sections (b)(2)(I) and (m)’’ after ‘‘under subsection 

11 (d)(4)’’. 

12 (b) AMENDMENT TO SECTION 1128B.—Section 

13 1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a– 

14 7b(b)(3)) is amended— 

15 (1) by striking ‘‘and’’ at the end of subpara16 graph (I); 

17 (2) by striking the period at the end of subpara18 graph (J) and inserting ‘‘; and’’; and 

19 (3) by adding at the end the following new sub20 paragraph: 

21 ‘‘(K) an incentive payment made to a Medi22 care fee-for-service beneficiary by an ACO under 

23 an ACO Beneficiary Incentive Program estab24 lished under subsection (m) of section 1899, if 

25 the payment is made in accordance with the re-
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1 quirements of such subsection and meets such 

2 other conditions as the Secretary may estab3 lish.’’. 

4 (c) EVALUATION AND REPORT.— 

5 (1) EVALUATION.—The Secretary of Health and 

6 Human Services (in this subsection referred to as the 

7 ‘‘Secretary’’) shall conduct an evaluation of the ACO 

8 Beneficiary Incentive Program established under sub9 sections (b)(2)(I) and (m) of section 1899 of the So10 cial Security Act (42 U.S.C. 1395jjj), as added by 

11 subsection (a). The evaluation shall include an anal12 ysis of the impact of the implementation of the Pro13 gram on expenditures and beneficiary health outcomes 

14 under title XVIII of the Social Security Act (42 

15 U.S.C. 1395 et seq.). 

16 (2) REPORT.—Not later than October 1, 2023, 

17 the Secretary shall submit to Congress a report con18 taining the results of the evaluation under paragraph 

19 (1), together with recommendations for such legisla20 tion and administrative action as the Secretary deter21 mines appropriate. 
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1 SEC. 2332. GAO STUDY AND REPORT ON LONGITUDINAL 

2 COMPREHENSIVE CARE PLANNING SERVICES 

3 UNDER MEDICARE PART B. 

4 (a) STUDY.—The Comptroller General shall conduct a 

5 study on the establishment under part B of the Medicare 

6 program under title XVIII of the Social Security Act of 

7 a payment code for a visit for longitudinal comprehensive 

8 care planning services. Such study shall include an anal9 ysis of the following to the extent such information is avail10 able: 

11 (1) The frequency with which services similar to 

12 longitudinal comprehensive care planning services are 

13 furnished to Medicare beneficiaries, which providers 

14 of services and suppliers are furnishing those services, 

15 whether Medicare reimbursement is being received for 

16 those services, and, if so, through which codes those 

17 services are being reimbursed. 

18 (2) Whether, and the extent to which, longitu19 dinal comprehensive care planning services would 

20 overlap, and could therefore result in duplicative pay21 ment, with services covered under the hospice benefit 

22 as well as the chronic care management code, evalua23 tion and management codes, or other codes that al24 ready exist under part B of the Medicare program. 

25 (3) Any barriers to hospitals, skilled nursing fa26 cilities, hospice programs, home health agencies, and 
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1 other applicable providers working with a Medicare 

2 beneficiary to engage in the care planning process 

3 and complete the necessary documentation to support 

4 the treatment and care plan of the beneficiary and 

5 provide such documentation to other providers and 

6 the beneficiary or the beneficiary’s representative. 

7 (4) Any barriers to providers, other than the pro8 vider furnishing longitudinal comprehensive care 

9 planning services, accessing the care plan and associ10 ated documentation for use related to the care of the 

11 Medicare beneficiary. 

12 (5) Potential options for ensuring that applica13 ble providers are notified of a patient’s existing longi14 tudinal care plan and that applicable providers con15 sider that plan in making their treatment decisions, 

16 and what the challenges might be in implementing 

17 such options. 

18 (6) Stakeholder’s views on the need for the devel19 opment of quality metrics with respect to longitudinal 

20 comprehensive care planning services, such as meas21 ures related to— 

22 (A) the process of eliciting input from the 

23 Medicare beneficiary or from a legally author24 ized representative and documenting in the med25 ical record the patient-directed care plan; 
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1 (B) the effectiveness and patient2 centeredness of the care plan in organizing deliv3 ery of services consistent with the plan; 

4 (C) the availability of the care plan and as5 sociated documentation to other providers that 

6 care for the beneficiary; and 

7 (D) the extent to which the beneficiary re8 ceived services and support that is free from dis9 crimination based on advanced age, disability 

10 status, or advanced illness. 

11 (7) Stakeholder’s views on how such quality 

12 metrics would provide information on— 

13 (A) the goals, values, and preferences of the 

14 beneficiary; 

15 (B) the documentation of the care plan; 

16 (C) services furnished to the beneficiary; 

17 and 

18 (D) outcomes of treatment. 

19 (8) Stakeholder’s views on— 

20 (A) the type of training and education 

21 needed for applicable providers, individuals, and 

22 caregivers in order to facilitate longitudinal 

23 comprehensive care planning services; 
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1 (B) the types of providers of services and 

2 suppliers that should be included in the inter3 disciplinary team of an applicable provider; and 

4 (C) the characteristics of Medicare bene5 ficiaries that would be most appropriate to re6 ceive longitudinal comprehensive care planning 

7 services, such as individuals with advanced dis8 ease and individuals who need assistance with 

9 multiple activities of daily living. 

10 (9) Stakeholder’s views on the frequency with 

11 which longitudinal comprehensive care planning serv12 ices should be furnished. 

13 (b) REPORT.—Not later than 18 months after the date 

14 of the enactment of this Act, the Comptroller General shall 

15 submit to Congress a report containing the results of the 

16 study conducted under subsection (a), together with rec17 ommendations for such legislation and administrative ac18 tion as the Comptroller General determines appropriate. 

19 (c) DEFINITIONS.—In this section: 

20 (1) APPLICABLE PROVIDER.—The term ‘‘applica21 ble provider’’ means a hospice program (as defined in 

22 subsection (dd)(2) of section 1861 of the Social Secu23 rity Act (42 U.S.C. 1395ww)) or other provider of 

24 services (as defined in subsection (u) of such section) 
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1 or supplier (as defined in subsection (d) of such sec2 tion) that— 

3 (A) furnishes longitudinal comprehensive 

4 care planning services through an interdiscipli5 nary team; and 

6 (B) meets such other requirements as the 

7 Secretary may determine to be appropriate. 

8 (2) COMPTROLLER GENERAL.—The term ‘‘Comp9 troller General’’ means the Comptroller General of the 

10 United States. 

11 (3) INTERDISCIPLINARY TEAM.—The term 

12 ‘‘interdisciplinary team’’ means a group that— 

13 (A) includes the personnel described in sub14 section (dd)(2)(B)(i) of such section 1861; 

15 (B) may include a chaplain, minister, or 

16 other clergy; and 

17 (C) may include other direct care personnel. 

18 (4) LONGITUDINAL COMPREHENSIVE CARE PLAN19 NING SERVICES.—The term ‘‘longitudinal comprehen20 sive care planning services’’ means a voluntary 

21 shared decisionmaking process that is furnished by an 

22 applicable provider through an interdisciplinary 

23 team and includes a conversation with Medicare bene24 ficiaries who have received a diagnosis of a serious or 

25 life-threatening illness. The purpose of such services is 
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1 to discuss a longitudinal care plan that addresses the 

2 progression of the disease, treatment options, the 

3 goals, values, and preferences of the beneficiary, and 

4 the availability of other resources and social supports 

5 that may reduce the beneficiary’s health risks and 

6 promote self-management and shared decisionmaking. 

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

8 the Secretary of Health and Human Services. 

9 Subtitle E—Other Policies to Im10 prove Care for the Chronically 

11 Ill 

12 SEC. 2341. GAO STUDY AND REPORT ON IMPROVING MEDI13 CATION SYNCHRONIZATION. 

14 (a) STUDY.—The Comptroller General of the United 

15 States (in this section referred to as the ‘‘Comptroller Gen16 eral’’) shall conduct a study on the extent to which Medicare 

17 prescription drug plans (MA–PD plans and stand alone 

18 prescription drug plans) under part D of title XVIII of the 

19 Social Security Act and private payors use programs that 

20 synchronize pharmacy dispensing so that individuals may 

21 receive multiple prescriptions on the same day to facilitate 

22 comprehensive counseling and promote medication adher23 ence. The study shall include a analysis of the following: 

24 (1) The extent to which pharmacies have adopted 

25 such programs. 
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1 (2) The common characteristics of such pro2 grams, including how pharmacies structure coun3 seling sessions under such programs and the types of 

4 payment and other arrangements that Medicare pre5 scription drug plans and private payors employ 

6 under such programs to support the efforts of phar7 macies. 

8 (3) How such programs compare for Medicare 

9 prescription drug plans and private payors. 

10 (4) What is known about how such programs af11 fect patient medication adherence and overall patient 

12 health outcomes, including if adherence and outcomes 

13 vary by patient subpopulations, such as disease state 

14 and socioeconomic status. 

15 (5) What is known about overall patient satisfac16 tion with such programs and satisfaction with such 

17 programs, including within patient subpopulations, 

18 such as disease state and socioeconomic status. 

19 (6) The extent to which laws and regulations of 

20 the Medicare program support such programs. 

21 (7) Barriers to the use of medication synchroni22 zation programs by Medicare prescription drug plans. 

23 (b) REPORT.—Not later than 18 months after the date 

24 of the enactment of this Act, the Comptroller General shall 

25 submit to Congress a report containing the results of the 
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1 study under subsection (a), together with recommendations 

2 for such legislation and administrative action as the Comp3 troller General determines appropriate. 

4 SEC. 2342. GAO STUDY AND REPORT ON IMPACT OF OBE5 SITY DRUGS ON PATIENT HEALTH AND 

6 SPENDING. 

7 (a) STUDY.—The Comptroller General of the United 

8 States (in this section referred to as the ‘‘Comptroller Gen9 eral’’) shall, to the extent data are available, conduct a 

10 study on the use of prescription drugs to manage the weight 

11 of obese patients and the impact of coverage of such drugs 

12 on patient health and on health care spending. Such study 

13 shall examine the use and impact of these obesity drugs in 

14 the non-Medicare population and for Medicare beneficiaries 

15 who have such drugs covered through an MA–PD plan (as 

16 defined in section 1860D–1(a)(3)(C) of the Social Security 

17 Act (42 U.S.C. 1395w–101(a)(3)(C))) as a supplemental 

18 health care benefit. The study shall include an analysis of 

19 the following: 

20 (1) The prevalence of obesity in the Medicare 

21 and non-Medicare population. 

22 (2) The utilization of obesity drugs. 

23 (3) The distribution of Body Mass Index by in24 dividuals taking obesity drugs, to the extent prac25 ticable. 
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1 (4) What is known about the use of obesity drugs 

2 in conjunction with the receipt of other items or serv3 ices, such as behavioral counseling, and how these 

4 compare to items and services received by obese indi5 viduals who do not take obesity drugs. 

6 (5) Physician considerations and attitudes re7 lated to prescribing obesity drugs. 

8 (6) The extent to which coverage policies cease or 

9 limit coverage for individuals who fail to receive clin10 ical benefit. 

11 (7) What is known about the extent to which in12 dividuals who take obesity drugs adhere to the pre13 scribed regimen. 

14 (8) What is known about the extent to which in15 dividuals who take obesity drugs maintain weight loss 

16 over time. 

17 (9) What is known about the subsequent impact 

18 such drugs have on medical services that are directly 

19 related to obesity, including with respect to sub20 populations determined based on the extent of obesity. 

21 (10) What is known about the spending associ22 ated with the care of individuals who take obesity 

23 drugs, compared to the spending associated with the 

24 care of individuals who do not take such drugs. 
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1 (b) REPORT.—Not later than 18 months after the date 

2 of the enactment of this Act, the Comptroller General shall 

3 submit to Congress a report containing the results of the 

4 study under subsection (a), together with recommendations 

5 for such legislation and administrative action as the Comp6 troller General determines appropriate. 

7 SEC. 2343. HHS STUDY AND REPORT ON LONG-TERM RISK 

8 FACTORS FOR CHRONIC CONDITIONS AMONG 

9 MEDICARE BENEFICIARIES. 

10 (a) STUDY.—The Secretary of Health and Human 

11 Services (in this section referred to as the ‘‘Secretary’’) shall 

12 conduct a study on long-term cost drivers to the Medicare 

13 program, including obesity, tobacco use, mental health con14 ditions, and other factors that may contribute to the deterio15 ration of health conditions among individuals with chronic 

16 conditions in the Medicare population. The study shall in17 clude an analysis of any barriers to collecting and ana18 lyzing such information and how to remove any such bar19 riers (including through legislation and administrative ac20 tions). 

21 (b) REPORT.—Not later than 18 months after the date 

22 of the enactment of this Act, the Secretary shall submit to 

23 Congress a report containing the results of the study under 

24 subsection (a), together with recommendations for such leg25 islation and administrative action as the Secretary deter-
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1 mines appropriate. The Secretary shall also post such re2 port on the Internet website of the Department of Health 

3 and Human Services. 

4 TITLE IV—MEDICARE PART B 

5 MISCELLANEOUS POLICIES 

6 Subtitle A—Medicare Part B 

7 Improvement Act 

8 SEC. 2401. HOME INFUSION THERAPY SERVICES TEM9 PORARY TRANSITIONAL PAYMENT. 

10 (a) IN GENERAL.—Section 1834(u) of the Social Secu11 rity Act (42 U.S.C. 1395m(u)) is amended by adding at 

12 the end the following new paragraph: 

13 ‘‘(7) HOME INFUSION THERAPY SERVICES TEM14 PORARY TRANSITIONAL PAYMENT.— 

15 ‘‘(A) TEMPORARY TRANSITIONAL PAY16 MENT.— 

17 ‘‘(i) IN GENERAL.—The Secretary 

18 shall, in accordance with the payment 

19 methodology described in subparagraph (B) 

20 and subject to the provisions of this para21 graph, provide a home infusion therapy 

22 services temporary transitional payment 

23 under this part to an eligible home infusion 

24 supplier (as defined in subparagraph (F)) 

25 for items and services described in subpara-
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1 graphs (A) and (B) of section 1861(iii)(2)) 

2 furnished during the period specified in 

3 clause (ii) by such supplier in coordination 

4 with the furnishing of transitional home in5 fusion drugs (as defined in clause (iii)). 

6 ‘‘(ii) PERIOD SPECIFIED.—For pur7 poses of clause (i), the period specified in 

8 this clause is the period beginning on Janu9 ary 1, 2019, and ending on the day before 

10 the date of the implementation of the pay11 ment system under paragraph (1)(A). 

12 ‘‘(iii) TRANSITIONAL HOME INFUSION

13 DRUG DEFINED.—For purposes of this para14 graph, the term ‘transitional home infusion 

15 drug’ has the meaning given to the term 

16 ‘home infusion drug’ under section 

17 1861(iii)(3)(C)), except that clause (ii) of 

18 such section shall not apply if a drug de19 scribed in such clause is identified in 

20 clauses (i), (ii), (iii) or (iv) of subpara21 graph (C) as of the date of the enactment of 

22 this paragraph. 

23 ‘‘(B) PAYMENT METHODOLOGY.—For pur24 poses of this paragraph, the Secretary shall es25 tablish a payment methodology, with respect to 
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1 items and services described in subparagraph 

2 (A)(i). Under such payment methodology the 

3 Secretary shall— 

4 ‘‘(i) create the three payment categories 

5 described in clauses (i), (ii), and (iii) of 

6 subparagraph (C); 

7 ‘‘(ii) assign drugs to such categories, in 

8 accordance with such clauses; 

9 ‘‘(iii) assign appropriate Healthcare 

10 Common Procedure Coding System 

11 (HCPCS) codes to each payment category; 

12 and 

13 ‘‘(iv) establish a single payment 

14 amount for each such payment category, in 

15 accordance with subparagraph (D), for each 

16 infusion drug administration calendar day 

17 in the individual’s home for drugs assigned 

18 to such category. 

19 ‘‘(C) PAYMENT CATEGORIES.— 

20 ‘‘(i) PAYMENT CATEGORY 1.—The Sec21 retary shall create a payment category 1 

22 and assign to such category drugs which are 

23 covered under the Local Coverage Deter24 mination on External Infusion Pumps 

25 (LCD number L33794) and billed with the 
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1 following HCPCS codes (as identified as of 

2 January 1, 2018, and as subsequently 

3 modified by the Secretary): J0133, J0285, 

4 J0287, J0288, J0289, J0895, J1170, J1250, 

5 J1265, J1325, J1455, J1457, J1570, J2175, 

6 J2260, J2270, J2274, J2278, J3010, or 

7 J3285. 

8 ‘‘(ii) PAYMENT CATEGORY 2.—The Sec9 retary shall create a payment category 2 

10 and assign to such category drugs which are 

11 covered under such local coverage deter12 mination and billed with the following 

13 HCPCS codes (as identified as of January 

14 1, 2018, and as subsequently modified by 

15 the Secretary): J1555 JB, J1559 JB, J1561 

16 JB, J1562 JB, J1569 JB, or J1575 JB. 

17 ‘‘(iii) PAYMENT CATEGORY 3.—The 

18 Secretary shall create a payment category 3 

19 and assign to such category drugs which are 

20 covered under such local coverage deter21 mination and billed with the following 

22 HCPCS codes (as identified as of January 

23 1, 2018, and as subsequently modified by 

24 the Secretary): J9000, J9039, J9040, 
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1 J9065, J9100, J9190, J9200, J9360, or 

2 J9370. 

3 ‘‘(iv) INFUSION DRUGS NOT OTHER4 WISE INCLUDED.—With respect to drugs 

5 that are not included in payment category 

6 1, 2, or 3 under clause (i), (ii), or (iii), re7 spectively, the Secretary shall assign to the 

8 most appropriate of such categories, as de9 termined by the Secretary, drugs which 

10 are— 

11 ‘‘(I) covered under such local cov12 erage determination and billed under 

13 HCPCS codes J7799 or J7999 (as 

14 identified as of July 1, 2017, and as 

15 subsequently modified by the Sec16 retary); or 

17 ‘‘(II) billed under any code that is 

18 implemented after the date of the en19 actment of this paragraph and in20 cluded in such local coverage deter21 mination or included in subregulatory 

22 guidance as a home infusion drug de23 scribed in subparagraph (A)(i). 

24 ‘‘(D) PAYMENT AMOUNTS.— 
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1 ‘‘(i) IN GENERAL.—Under the payment 

2 methodology, the Secretary shall pay eligible 

3 home infusion suppliers, with respect to 

4 items and services described in subpara5 graph (A)(i) furnished during the period 

6 described in subparagraph (A)(ii) by such 

7 supplier to an individual, at amounts equal 

8 to the amounts determined under the physi9 cian fee schedule established under section 

10 1848 for services furnished during the year 

11 for codes and units of such codes described 

12 in clauses (ii), (iii), and (iv) with respect 

13 to drugs included in the payment category 

14 under subparagraph (C) specified in the re15 spective clause, determined without applica16 tion of the geographic adjustment under 

17 subsection (e) of such section. 

18 ‘‘(ii) PAYMENT AMOUNT FOR CATEGORY

19 1.—For purposes of clause (i), the codes and 

20 units described in this clause, with respect 

21 to drugs included in payment category 1 

22 described in subparagraph (C)(i), are one 

23 unit of HCPCS code 96365 plus three units 

24 of HCPCS code 96366 (as identified as of 
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1 January 1, 2018, and as subsequently 

2 modified by the Secretary). 

3 ‘‘(iii) PAYMENT AMOUNT FOR CAT4 EGORY 2.—For purposes of clause (i), the 

5 codes and units described in this clause, 

6 with respect to drugs included in payment 

7 category 2 described in subparagraph 

8 (C)(i), are one unit of HCPCS code 96369 

9 plus three units of HCPCS code 96370 (as 

10 identified as of January 1, 2018, and as 

11 subsequently modified by the Secretary). 

12 ‘‘(iv) PAYMENT AMOUNT FOR CAT13 EGORY 3.—For purposes of clause (i), the 

14 codes and units described in this clause, 

15 with respect to drugs included in payment 

16 category 3 described in subparagraph 

17 (C)(i), are one unit of HCPCS code 96413 

18 plus three units of HCPCS code 96415 (as 

19 identified as of January 1, 2018, and as 

20 subsequently modified by the Secretary). 

21 ‘‘(E) CLARIFICATIONS.— 

22 ‘‘(i) INFUSION DRUG ADMINISTRATION

23 DAY.—For purposes of this subsection, with 

24 respect to the furnishing of transitional 

25 home infusion drugs or home infusion drugs 
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1 to an individual by an eligible home infu2 sion supplier or a qualified home infusion 

3 therapy supplier, a reference to payment to 

4 such supplier for an infusion drug adminis5 tration calendar day in the individual’s 

6 home shall refer to payment only for the 

7 date on which professional services (as de8 scribed in section 1861(iii)(2)(A)) were fur9 nished to administer such drugs to such in10 dividual. For purposes of the previous sen11 tence, an infusion drug administration cal12 endar day shall include all such drugs ad13 ministered to such individual on such day. 

14 ‘‘(ii) TREATMENT OF MULTIPLE DRUGS

15 ADMINISTERED ON SAME INFUSION DRUG

16 ADMINISTRATION DAY.—In the case that an 

17 eligible home infusion supplier, with respect 

18 to an infusion drug administration cal19 endar day in an individual’s home, fur20 nishes to such individual transitional home 

21 infusion drugs which are not all assigned to 

22 the same payment category under subpara23 graph (C), payment to such supplier for 

24 such infusion drug administration calendar 

25 day in the individual’s home shall be a sin-
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1 gle payment equal to the amount of pay2 ment under this paragraph for the drug, 

3 among all such drugs so furnished to such 

4 individual during such calendar day, for 

5 which the highest payment would be made 

6 under this paragraph. 

7 ‘‘(F) ELIGIBLE HOME INFUSION SUP8 PLIERS.—In this paragraph, the term ‘eligible 

9 home infusion supplier’ means a supplier that is 

10 enrolled under this part as a pharmacy that pro11 vides external infusion pumps and external infu12 sion pump supplies and that maintains all 

13 pharmacy licensure requirements in the State in 

14 which the applicable infusion drugs are adminis15 tered. 

16 ‘‘(G) IMPLEMENTATION.—Notwithstanding 

17 any other provision of law, the Secretary may 

18 implement this paragraph by program instruc19 tion or otherwise.’’. 

20 (b) CONFORMING AMENDMENT.— 

21 (1) Section 1842(b)(6)(I) of the Social Security 

22 Act (42 U.S.C. 1395u(b)(6)(I)) is amended by insert23 ing ‘‘or, in the case of items and services described in 

24 clause (i) of section 1834(u)(7)(A) furnished to an in25 dividual during the period described in clause (ii) of 
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1 such section, payment shall be made to the eligible 

2 home infusion therapy supplier’’ after ‘‘payment shall 

3 be made to the qualified home infusion therapy sup4 plier’’. 

5 (2) Section 5012(d) of the 21st Century Cures 

6 Act is amended by inserting the following before the 

7 period at the end the following: ‘‘, except that the 

8 amendments made by paragraphs (1) and (2) of sub9 section (c) shall apply to items and services furnished 

10 on or after January 1, 2019’’. 

11 SEC. 2402. ORTHOTIST’S AND PROSTHETIST’S CLINICAL 

12 NOTES AS PART OF THE PATIENT’S MEDICAL 

13 RECORD. 

14 Section 1834(h) of the Social Security Act (42 U.S.C. 

15 1395m(h)) is amended by adding at the end the following 

16 new paragraph: 

17 ‘‘(5) DOCUMENTATION CREATED BY ORTHOTISTS

18 AND PROSTHETISTS.—For purposes of determining 

19 the reasonableness and medical necessity of orthotics 

20 and prosthetics, documentation created by an 

21 orthotist or prosthetist shall be considered part of the 

22 individual’s medical record to support documentation 

23 created by eligible professionals described in section 

24 1848(k)(3)(B).’’. 
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1 SEC. 2403. INDEPENDENT ACCREDITATION FOR DIALYSIS 

2 FACILITIES AND ASSURANCE OF HIGH QUAL3 ITY SURVEYS. 

4 (a) ACCREDITATION AND SURVEYS.— 

5 (1) IN GENERAL.—Section 1865 of the Social Se6 curity Act (42 U.S.C. 1395bb) is amended— 

7 (A) in subsection (a)— 

8 (i) in paragraph (1), in the matter 

9 preceding subparagraph (A), by striking ‘‘or 

10 the conditions and requirements under sec11 tion 1881(b)’’; and 

12 (ii) in paragraph (4), by inserting 

13 ‘‘(including a renal dialysis facility)’’ after 

14 ‘‘facility’’; and 

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

16 subsection: 

17 ‘‘(e) With respect to an accreditation body that has re18 ceived approval from the Secretary under subsection 

19 (a)(3)(A) for accreditation of provider entities that are re20 quired to meet the conditions and requirements under sec21 tion 1881(b), in addition to review and oversight authori22 ties otherwise applicable under this title, the Secretary shall 

23 (as the Secretary determines appropriate) conduct, with re24 spect to such accreditation body and provider entities, any 

25 or all of the following as frequently as is otherwise required 
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1 to be conducted under this title with respect to other accredi2 tation bodies or other provider entities: 

3 ‘‘(1) Validation surveys referred to in subsection 

4 (d). 

5 ‘‘(2) Accreditation program reviews (as defined 

6 in section 488.8(c) of title 42 of the Code of Federal 

7 Regulations, or a successor regulation). 

8 ‘‘(3) Performance reviews (as defined in section 

9 488.8(a) of title 42 of the Code of Federal Regula10 tions, or a successor regulation).’’. 

11 (2) TIMING FOR ACCEPTANCE OF REQUESTS

12 FROM ACCREDITATION ORGANIZATIONS.—Not later 

13 than 90 days after the date of enactment of this Act, 

14 the Secretary of Health and Human Services shall 

15 begin accepting requests from national accreditation 

16 bodies for a finding described in section 

17 1865(a)(3)(A) of the Social Security Act (42 U.S.C. 

18 1395bb(a)(3)(A)) for purposes of accrediting provider 

19 entities that are required to meet the conditions and 

20 requirements under section 1881(b) of such Act (42 

21 U.S.C. 1395rr(b)). 

22 (b) REQUIREMENT FOR TIMING OF SURVEYS OF NEW

23 DIALYSIS FACILITIES.—Section 1881(b)(1) of the Social Se24 curity Act (42 U.S.C. 1395rr(b)(1)) is amended by adding 

25 at the end the following new sentence: ‘‘Beginning 180 days 
300 

•HR 1892 EAH 

1 after the date of the enactment of this sentence, an initial 

2 survey of a provider of services or a renal dialysis facility 

3 to determine if the conditions and requirements under this 

4 paragraph are met shall be initiated not later than 90 days 

5 after such date on which both the provider enrollment form 

6 (without regard to whether such form is submitted prior 

7 to or after such date of enactment) has been determined by 

8 the Secretary to be complete and the provider’s enrollment 

9 status indicates approval is pending the results of such sur10 vey.’’. 

11 SEC. 2404. MODERNIZING THE APPLICATION OF THE STARK 

12 RULE UNDER MEDICARE. 

13 (a) CLARIFICATION OF THE WRITING REQUIREMENT

14 AND SIGNATURE REQUIREMENT FOR ARRANGEMENTS PUR15 SUANT TO THE STARK RULE.— 

16 (1) WRITING REQUIREMENT.—Section 

17 1877(h)(1) of the Social Security Act (42 U.S.C. 

18 1395nn(h)(1)) is amended by adding at the end the 

19 following new subparagraph: 

20 ‘‘(D) WRITTEN REQUIREMENT CLARIFIED.—In 

21 the case of any requirement pursuant to this section 

22 for a compensation arrangement to be in writing, 

23 such requirement shall be satisfied by such means as 

24 determined by the Secretary, including by a collection 

25 of documents, including contemporaneous documents 
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1 evidencing the course of conduct between the parties 

2 involved.’’. 

3 (2) SIGNATURE REQUIREMENT.—Section 

4 1877(h)(1) of the Social Security Act (42 U.S.C. 

5 1395nn(h)(1)), as amended by paragraph (1), is fur6 ther amended by adding at the end the following new 

7 subparagraph: 

8 ‘‘(E) SPECIAL RULE FOR SIGNATURE RE9 QUIREMENTS.—In the case of any requirement 

10 pursuant to this section for a compensation ar11 rangement to be in writing and signed by the 

12 parties, such signature requirement shall be met 

13 if— 

14 ‘‘(i) not later than 90 consecutive cal15 endar days immediately following the date 

16 on which the compensation arrangement be17 came noncompliant, the parties obtain the 

18 required signatures; and 

19 ‘‘(ii) the compensation arrangement 

20 otherwise complies with all criteria of the 

21 applicable exception.’’. 

22 (b) INDEFINITE HOLDOVER FOR LEASE ARRANGE23 MENTS AND PERSONAL SERVICES ARRANGEMENTS PURSU24 ANT TO THE STARK RULE.—Section 1877(e) of the Social 

25 Security Act (42 U.S.C. 1395nn(e)) is amended— 
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1 (1) in paragraph (1), by adding at the end the 

2 following new subparagraph: 

3 ‘‘(C) HOLDOVER LEASE ARRANGEMENTS.— 

4 In the case of a holdover lease arrangement for 

5 the lease of office space or equipment, which im6 mediately follows a lease arrangement described 

7 in subparagraph (A) for the use of such office 

8 space or subparagraph (B) for the use of such 

9 equipment and that expired after a term of at 

10 least 1 year, payments made by the lessee to the 

11 lessor pursuant to such holdover lease arrange12 ment, if— 

13 ‘‘(i) the lease arrangement met the con14 ditions of subparagraph (A) for the lease of 

15 office space or subparagraph (B) for the use 

16 of equipment when the arrangement ex17 pired; 

18 ‘‘(ii) the holdover lease arrangement is 

19 on the same terms and conditions as the 

20 immediately preceding arrangement; and 

21 ‘‘(iii) the holdover arrangement con22 tinues to satisfy the conditions of subpara23 graph (A) for the lease of office space or 

24 subparagraph (B) for the use of equip25 ment.’’; and 
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1 (2) in paragraph (3), by adding at the end the 

2 following new subparagraph: 

3 ‘‘(C) HOLDOVER PERSONAL SERVICE AR4 RANGEMENT.—In the case of a holdover personal 

5 service arrangement, which immediately follows 

6 an arrangement described in subparagraph (A) 

7 that expired after a term of at least 1 year, re8 muneration from an entity pursuant to such 

9 holdover personal service arrangement, if— 

10 ‘‘(i) the personal service arrangement 

11 met the conditions of subparagraph (A) 

12 when the arrangement expired; 

13 ‘‘(ii) the holdover personal service ar14 rangement is on the same terms and condi15 tions as the immediately preceding arrange16 ment; and 

17 ‘‘(iii) the holdover arrangement con18 tinues to satisfy the conditions of subpara19 graph (A).’’. 
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1 Subtitle B—Additional Provisions 

2 SEC. 2411. MAKING PERMANENT THE REMOVAL OF THE 

3 RENTAL CAP FOR DURABLE MEDICAL EQUIP4 MENT UNDER MEDICARE WITH RESPECT TO 

5 SPEECH GENERATING DEVICES. 

6 Section 1834(a)(2)(A)(iv) of the Social Security Act 

7 (42 U.S.C. 1395m(a)(2)(A)(iv)) is amended by striking 

8 ‘‘and before October 1, 2018,’’. 

9 SEC. 2412. INCREASED CIVIL AND CRIMINAL PENALTIES 

10 AND INCREASED SENTENCES FOR FEDERAL 

11 HEALTH CARE PROGRAM FRAUD AND ABUSE. 

12 (a) INCREASED CIVIL MONEY PENALTIES AND CRIMI13 NAL FINES.— 

14 (1) INCREASED CIVIL MONEY PENALTIES.—Sec15 tion 1128A of the Social Security Act (42 U.S.C. 

16 1320a–7a) is amended— 

17 (A) in subsection (a), in the matter fol18 lowing paragraph (10)— 

19 (i) by striking ‘‘$10,000’’ and inserting 

20 ‘‘$20,000’’ each place it appears; 

21 (ii) by striking ‘‘$15,000’’ and insert22 ing ‘‘$30,000’’; and 

23 (iii) by striking ‘‘$50,000’’ and insert24 ing ‘‘$100,000’’ each place it appears; and 

25 (B) in subsection (b)— 
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1 (i) in paragraph (1), in the flush text 

2 following subparagraph (B), by striking 

3 ‘‘$2,000’’ and inserting ‘‘$5,000’’; 

4 (ii) in paragraph (2), by striking 

5 ‘‘$2,000’’ and inserting ‘‘$5,000’’; and 

6 (iii) in paragraph (3)(A)(i), by strik7 ing ‘‘$5,000’’ and inserting ‘‘$10,000’’. 

8 (2) INCREASED CRIMINAL FINES.—Section 

9 1128B of such Act (42 U.S.C. 1320a–7b) is amend10 ed— 

11 (A) in subsection (a), in the matter fol12 lowing paragraph (6)— 

13 (i) by striking ‘‘$25,000’’ and inserting 

14 ‘‘$100,000’’; and 

15 (ii) by striking ‘‘$10,000’’ and insert16 ing ‘‘$20,000’’; 

17 (B) in subsection (b)— 

18 (i) in paragraph (1), in the flush text 

19 following subparagraph (B), by striking 

20 ‘‘$25,000’’ and inserting ‘‘$100,000’’; and 

21 (ii) in paragraph (2), in the flush text 

22 following subparagraph (B), by striking 

23 ‘‘$25,000’’ and inserting ‘‘$100,000’’; 

24 (C) in subsection (c), by striking ‘‘$25,000’’ 

25 and inserting ‘‘$100,000’’; 
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1 (D) in subsection (d), in the flush text fol2 lowing paragraph (2), by striking ‘‘$25,000’’ and 

3 inserting ‘‘$100,000’’; and 

4 (E) in subsection (e), by striking ‘‘$2,000’’ 

5 and inserting ‘‘$4,000’’. 

6 (b) INCREASED SENTENCES FOR FELONIES INVOLVING

7 FEDERAL HEALTH CARE PROGRAM FRAUD AND ABUSE.— 

8 (1) FALSE STATEMENTS AND REPRESENTA9 TIONS.—Section 1128B(a) of the Social Security Act 

10 (42 U.S.C. 1320a–7b(a)) is amended, in the matter 

11 following paragraph (6), by striking ‘‘not more than 

12 five years or both, or (ii)’’ and inserting ‘‘not more 

13 than 10 years or both, or (ii)’’. 

14 (2) ANTIKICKBACK.—Section 1128B(b) of such 

15 Act (42 U.S.C. 1320a–7b(b)) is amended— 

16 (A) in paragraph (1), in the flush text fol17 lowing subparagraph (B), by striking ‘‘not more 

18 than five years’’ and inserting ‘‘not more than 

19 10 years’’; and 

20 (B) in paragraph (2), in the flush text fol21 lowing subparagraph (B), by striking ‘‘not more 

22 than five years’’ and inserting ‘‘not more than 

23 10 years’’. 

24 (3) FALSE STATEMENT OR REPRESENTATION

25 WITH RESPECT TO CONDITIONS OR OPERATIONS OF
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1 FACILITIES.—Section 1128B(c) of such Act (42 U.S.C. 

2 1320a–7b(c)) is amended by striking ‘‘not more than 

3 five years’’ and inserting ‘‘not more than 10 years’’. 

4 (4) EXCESS CHARGES.—Section 1128B(d) of 

5 such Act (42 U.S.C. 1320a–7b(d)) is amended, in the 

6 flush text following paragraph (2), by striking ‘‘not 

7 more than five years’’ and inserting ‘‘not more than 

8 10 years’’. 

9 (c) EFFECTIVE DATE.—The amendments made by this 

10 section shall apply to acts committed after the date of the 

11 enactment of this Act. 

12 SEC. 2413. REDUCING THE VOLUME OF FUTURE EHR-RE13 LATED SIGNIFICANT HARDSHIP REQUESTS. 

14 Section 1848(o)(2)(A) of the Social Security Act (42 

15 U.S.C. 1395w–4(o)(2)(A)) and section 1886(n)(3)(A) of 

16 such Act (42 U.S.C. 1395ww(n)(3)(A)) are each amended 

17 in the last sentence by striking ‘‘by requiring’’ and all that 

18 follows through ‘‘this paragraph’’. 

19 SEC. 2414. COVERAGE OF CERTAIN DNA SPECIMEN PROVE20 NANCE ASSAY TESTS UNDER MEDICARE. 

21 (a) BENEFIT.— 

22 (1) COVERAGE.—Section 1861 of the Social Se23 curity Act (42 U.S.C. 1395x) is amended— 

24 (A) in subsection (s)(2)— 
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1 (i) in subparagraph (FF), by striking 

2 ‘‘and’’ at the end; 

3 (ii) in subparagraph (GG), by insert4 ing ‘‘and’’ at the end; and 

5 (iii) by adding at the end the following 

6 new subparagraph: 

7 ‘‘(HH) a prostate cancer DNA Specimen Prove8 nance Assay test (DSPA test) (as defined in sub9 section (jjj)); and’’; and 

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

11 subsection: 

12 ‘‘(jjj) PROSTATE CANCER DNA SPECIMENT PROVE13 NANCE ASSAY TEST.—The term ‘prostate cancer DNA Spec14 imen Provenance Assay Test’ (DSPA test) means a test 

15 that, after a determination of cancer in one or more pros16 tate biopsy specimens obtained from an individual, assesses 

17 the identity of the DNA in such specimens by comparing 

18 such DNA with the DNA that was separately taken from 

19 such individual at the time of the biopsy.’’. 

20 (2) EXCLUSION FROM COVERAGE.—Section 

21 1862(a)(1) of the Social Security Act (42 U.S.C. 

22 1395y(a)(1)) is amended— 

23 (A) in subparagraph (O), by striking ‘‘and’’ 

24 at the end; 
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1 (B) in subparagraph (P), by striking the 

2 semicolon at the end and inserting ‘‘, and’’; and 

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

4 subparagraph: 

5 ‘‘(Q) in the case of a prostate cancer DNA Speci6 men Provenance Assay test (DSPA test) (as defined 

7 in section 1861(jjj)), unless such test is furnished on 

8 or after January 1, 2019, and before January 1, 

9 2024, and such test is ordered by the physician who 

10 furnished the prostate cancer biopsy that obtained the 

11 specimen tested;’’. 

12 (b) PAYMENT AMOUNT AND RELATED REQUIRE13 MENTS.—Section 1834 of the Social Security Act (42 

14 U.S.C. 1395m), as amended by section 2204, is further 

15 amended by adding at the end the following new subsection: 

16 ‘‘(w) PROSTATE CANCER DNA SPECIMEN PROVE17 NANCE ASSAY TESTS.— 

18 ‘‘(1) PAYMENT FOR COVERED TESTS.— 

19 ‘‘(A) IN GENERAL.—Subject to subpara20 graph (B), the payment amount for a prostate 

21 cancer DNA Specimen Provenance Assay test 

22 (DSPA test) (as defined in section 1861(jjj)) 

23 shall be $200. Such payment shall be payment 

24 for all of the specimens obtained from the biopsy 

25 furnished to an individual that are tested. 
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1 ‘‘(B) LIMITATION.—Payment for a DSPA 

2 test under subparagraph (A) may only be made 

3 on an assignment-related basis. 

4 ‘‘(C) PROHIBITION ON SEPARATE PAY5 MENT.—No separate payment shall be made for 

6 obtaining DNA that was separately taken from 

7 an individual at the time of a biopsy described 

8 in subparagraph (A). 

9 ‘‘(2) HCPCS CODE AND MODIFIER ASSIGN10 MENT.— 

11 ‘‘(A) IN GENERAL.—The Secretary shall as12 sign one or more HCPCS codes to a prostate 

13 cancer DNA Specimen Provenance Assay test 

14 and may use a modifier to facilitate making 

15 payment under this section for such test. 

16 ‘‘(B) IDENTIFICATION OF DNA MATCH ON

17 CLAIM.—The Secretary shall require an indica18 tion on a claim for a prostate cancer DNA Spec19 imen Provenance Assay test of whether the DNA 

20 of the prostate biopsy specimens match the DNA 

21 of the individual diagnosed with prostate cancer. 

22 Such indication may be made through use of a 

23 HCPCS code, a modifier, or other means, as de24 termined appropriate by the Secretary. 

25 ‘‘(3) DNA MATCH REVIEW.— 
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1 ‘‘(A) IN GENERAL.—The Secretary shall re2 view at least three years of claims under part B 

3 for prostate cancer DNA Specimen Provenance 

4 Assay tests to identify whether the DNA of the 

5 prostate biopsy specimens match the DNA of the 

6 individuals diagnosed with prostate cancer. 

7 ‘‘(B) POSTING ON INTERNET WEBSITE.—Not 

8 later than July 1, 2022, the Secretary shall post 

9 on the Internet website of the Centers for Medi10 care & Medicaid Services the findings of the re11 view conducted under subparagraph (A).’’. 

12 (c) COST-SHARING.—Section 1833(a)(1) of the Social 

13 Security Act (42 U.S.C. 1395l(a)(1)) is amended— 

14 (1) by striking ‘‘and (BB)’’ and inserting 

15 ‘‘(BB)’’; and 

16 (2) by inserting before the semicolon at the end 

17 the following: ‘‘, and (CC) with respect to a prostate 

18 cancer DNA Specimen Provenance Assay test (DSPA 

19 test) (as defined in section 1861(jjj)), the amount 

20 paid shall be an amount equal to 80 percent of the 

21 lesser of the actual charge for the test or the amount 

22 specified under section 1834(w)’’. 
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1 SEC. 2415. STRENGTHENING RULES IN CASE OF COMPETI2 TION FOR DIABETIC TESTING STRIPS. 

3 (a) SPECIAL RULE IN CASE OF COMPETITION FOR DI4 ABETIC TESTING STRIPS.— 

5 (1) IN GENERAL.—Paragraph (10) of section 

6 1847(b) of the Social Security Act (42 U.S.C. 1395w– 

7 3(b)) is amended— 

8 (A) in subparagraph (A), by striking the 

9 second sentence and inserting the following new 

10 sentence: ‘‘With respect to bids to furnish such 

11 types of products on or after January 1, 2019, 

12 the volume for such types of products shall be de13 termined by the Secretary through the use of 

14 multiple sources of data (from mail order and 

15 non-mail order Medicare markets), including 

16 market-based data measuring sales of diabetic 

17 testing strip products that are not exclusively 

18 sold by a single retailer from such markets.’’; 

19 and 

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

21 subparagraphs: 

22 ‘‘(C) DEMONSTRATION OF ABILITY TO FUR23 NISH TYPES OF DIABETIC TESTING STRIP PROD24 UCTS.—With respect to bids to furnish diabetic 

25 testing strip products on or after January 1, 

26 2019, an entity shall attest to the Secretary that 
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1 the entity has the ability to obtain an inventory 

2 of the types and quantities of diabetic testing 

3 strip products that will allow the entity to fur4 nish such products in a manner consistent with 

5 its bid and— 

6 ‘‘(i) demonstrate to the Secretary, 

7 through letters of intent with manufactur8 ers, wholesalers, or other suppliers, or other 

9 evidence as the Secretary may specify, such 

10 ability; or 

11 ‘‘(ii) demonstrate to the Secretary that 

12 it made a good faith attempt to obtain such 

13 a letter of intent or such other evidence. 

14 ‘‘(D) USE OF UNLISTED TYPES IN CALCULA15 TION OF PERCENTAGE.—With respect to bids to 

16 furnish diabetic testing strip products on or after 

17 January 1, 2019, in determining under subpara18 graph (A) whether a bid submitted by an entity 

19 under such subparagraph covers 50 percent (or 

20 such higher percentage as the Secretary may 

21 specify) of all types of diabetic testing strip 

22 products, the Secretary may not attribute a per23 centage to types of diabetic testing strip products 

24 that the Secretary does not identify by brand, 

25 model, and market share volume. 
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1 ‘‘(E) ADHERENCE TO DEMONSTRATION.— 

2 ‘‘(i) IN GENERAL.—In the case of an 

3 entity that is furnishing diabetic testing 

4 strip products on or after January 1, 2019, 

5 under a contract entered into under the 

6 competition conducted pursuant to para7 graph (1), the Secretary shall establish a 

8 process to monitor, on an ongoing basis, the 

9 extent to which such entity continues to 

10 cover the product types included in the enti11 ty’s bid. 

12 ‘‘(ii) TERMINATION.—If the Secretary 

13 determines that an entity described in 

14 clause (i) fails to maintain in inventory, or 

15 otherwise maintain ready access to (through 

16 requirements, contracts, or otherwise) a type 

17 of product included in the entity’s bid, the 

18 Secretary may terminate such contract un19 less the Secretary finds that the failure of 

20 the entity to maintain inventory of, or 

21 ready access to, the product is the result of 

22 the discontinuation of the product by the 

23 product manufacturer, a market-wide short24 age of the product, or the introduction of a 
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1 newer model or version of the product in the 

2 market involved.’’. 

3 (b) CODIFYING AND EXPANDING ANTI-SWITCHING

4 RULE.—Section 1847(b) of the Social Security Act (42 

5 U.S.C. 1395w–3(b)), as amended by subsection (a)(1), is 

6 further amended— 

7 (1) by redesignating paragraph (11) as para8 graph (12); and 

9 (2) by inserting after paragraph (10) the fol10 lowing new paragraph: 

11 ‘‘(11) ADDITIONAL SPECIAL RULES IN CASE OF

12 COMPETITION FOR DIABETIC TESTING STRIPS.— 

13 ‘‘(A) IN GENERAL.—With respect to an enti14 ty that is furnishing diabetic testing strip prod15 ucts to individuals under a contract entered into 

16 under the competitive acquisition program estab17 lished under this section, the entity shall furnish 

18 to each individual a brand of such products that 

19 is compatible with the home blood glucose mon20 itor selected by the individual. 

21 ‘‘(B) PROHIBITION ON INFLUENCING AND

22 INCENTIVIZING.—An entity described in sub23 paragraph (A) may not attempt to influence or 

24 incentivize an individual to switch the brand of 
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1 glucose monitor or diabetic testing strip product 

2 selected by the individual, including by— 

3 ‘‘(i) persuading, pressuring, or advis4 ing the individual to switch; or 

5 ‘‘(ii) furnishing information about al6 ternative brands to the individual where the 

7 individual has not requested such informa8 tion. 

9 ‘‘(C) PROVISION OF INFORMATION.— 

10 ‘‘(i) STANDARDIZED INFORMATION.— 

11 Not later than January 1, 2019, the Sec12 retary shall develop and make available to 

13 entities described in subparagraph (A) 

14 standardized information that describes the 

15 rights of an individual with respect to such 

16 an entity. The information described in the 

17 preceding sentence shall include information 

18 regarding— 

19 ‘‘(I) the requirements established 

20 under subparagraphs (A) and (B); 

21 ‘‘(II) the right of the individual to 

22 purchase diabetic testing strip products 

23 from another mail order supplier of 

24 such products or a retail pharmacy if 

25 the entity is not able to furnish the 
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1 brand of such product that is compat2 ible with the home blood glucose mon3 itor selected by the individual; and 

4 ‘‘(III) the right of the individual 

5 to return diabetic testing strip prod6 ucts furnished to the individual by the 

7 entity. 

8 ‘‘(ii) REQUIREMENT.—With respect to 

9 diabetic testing strip products furnished on 

10 or after the date on which the Secretary de11 velops the standardized information under 

12 clause (i), an entity described in subpara13 graph (A) may not communicate directly to 

14 an individual until the entity has verbally 

15 provided the individual with such standard16 ized information. 

17 ‘‘(D) ORDER REFILLS.—With respect to di18 abetic testing strip products furnished on or 

19 after January 1, 2019, the Secretary shall re20 quire an entity furnishing diabetic testing strip 

21 products to an individual to contact and receive 

22 a request from the individual for such products 

23 not more than 14 days prior to dispensing a re24 fill of such products to the individual.’’. 
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1 (c) IMPLEMENTATION; NON-APPLICATION OF THE PA2 PERWORK REDUCTION ACT.— 

3 (1) IMPLEMENTATION.—Notwithstanding any 

4 other provision of law, the Secretary of Health and 

5 Human Services may implement the provisions of, 

6 and amendments made by, this section by program 

7 instruction or otherwise. 

8 (2) NON-APPLICATION OF THE PAPERWORK RE9 DUCTION ACT.—Chapter 35 of title 44, United States 

10 Code (commonly referred to as the ‘‘Paperwork Re11 duction Act of 1995’’), shall not apply to this section 

12 or the amendments made by this section. 

13 TITLE V—OTHER HEALTH 

14 EXTENDERS 

15 SEC. 2501. EXTENSION FOR COMMUNITY HEALTH CENTERS, 

16 THE NATIONAL HEALTH SERVICE CORPS, AND 

17 TEACHING HEALTH CENTERS THAT OPERATE 

18 GME PROGRAMS. 

19 (a) COMMUNITY HEALTH CENTERS FUNDING.—Sec20 tion 10503(b)(1) of the Patient Protection and Affordable 

21 Care Act (42 U.S.C. 254b–2(b)(1)), as amended by section 

22 3101 of Public Law 115–96, is amended by amending sub23 paragraph (F) to read as follows: 

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

25 2018 and 2019.’’. 
319 

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

3 U.S.C. 254b) is amended— 

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

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

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

7 and inserting ‘‘use disorder’’; 

8 (3) in subsection (c)— 

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

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

12 that follows through ‘‘The Secretary’’ and insert13 ing the following: 

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

15 (C) in paragraph (1), as amended, by redes16 ignating clauses (i) through (v) as subpara17 graphs (A) through (E) and moving the margin 

18 of each of such redesignated subparagraph 2 ems 

19 to the left; 

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

21 following: 

22 ‘‘(d) IMPROVING QUALITY OF CARE.— 

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

24 may award supplemental grant funds to health cen25 ters funded under this section to implement evidence- 
320 

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1 based models for increasing access to high-quality pri2 mary care services, which may include models related 

3 to— 

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

6 ‘‘(B) workforce configuration; 

7 ‘‘(C) reducing the cost of care; 

8 ‘‘(D) enhancing care coordination; 

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

10 technology-enabled collaborative learning and ca11 pacity building models; 

12 ‘‘(F) care integration, including integration 

13 of behavioral health, mental health, or substance 

14 use disorder services; and 

15 ‘‘(G) addressing emerging public health or 

16 substance use disorder issues to meet the health 

17 needs of the population served by the health cen18 ter. 

19 ‘‘(2) SUSTAINABILITY.—In making supplemental 

20 awards under this subsection, the Secretary may con21 sider whether the health center involved has submitted 

22 a plan for continuing the activities funded under this 

23 subsection after supplemental funding is expended. 

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

25 may give special consideration to applications for 
321 

•HR 1892 EAH 

1 supplemental funding under this subsection that seek 

2 to address significant barriers to access to care in 

3 areas with a greater shortage of health care providers 

4 and health services relative to the national average.’’; 

5 (5) in subsection (e)(1)— 

6 (A) in subparagraph (B)— 

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

8 ‘‘1 year’’; and 

9 (ii) by adding at the end the following: 

10 ‘‘The Secretary shall not make a grant 

11 under this paragraph unless the applicant 

12 provides assurances to the Secretary that 

13 within 120 days of receiving grant funding 

14 for the operation of the health center, the 

15 applicant will submit, for approval by the 

16 Secretary, an implementation plan to meet 

17 the requirements of subsection (k)(3). The 

18 Secretary may extend such 120-day period 

19 for achieving compliance upon a demonstra20 tion of good cause by the health center.’’; 

21 and 

22 (B) in subparagraph (C)— 

23 (i) in the subparagraph heading, by 

24 striking ‘‘AND PLANS’’; 
322 

•HR 1892 EAH 

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

2 in subparagraphs (B) and (C) of subsection 

3 (c)(1))’’; 

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

5 the purchase’’ and inserting the following: 

6 ‘‘including— 

7 ‘‘(i) the purchase’’; 

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

9 data and information systems’’ after ‘‘of 

10 equipment’’; 

11 (v) by striking the period at the end 

12 and inserting a semicolon; and 

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

14 ‘‘(ii) the provision of training and 

15 technical assistance; and 

16 ‘‘(iii) other activities that— 

17 ‘‘(I) reduce costs associated with 

18 the provision of health services; 

19 ‘‘(II) improve access to, and 

20 availability of, health services provided 

21 to individuals served by the centers; 

22 ‘‘(III) enhance the quality and co23 ordination of health services; or 

24 ‘‘(IV) improve the health status of 

25 communities.’’; 
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1 (6) in subsection (e)(5)(B)— 

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

3 striking ‘‘AND PLANS’’; and 

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

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

6 to a network or plan’’ and inserting ‘‘to a health 

7 center or to a network’’; 

8 (7) in subsection (e), by adding at the end the 

9 following: 

10 ‘‘(6) NEW ACCESS POINTS AND EXPANDED SERV11 ICES.— 

12 ‘‘(A) APPROVAL OF NEW ACCESS POINTS.— 

13 ‘‘(i) IN GENERAL.—The Secretary may 

14 approve applications for grants under sub15 paragraph (A) or (B) of paragraph (1) to 

16 establish new delivery sites. 

17 ‘‘(ii) SPECIAL CONSIDERATION.—In 

18 carrying out clause (i), the Secretary may 

19 give special consideration to applicants that 

20 have demonstrated the new delivery site will 

21 be located within a sparsely populated area, 

22 or an area which has a level of unmet need 

23 that is higher relative to other applicants. 

24 ‘‘(iii) CONSIDERATION OF APPLICA25 TIONS.—In carrying out clause (i), the Sec-
324 

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1 retary shall approve applications for grants 

2 in such a manner that the ratio of the 

3 medically underserved populations in rural 

4 areas which may be expected to use the serv5 ices provided by the applicants involved to 

6 the medically underserved populations in 

7 urban areas which may be expected to use 

8 the services provided by the applicants is 

9 not less than two to three or greater than 

10 three to two. 

11 ‘‘(iv) SERVICE AREA OVERLAP.—If in 

12 carrying out clause (i) the applicant pro13 poses to serve an area that is currently 

14 served by another health center funded 

15 under this section, the Secretary may con16 sider whether the award of funding to an 

17 additional health center in the area can be 

18 justified based on the unmet need for addi19 tional services within the catchment area. 

20 ‘‘(B) APPROVAL OF EXPANDED SERVICE AP21 PLICATIONS.— 

22 ‘‘(i) IN GENERAL.—The Secretary may 

23 approve applications for grants under sub24 paragraph (A) or (B) of paragraph (1) to 

25 expand the capacity of the applicant to pro-
325 

•HR 1892 EAH 

1 vide required primary health services de2 scribed in subsection (b)(1) or additional 

3 health services described in subsection 

4 (b)(2). 

5 ‘‘(ii) PRIORITY EXPANSION

6 PROJECTS.—In carrying out clause (i), the 

7 Secretary may give special consideration to 

8 expanded service applications that seek to 

9 address emerging public health or behav10 ioral health, mental health, or substance 

11 abuse issues through increasing the avail12 ability of additional health services de13 scribed in subsection (b)(2) in an area in 

14 which there are significant barriers to ac15 cessing care. 

16 ‘‘(iii) CONSIDERATION OF APPLICA17 TIONS.—In carrying out clause (i), the Sec18 retary shall approve applications for grants 

19 in such a manner that the ratio of the 

20 medically underserved populations in rural 

21 areas which may be expected to use the serv22 ices provided by the applicants involved to 

23 the medically underserved populations in 

24 urban areas which may be expected to use 

25 the services provided by such applicants is 
326 

•HR 1892 EAH 

1 not less than two to three or greater than 

2 three to two.’’; 

3 (8) in subsection (h)— 

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

5 children and youth at risk of homelessness’’ and 

6 inserting ‘‘, children and youth at risk of home7 lessness, homeless veterans, and veterans at risk 

8 of homelessness’’; and 

9 (B) in paragraph (5)— 

10 (i) by striking subparagraph (B); 

11 (ii) by redesignating subparagraph (C) 

12 as subparagraph (B); and 

13 (iii) in subparagraph (B) (as so redes14 ignated)— 

15 (I) in the subparagraph heading, 

16 by striking ‘‘ABUSE’’ and inserting 

17 ‘‘USE DISORDER’’; and 

18 (II) by striking ‘‘abuse’’ and in19 serting ‘‘use disorder’’; 

20 (9) in subsection (k)— 

21 (A) in paragraph (2)— 

22 (i) in the paragraph heading, by in23 serting ‘‘UNMET’’ before ‘‘NEED’’; 
327 

•HR 1892 EAH 

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

3 (e)(6)’’ after ‘‘subsection (e)(1)’’; 

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

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

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

7 ‘‘and’’ at the end; 

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

9 the period at the end and inserting ‘‘; and’’; 

10 and 

11 (vi) by adding after subparagraph (C) 

12 the following: 

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

14 grant pursuant to subsection (e)(6), a dem15 onstration that the applicant has consulted with 

16 appropriate State and local government agen17 cies, and health care providers regarding the 

18 need for the health services to be provided at the 

19 proposed delivery site.’’; 

20 (B) in paragraph (3)— 

21 (i) in the matter preceding subpara22 graph (A), by inserting ‘‘or subsection 

23 (e)(6)’’ after ‘‘subsection (e)(1)(B)’’; 

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

25 ‘‘in the catchment area of the center’’ and 
328 

•HR 1892 EAH 

1 inserting ‘‘, including other health care pro2 viders that provide care within the 

3 catchment area, local hospitals, and spe4 cialty providers in the catchment area of 

5 the center, to provide access to services not 

6 available through the health center and to 

7 reduce the non-urgent use of hospital emer8 gency departments’’; 

9 (iii) in subparagraph (H)(ii), by in10 serting ‘‘who shall be directly employed by 

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

12 a director for the center’’; 

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

14 ‘‘and’’ at the end; 

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

16 the period and inserting ‘‘; and’’; and 

17 (vi) by inserting after subparagraph 

18 (M), the following: 

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

20 procedures in place to ensure the appropriate use 

21 of Federal funds in compliance with applicable 

22 Federal statutes, regulations, and the terms and 

23 conditions of the Federal award.’’; and 

24 (C) by striking paragraph (4); 
329 

•HR 1892 EAH 

1 (10) in subsection (l), by adding at the end the 

2 following: ‘‘Funds expended to carry out activities 

3 under this subsection and operational support activi4 ties under subsection (m) shall not exceed 3 percent 

5 of the amount appropriated for this section for the fis6 cal year involved.’’; 

7 (11) in subsection (q)(4), by adding at the end 

8 the following: ‘‘A waiver provided by the Secretary 

9 under this paragraph may not remain in effect for 

10 more than 1 year and may not be extended after such 

11 period. An entity may not receive more than one 

12 waiver under this paragraph in consecutive years.’’; 

13 (12) in subsection (r)(3)— 

14 (A) by striking ‘‘appropriate committees of 

15 Congress a report concerning the distribution of 

16 funds under this section’’ and inserting the fol17 lowing: ‘‘Committee on Health, Education, 

18 Labor, and Pensions of the Senate, and the Com19 mittee on Energy and Commerce of the House of 

20 Representatives, a report including, at a min21 imum— 

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

23 out this section’’; 
330 

•HR 1892 EAH 

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

2 shall include an assessment’’ and inserting the 

3 following: ‘‘populations; 

4 ‘‘(B) an assessment’’; 

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

6 substantial changes in the distribution of funds.’’ 

7 and inserting a semicolon; and 

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

9 ‘‘(C) the distribution of awards and funding 

10 for new or expanded services in each of rural 

11 areas and urban areas; 

12 ‘‘(D) the distribution of awards and fund13 ing for establishing new access points, and the 

14 number of new access points created; 

15 ‘‘(E) the amount of unexpended funding for 

16 loan guarantees and loan guarantee authority 

17 under title XVI; 

18 ‘‘(F) the rationale for any substantial 

19 changes in the distribution of funds; 

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

21 and access points; 

22 ‘‘(H) the number and reason for any grants 

23 awarded pursuant to subsection (e)(1)(B); and 

24 ‘‘(I) the number and reason for any waivers 

25 provided pursuant to subsection (q)(4).’’; 
331 

•HR 1892 EAH 

1 (13) in subsection (r), by adding at the end the 

2 following new paragraph: 

3 ‘‘(5) FUNDING FOR PARTICIPATION OF HEALTH

4 CENTERS IN ALL OF US RESEARCH PROGRAM.—In ad5 dition to any amounts made available pursuant to 

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

7 Act, or section 10503 of the Patient Protection and 

8 Affordable Care Act, there is authorized to be appro9 priated, and there is appropriated, out of any monies 

10 in the Treasury not otherwise appropriated, to the 

11 Secretary $25,000,000 for fiscal year 2018 to support 

12 the participation of health centers in the All of Us 

13 Research Program under the Precision Medicine Ini14 tiative under section 498E of this Act.’’; and 

15 (14) by striking subsection (s). 

16 (c) NATIONAL HEALTH SERVICE CORPS.—Section 

17 10503(b)(2) of the Patient Protection and Affordable Care 

18 Act (42 U.S.C. 254b–2(b)(2)), as amended by section 3101 

19 of Public Law 115–96, is amended by amending subpara20 graph (F) to read as follows: 

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

22 2018 and 2019.’’. 

23 (d) TEACHING HEALTH CENTERS THAT OPERATE

24 GRADUATE MEDICAL EDUCATION PROGRAMS.— 
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•HR 1892 EAH 

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

2 of the Public Health Service Act (42 U.S.C. 256h) is 

3 amended to read as follows: 

4 ‘‘(a) PAYMENTS.— 

5 ‘‘(1) IN GENERAL.—Subject to subsection (h)(2), 

6 the Secretary shall make payments under this section 

7 for direct expenses and indirect expenses to qualified 

8 teaching health centers that are listed as sponsoring 

9 institutions by the relevant accrediting body for, as 

10 appropriate— 

11 ‘‘(A) maintenance of filled positions at ex12 isting approved graduate medical residency 

13 training programs; 

14 ‘‘(B) expansion of existing approved grad15 uate medical residency training programs; and 

16 ‘‘(C) establishment of new approved grad17 uate medical residency training programs. 

18 ‘‘(2) PER RESIDENT AMOUNT.—In making pay19 ments under paragraph (1), the Secretary shall con20 sider the cost of training residents at teaching health 

21 centers and the implications of the per resident 

22 amount on approved graduate medical residency 

23 training programs at teaching health centers. 
333 

•HR 1892 EAH 

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

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

3 qualified teaching health centers that— 

4 ‘‘(A) serve a health professional shortage 

5 area with a designation in effect under section 

6 332 or a medically underserved community (as 

7 defined in section 799B); or 

8 ‘‘(B) are located in a rural area (as defined 

9 in section 1886(d)(2)(D) of the Social Security 

10 Act).’’. 

11 (2) FUNDING.—Paragraph (1) of section 

12 340H(g) of the Public Health Service Act (42 U.S.C. 

13 256h(g)), as amended by section 3101 of Public Law 

14 115–96, is amended by striking ‘‘and $30,000,000 for 

15 the period of the first and second quarters of fiscal 

16 year 2018’’ and inserting ‘‘and $126,500,000 for each 

17 of fiscal years 2018 and 2019’’. 

18 (3) ANNUAL REPORTING.—Subsection (h)(1) of 

19 section 340H of the Public Health Service Act (42 

20 U.S.C. 256h) is amended— 

21 (A) by redesignating subparagraph (D) as 

22 subparagraph (H); and 

23 (B) by inserting after subparagraph (C) the 

24 following: 
334 

•HR 1892 EAH 

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

2 residents described in paragraph (4). 

3 ‘‘(E) The number of visits by patients treat4 ed by residents described in paragraph (4). 

5 ‘‘(F) Of the number of residents described in 

6 paragraph (4) who completed their residency 

7 training at the end of such residency academic 

8 year, the number and percentage of such resi9 dents entering primary care practice (meaning 

10 any of the areas of practice listed in the defini11 tion of a primary care residency program in sec12 tion 749A). 

13 ‘‘(G) Of the number of residents described in 

14 paragraph (4) who completed their residency 

15 training at the end of such residency academic 

16 year, the number and percentage of such resi17 dents who entered practice at a health care facil18 ity— 

19 ‘‘(i) primarily serving a health profes20 sional shortage area with a designation in 

21 effect under section 332 or a medically un22 derserved community (as defined in section 

23 799B); or 
335 

•HR 1892 EAH 

1 ‘‘(ii) located in a rural area (as de2 fined in section 1886(d)(2)(D) of the Social 

3 Security Act).’’. 

4 (4) REPORT ON TRAINING COSTS.—Not later 

5 than March 31, 2019, the Secretary of Health and 

6 Human Services shall submit to the Congress a report 

7 on the direct graduate expenses of approved graduate 

8 medical residency training programs, and the indi9 rect expenses associated with the additional costs of 

10 teaching residents, of qualified teaching health centers 

11 (as such terms are used or defined in section 340H 

12 of the Public Health Service Act (42 U.S.C. 256h)). 

13 (5) DEFINITION.—Subsection (j) of section 340H 

14 of the Public Health Service Act (42 U.S.C. 256h) is 

15 amended— 

16 (A) by redesignating paragraphs (2) and 

17 (3) as paragraphs (3) and (4), respectively; and 

18 (B) by inserting after paragraph (1) the fol19 lowing: 

20 ‘‘(2) NEW APPROVED GRADUATE MEDICAL RESI21 DENCY TRAINING PROGRAM.—The term ‘new approved 

22 graduate medical residency training program’ means 

23 an approved graduate medical residency training 

24 program for which the sponsoring qualified teaching 

25 health center has not received a payment under this 
336 

•HR 1892 EAH 

1 section for a previous fiscal year (other than pursuant 

2 to subsection (a)(1)(C)).’’. 

3 (6) TECHNICAL CORRECTION.—Subsection (f) of 

4 section 340H (42 U.S.C. 256h) is amended by strik5 ing ‘‘hospital’’ each place it appears and inserting 

6 ‘‘teaching health center’’. 

7 (7) PAYMENTS FOR PREVIOUS FISCAL YEARS.— 

8 The provisions of section 340H of the Public Health 

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

10 before the date of enactment of Public Law 115–96, 

11 shall continue to apply with respect to payments 

12 under such section for fiscal years before fiscal year 

13 2018. 

14 (e) APPLICATION.—Amounts appropriated pursuant to 

15 this section for fiscal year 2018 or 2019 are subject to the 

16 requirements contained in Public Law 115–31 for funds for 

17 programs authorized under sections 330 through 340 of the 

18 Public Health Service Act (42 U.S.C. 254b–256). 

19 (f) CONFORMING AMENDMENT.—Paragraph (4) of sec20 tion 3014(h) of title 18, United States Code, as amended 

21 by section 3101 of Public Law 115–96, is amended by strik22 ing ‘‘and section 3101(d) of the CHIP and Public Health 

23 Funding Extension Act’’ and inserting ‘‘and section 

24 2501(e) of the SUSTAIN Care Act of 2018’’. 
337 

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1 SEC. 2502. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 

2 (a) SPECIAL DIABETES PROGRAM FOR TYPE I DIABE3 TES.—Subparagraph (D) of section 330B(b)(2) of the Pub4 lic Health Service Act (42 U.S.C. 254c–2(b)(2)), as amend5 ed by section 3102 of Public Law 115–96, is amended to 

6 read as follows: 

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

8 2018 and 2019, to remain available until ex9 pended.’’. 

10 (b) SPECIAL DIABETES PROGRAM FOR INDIANS.—Sub11 paragraph (D) of section 330C(c)(2) of the Public Health 

12 Service Act (42 U.S.C. 254c–3(c)(2)), as amended by sec13 tion 3102 of Public Law 115–96, is amended to read as 

14 follows: 

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

16 2018 and 2019, to remain available until ex17 pended.’’. 

18 SEC. 2503. EXTENSION FOR FAMILY-TO-FAMILY HEALTH IN19 FORMATION CENTERS. 

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

21 701(c)) is amended— 

22 (1) in paragraph (1)(A)— 

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

24 end; 

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

26 the end and inserting ‘‘; and’’; and 
338 

•HR 1892 EAH 

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

2 clause: 

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

4 and 2019.’’; 

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

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

7 years 2018 and 2019, such centers shall also be devel8 oped in all territories and at least one such center 

9 shall be developed for Indian Tribes’’; and 

10 (3) by amending paragraph (5) to read as fol11 lows: 

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

13 ‘‘(A) the term ‘Indian Tribe’ has the meaning 

14 given to the term ‘Indian tribe’ in section 4 of the In15 dian Health Care Improvement Act (25 U.S.C. 1603); 

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

17 and the District of Columbia; and 

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

19 Guam, American Samoa, the United States Virgin Is20 lands, and the Northern Mariana Islands.’’. 

21 SEC. 2504. EXTENSION FOR SEXUAL RISK AVOIDANCE EDU22 CATION. 

23 (a) IN GENERAL.—Section 510 of the Social Security 

24 Act (42 U.S.C. 710) is amended to read as follows: 
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•HR 1892 EAH 

1 ‘‘SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION. 

2 ‘‘(a) IN GENERAL.— 

3 ‘‘(1) ALLOTMENTS TO STATES.—For the purpose 

4 described in subsection (b), the Secretary shall, for 

5 each of fiscal years 2018 and 2019, allot to each State 

6 which has transmitted an application for the fiscal 

7 year under section 505(a) an amount equal to the 

8 product of— 

9 ‘‘(A) the amount appropriated pursuant to 

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

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

12 fiscal year; and 

13 ‘‘(B) the proportion that the number of low14 income children in the State bears to the total of 

15 such numbers of children for all the States. 

16 ‘‘(2) OTHER ALLOTMENTS.— 

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

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

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

20 State which has not transmitted an application 

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

22 one or more entities in the State the amount that 

23 would have been allotted to the State under 

24 paragraph (1) if the State had submitted such 

25 an application. 
340 

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

2 the recipients of allotments under subparagraph 

3 (A) by means of a competitive grant process 

4 under which— 

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

6 deadline for the State involved to submit an 

7 application for the fiscal year under section 

8 505(a), the Secretary publishes a notice so9 liciting grant applications; and 

10 ‘‘(ii) not later than 120 days after such 

11 deadline, all such applications must be sub12 mitted. 

13 ‘‘(b) PURPOSE.— 

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

15 paragraph (5) and information collection and report16 ing under paragraph (6), the purpose of an allotment 

17 under subsection (a) to a State (or to another entity 

18 in the State pursuant to subsection (a)(2)) is to en19 able the State or other entity to implement education 

20 exclusively on sexual risk avoidance (meaning volun21 tarily refraining from sexual activity). 

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

23 sexual risk avoidance pursuant to an allotment under 

24 this section shall— 
341 

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1 ‘‘(A) ensure that the unambiguous and pri2 mary emphasis and context for each topic de3 scribed in paragraph (3) is a message to youth 

4 that normalizes the optimal health behavior of 

5 avoiding nonmarital sexual activity; 

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

7 ‘‘(C) be age-appropriate; 

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

9 developmental theories for the age group receiv10 ing the education; and 

11 ‘‘(E) be culturally appropriate, recognizing 

12 the experiences of youth from diverse commu13 nities, backgrounds, and experiences. 

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

16 shall address each of the following topics: 

17 ‘‘(A) The holistic individual and societal 

18 benefits associated with personal responsibility, 

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

21 ‘‘(B) The advantage of refraining from non22 marital sexual activity in order to improve the 

23 future prospects and physical and emotional 

24 health of youth. 
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1 ‘‘(C) The increased likelihood of avoiding 

2 poverty when youth attain self-sufficiency and 

3 emotional maturity before engaging in sexual ac4 tivity. 

5 ‘‘(D) The foundational components of 

6 healthy relationships and their impact on the 

7 formation of healthy marriages and safe and sta8 ble families. 

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

10 as drug and alcohol usage, increase the risk for 

11 teen sex. 

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

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

15 remains a youth risk behavior. 

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

17 avoidance pursuant to an allotment under this section 

18 shall ensure that— 

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

21 ensures that students understand that contracep22 tion offers physical risk reduction, but not risk 

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

4 ‘‘(5) RESEARCH.— 

5 ‘‘(A) IN GENERAL.—A State or other entity 

6 receiving an allotment pursuant to subsection (a) 

7 may use up to 20 percent of such allotment to 

8 build the evidence base for sexual risk avoidance 

9 education by conducting or supporting research. 

10 ‘‘(B) REQUIREMENTS.—Any research con11 ducted or supported pursuant to subparagraph 

12 (A) shall be— 

13 ‘‘(i) rigorous; 

14 ‘‘(ii) evidence-based; and 

15 ‘‘(iii) designed and conducted by inde16 pendent researchers who have experience in 

17 conducting and publishing research in peer18 reviewed outlets. 

19 ‘‘(6) INFORMATION COLLECTION AND REPORT20 ING.—A State or other entity receiving an allotment 

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

22 Secretary— 

23 ‘‘(A) collect information on the programs 

24 and activities funded through the allotment; and 
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1 ‘‘(B) submit reports to the Secretary on the 

2 data from such programs and activities. 

3 ‘‘(c) NATIONAL EVALUATION.— 

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

5 ‘‘(A) in consultation with appropriate State 

6 and local agencies, conduct one or more rigorous 

7 evaluations of the education funded through this 

8 section and associated data; and 

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

10 results of such evaluations, together with a sum11 mary of the information collected pursuant to 

12 subsection (b)(6). 

13 ‘‘(2) CONSULTATION.—In conducting the evalua14 tions required by paragraph (1), including the estab15 lishment of rigorous evaluation methodologies, the 

16 Secretary shall consult with relevant stakeholders and 

17 evaluation experts. 

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

19 ‘‘(1) Sections 503, 507, and 508 apply to allot20 ments under subsection (a) to the same extent and in 

21 the same manner as such sections apply to allotments 

22 under section 502(c). 

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

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

25 Secretary to be appropriate. 
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1 ‘‘(e) DEFINITIONS.—In this section: 

2 ‘‘(1) The term ‘age-appropriate’ means suitable 

3 (in terms of topics, messages, and teaching methods) 

4 to the developmental and social maturity of the par5 ticular age or age group of children or adolescents, 

6 based on developing cognitive, emotional, and behav7 ioral capacity typical for the age or age group. 

8 ‘‘(2) The term ‘medically accurate and complete’ 

9 means verified or supported by the weight of research 

10 conducted in compliance with accepted scientific 

11 methods and— 

12 ‘‘(A) published in peer-reviewed journals, 

13 where applicable; or 

14 ‘‘(B) comprising information that leading 

15 professional organizations and agencies with rel16 evant expertise in the field recognize as accurate, 

17 objective, and complete. 

18 ‘‘(3) The term ‘rigorous’, with respect to research 

19 or evaluation, means using— 

20 ‘‘(A) established scientific methods for meas21 uring the impact of an intervention or program 

22 model in changing behavior (specifically sexual 

23 activity or other sexual risk behaviors), or reduc24 ing pregnancy, among youth; or 
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1 ‘‘(B) other evidence-based methodologies es2 tablished by the Secretary for purposes of this 

3 section. 

4 ‘‘(4) The term ‘youth’ refers to one or more indi5 viduals who have attained age 10 but not age 20. 

6 ‘‘(f) FUNDING.— 

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

8 there is appropriated, out of any money in the Treas9 ury not otherwise appropriated, $75,000,000 for each 

10 of fiscal years 2018 and 2019. 

11 ‘‘(2) RESERVATION.—The Secretary shall reserve, 

12 for each of fiscal years 2018 and 2019, not more than 

13 20 percent of the amount appropriated pursuant to 

14 paragraph (1) for administering the program under 

15 this section, including the conducting of national 

16 evaluations and the provision of technical assistance 

17 to the recipients of allotments.’’. 

18 (b) EFFECTIVE DATE.—The amendment made by this 

19 section takes effect on October 1, 2017. 

20 SEC. 2505. EXTENSION FOR PERSONAL RESPONSIBILITY 

21 EDUCATION. 

22 (a) IN GENERAL.—Section 513 of the Social Security 

23 Act (42 U.S.C. 713) is amended— 

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

25 and inserting ‘‘2019’’; and 
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1 (2) in subsection (a)(4)— 

2 (A) in subparagraph (A), by striking 

3 ‘‘2017’’ each place it appears and inserting 

4 ‘‘2019’’; and 

5 (B) in subparagraph (B)— 

6 (i) in the subparagraph heading, by 

7 striking ‘‘3-YEAR GRANTS’’ and inserting 

8 ‘‘COMPETITIVE PREP GRANTS’’; and 

9 (ii) in clause (i), by striking ‘‘solicit 

10 applications to award 3-year grants in each 

11 of fiscal years 2012 through 2017’’ and in12 serting ‘‘continue through fiscal year 2019 

13 grants awarded for any of fiscal years 2015 

14 through 2017’’; 

15 (3) in subsection (c)(1), by inserting after ‘‘youth 

16 with HIV/AIDS,’’ the following: ‘‘victims of human 

17 trafficking,’’; and 

18 (4) in subsection (f), by striking ‘‘2017’’ and in19 serting ‘‘2019’’. 

20 (b) EFFECTIVE DATE.—The amendments made by this 

21 section take effect on October 1, 2017. 
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1 TITLE VI—CHILD AND FAMILY 

2 SERVICES AND SUPPORT 

3 Subtitle A—Family First Prevention 

4 Services Act 

5 SEC. 2601. SHORT TITLE. 

6 This subtitle may be cited as the ‘‘Family First Pre7 vention Services Act’’. 

8 CHAPTER 1—INVESTING IN PREVENTION 

9 AND FAMILY SERVICES 

10 SEC. 2611. PURPOSE. 

11 The purpose of this chapter is to enable States to use 

12 Federal funds available under parts B and E of title IV 

13 of the Social Security Act to provide enhanced support to 

14 children and families and prevent foster care placements 

15 through the provision of mental health and substance abuse 

16 prevention and treatment services, in-home parent skill17 based programs, and kinship navigator services. 

18 Subchapter A—Prevention Activities Under 

19 Title IV–E 

20 SEC. 2621. FOSTER CARE PREVENTION SERVICES AND PRO21 GRAMS. 

22 (a) STATE OPTION.—Section 471 of the Social Secu23 rity Act (42 U.S.C. 671) is amended— 

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

25 all that follows through the semicolon and inserting ‘‘, 
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1 adoption assistance in accordance with section 473, 

2 and, at the option of the State, services or programs 

3 specified in subsection (e)(1) of this section for chil4 dren who are candidates for foster care or who are 

5 pregnant or parenting foster youth and the parents or 

6 kin caregivers of the children, in accordance with the 

7 requirements of that subsection;’’; and 

8 (2) by adding at the end the following: 

9 ‘‘(e) PREVENTION AND FAMILY SERVICES AND PRO10 GRAMS.— 

11 ‘‘(1) IN GENERAL.—Subject to the succeeding 

12 provisions of this subsection, the Secretary may make 

13 a payment to a State for providing the following serv14 ices or programs for a child described in paragraph 

15 (2) and the parents or kin caregivers of the child 

16 when the need of the child, such a parent, or such a 

17 caregiver for the services or programs are directly re18 lated to the safety, permanence, or well-being of the 

19 child or to preventing the child from entering foster 

20 care: 

21 ‘‘(A) MENTAL HEALTH AND SUBSTANCE

22 ABUSE PREVENTION AND TREATMENT SERV23 ICES.—Mental health and substance abuse pre24 vention and treatment services provided by a 

25 qualified clinician for not more than a 12-month 
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1 period that begins on any date described in 

2 paragraph (3) with respect to the child. 

3 ‘‘(B) IN-HOME PARENT SKILL-BASED PRO4 GRAMS.—In-home parent skill-based programs 

5 for not more than a 12-month period that begins 

6 on any date described in paragraph (3) with re7 spect to the child and that include parenting 

8 skills training, parent education, and individual 

9 and family counseling. 

10 ‘‘(2) CHILD DESCRIBED.—For purposes of para11 graph (1), a child described in this paragraph is the 

12 following: 

13 ‘‘(A) A child who is a candidate for foster 

14 care (as defined in section 475(13)) but can re15 main safely at home or in a kinship placement 

16 with receipt of services or programs specified in 

17 paragraph (1). 

18 ‘‘(B) A child in foster care who is a preg19 nant or parenting foster youth. 

20 ‘‘(3) DATE DESCRIBED.—For purposes of para21 graph (1), the dates described in this paragraph are 

22 the following: 

23 ‘‘(A) The date on which a child is identified 

24 in a prevention plan maintained under para-
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1 graph (4) as a child who is a candidate for foster 

2 care (as defined in section 475(13)). 

3 ‘‘(B) The date on which a child is identified 

4 in a prevention plan maintained under para5 graph (4) as a pregnant or parenting foster 

6 youth in need of services or programs specified 

7 in paragraph (1). 

8 ‘‘(4) REQUIREMENTS RELATED TO PROVIDING

9 SERVICES AND PROGRAMS.—Services and programs 

10 specified in paragraph (1) may be provided under 

11 this subsection only if specified in advance in the 

12 child’s prevention plan described in subparagraph (A) 

13 and the requirements in subparagraphs (B) through 

14 (E) are met: 

15 ‘‘(A) PREVENTION PLAN.—The State main16 tains a written prevention plan for the child that 

17 meets the following requirements (as applicable): 

18 ‘‘(i) CANDIDATES.—In the case of a 

19 child who is a candidate for foster care de20 scribed in paragraph (2)(A), the prevention 

21 plan shall— 

22 ‘‘(I) identify the foster care pre23 vention strategy for the child so that 

24 the child may remain safely at home, 

25 live temporarily with a kin caregiver 
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1 until reunification can be safely 

2 achieved, or live permanently with a 

3 kin caregiver; 

4 ‘‘(II) list the services or programs 

5 to be provided to or on behalf of the 

6 child to ensure the success of that pre7 vention strategy; and 

8 ‘‘(III) comply with such other re9 quirements as the Secretary shall es10 tablish. 

11 ‘‘(ii) PREGNANT OR PARENTING FOS12 TER YOUTH.—In the case of a child who is 

13 a pregnant or parenting foster youth de14 scribed in paragraph (2)(B), the prevention 

15 plan shall— 

16 ‘‘(I) be included in the child’s case 

17 plan required under section 475(1); 

18 ‘‘(II) list the services or programs 

19 to be provided to or on behalf of the 

20 youth to ensure that the youth is pre21 pared (in the case of a pregnant foster 

22 youth) or able (in the case of a par23 enting foster youth) to be a parent; 
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1 ‘‘(III) describe the foster care pre2 vention strategy for any child born to 

3 the youth; and 

4 ‘‘(IV) comply with such other re5 quirements as the Secretary shall es6 tablish. 

7 ‘‘(B) TRAUMA-INFORMED.—The services or 

8 programs to be provided to or on behalf of a 

9 child are provided under an organizational 

10 structure and treatment framework that involves 

11 understanding, recognizing, and responding to 

12 the effects of all types of trauma and in accord13 ance with recognized principles of a trauma-in14 formed approach and trauma-specific interven15 tions to address trauma’s consequences and fa16 cilitate healing. 

17 ‘‘(C) ONLY SERVICES AND PROGRAMS PRO18 VIDED IN ACCORDANCE WITH PROMISING, SUP19 PORTED, OR WELL-SUPPORTED PRACTICES PER20 MITTED.— 

21 ‘‘(i) IN GENERAL.—Only State expend22 itures for services or programs specified in 

23 subparagraph (A) or (B) of paragraph (1) 

24 that are provided in accordance with prac25 tices that meet the requirements specified in 
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1 clause (ii) of this subparagraph and that 

2 meet the requirements specified in clause 

3 (iii), (iv), or (v), respectively, for being a 

4 promising, supported, or well-supported 

5 practice, shall be eligible for a Federal 

6 matching payment under section 

7 474(a)(6)(A). 

8 ‘‘(ii) GENERAL PRACTICE REQUIRE9 MENTS.—The general practice requirements 

10 specified in this clause are the following: 

11 ‘‘(I) The practice has a book, 

12 manual, or other available writings 

13 that specify the components of the 

14 practice protocol and describe how to 

15 administer the practice. 

16 ‘‘(II) There is no empirical basis 

17 suggesting that, compared to its likely 

18 benefits, the practice constitutes a risk 

19 of harm to those receiving it. 

20 ‘‘(III) If multiple outcome studies 

21 have been conducted, the overall weight 

22 of evidence supports the benefits of the 

23 practice. 

24 ‘‘(IV) Outcome measures are reli25 able and valid, and are administrated 
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1 consistently and accurately across all 

2 those receiving the practice. 

3 ‘‘(V) There is no case data sug4 gesting a risk of harm that was prob5 ably caused by the treatment and that 

6 was severe or frequent. 

7 ‘‘(iii) PROMISING PRACTICE.—A prac8 tice shall be considered to be a ‘promising 

9 practice’ if the practice is superior to an 

10 appropriate comparison practice using con11 ventional standards of statistical signifi12 cance (in terms of demonstrated meaningful 

13 improvements in validated measures of im14 portant child and parent outcomes, such as 

15 mental health, substance abuse, and child 

16 safety and well-being), as established by the 

17 results or outcomes of at least one study 

18 that— 

19 ‘‘(I) was rated by an independent 

20 systematic review for the quality of the 

21 study design and execution and deter22 mined to be well-designed and well-exe23 cuted; and 
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1 ‘‘(II) utilized some form of control 

2 (such as an untreated group, a placebo 

3 group, or a wait list study). 

4 ‘‘(iv) SUPPORTED PRACTICE.—A prac5 tice shall be considered to be a ‘supported 

6 practice’ if— 

7 ‘‘(I) the practice is superior to an 

8 appropriate comparison practice using 

9 conventional standards of statistical 

10 significance (in terms of demonstrated 

11 meaningful improvements in validated 

12 measures of important child and par13 ent outcomes, such as mental health, 

14 substance abuse, and child safety and 

15 well-being), as established by the re16 sults or outcomes of at least one study 

17 that— 

18 ‘‘(aa) was rated by an inde19 pendent systematic review for the 

20 quality of the study design and 

21 execution and determined to be 

22 well-designed and well-executed; 

23 ‘‘(bb) was a rigorous ran24 dom-controlled trial (or, if not 

25 available, a study using a rig-
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1 orous quasi-experimental research 

2 design); and 

3 ‘‘(cc) was carried out in a 

4 usual care or practice setting; and 

5 ‘‘(II) the study described in sub6 clause (I) established that the practice 

7 has a sustained effect (when compared 

8 to a control group) for at least 6 

9 months beyond the end of the treat10 ment. 

11 ‘‘(v) WELL-SUPPORTED PRACTICE.—A 

12 practice shall be considered to be a ‘well13 supported practice’ if— 

14 ‘‘(I) the practice is superior to an 

15 appropriate comparison practice using 

16 conventional standards of statistical 

17 significance (in terms of demonstrated 

18 meaningful improvements in validated 

19 measures of important child and par20 ent outcomes, such as mental health, 

21 substance abuse, and child safety and 

22 well-being), as established by the re23 sults or outcomes of at least two studies 

24 that— 
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1 ‘‘(aa) were rated by an inde2 pendent systematic review for the 

3 quality of the study design and 

4 execution and determined to be 

5 well-designed and well-executed; 

6 ‘‘(bb) were rigorous random7 controlled trials (or, if not avail8 able, studies using a rigorous 

9 quasi-experimental research de10 sign); and 

11 ‘‘(cc) were carried out in a 

12 usual care or practice setting; and 

13 ‘‘(II) at least one of the studies de14 scribed in subclause (I) established that 

15 the practice has a sustained effect 

16 (when compared to a control group) for 

17 at least 1 year beyond the end of treat18 ment. 

19 ‘‘(D) GUIDANCE ON PRACTICES CRITERIA

20 AND PRE-APPROVED SERVICES AND PROGRAMS.— 

21 ‘‘(i) IN GENERAL.—Not later than Oc22 tober 1, 2018, the Secretary shall issue guid23 ance to States regarding the practices cri24 teria required for services or programs to 

25 satisfy the requirements of subparagraph 
359 

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1 (C). The guidance shall include a pre-ap2 proved list of services and programs that 

3 satisfy the requirements. 

4 ‘‘(ii) UPDATES.—The Secretary shall 

5 issue updates to the guidance required by 

6 clause (i) as often as the Secretary deter7 mines necessary. 

8 ‘‘(E) OUTCOME ASSESSMENT AND REPORT9 ING.—The State shall collect and report to the 

10 Secretary the following information with respect 

11 to each child for whom, or on whose behalf men12 tal health and substance abuse prevention and 

13 treatment services or in-home parent skill-based 

14 programs are provided during a 12-month pe15 riod beginning on the date the child is deter16 mined by the State to be a child described in 

17 paragraph (2): 

18 ‘‘(i) The specific services or programs 

19 provided and the total expenditures for each 

20 of the services or programs. 

21 ‘‘(ii) The duration of the services or 

22 programs provided. 

23 ‘‘(iii) In the case of a child described 

24 in paragraph (2)(A), the child’s placement 

25 status at the beginning, and at the end, of 
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1 the 1-year period, respectively, and whether 

2 the child entered foster care within 2 years 

3 after being determined a candidate for fos4 ter care. 

5 ‘‘(5) STATE PLAN COMPONENT.— 

6 ‘‘(A) IN GENERAL.—A State electing to pro7 vide services or programs specified in paragraph 

8 (1) shall submit as part of the State plan re9 quired by subsection (a) a prevention services 

10 and programs plan component that meets the re11 quirements of subparagraph (B). 

12 ‘‘(B) PREVENTION SERVICES AND PRO13 GRAMS PLAN COMPONENT.—In order to meet the 

14 requirements of this subparagraph, a prevention 

15 services and programs plan component, with re16 spect to each 5-year period for which the plan 

17 component is in operation in the State, shall in18 clude the following: 

19 ‘‘(i) How providing services and pro20 grams specified in paragraph (1) is ex21 pected to improve specific outcomes for chil22 dren and families. 

23 ‘‘(ii) How the State will monitor and 

24 oversee the safety of children who receive 

25 services and programs specified in para-
361 

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1 graph (1), including through periodic risk 

2 assessments throughout the period in which 

3 the services and programs are provided on 

4 behalf of a child and reexamination of the 

5 prevention plan maintained for the child 

6 under paragraph (4) for the provision of the 

7 services or programs if the State determines 

8 the risk of the child entering foster care re9 mains high despite the provision of the serv10 ices or programs. 

11 ‘‘(iii) With respect to the services and 

12 programs specified in subparagraphs (A) 

13 and (B) of paragraph (1), information on 

14 the specific promising, supported, or well15 supported practices the State plans to use to 

16 provide the services or programs, including 

17 a description of— 

18 ‘‘(I) the services or programs and 

19 whether the practices used are prom20 ising, supported, or well-supported; 

21 ‘‘(II) how the State plans to im22 plement the services or programs, in23 cluding how implementation of the 

24 services or programs will be continu25 ously monitored to ensure fidelity to 
362 

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1 the practice model and to determine 

2 outcomes achieved and how informa3 tion learned from the monitoring will 

4 be used to refine and improve prac5 tices; 

6 ‘‘(III) how the State selected the 

7 services or programs; 

8 ‘‘(IV) the target population for the 

9 services or programs; and 

10 ‘‘(V) how each service or program 

11 provided will be evaluated through a 

12 well-designed and rigorous process, 

13 which may consist of an ongoing, 

14 cross-site evaluation approved by the 

15 Secretary. 

16 ‘‘(iv) A description of the consultation 

17 that the State agencies responsible for ad18 ministering the State plans under this part 

19 and part B engage in with other State 

20 agencies responsible for administering 

21 health programs, including mental health 

22 and substance abuse prevention and treat23 ment services, and with other public and 

24 private agencies with experience in admin25 istering child and family services, including 
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1 community-based organizations, in order to 

2 foster a continuum of care for children de3 scribed in paragraph (2) and their parents 

4 or kin caregivers. 

5 ‘‘(v) A description of how the State 

6 shall assess children and their parents or 

7 kin caregivers to determine eligibility for 

8 services or programs specified in paragraph 

9 (1). 

10 ‘‘(vi) A description of how the services 

11 or programs specified in paragraph (1) that 

12 are provided for or on behalf of a child and 

13 the parents or kin caregivers of the child 

14 will be coordinated with other child and 

15 family services provided to the child and the 

16 parents or kin caregivers of the child under 

17 the State plans in effect under subparts 1 

18 and 2 of part B. 

19 ‘‘(vii) Descriptions of steps the State is 

20 taking to support and enhance a competent, 

21 skilled, and professional child welfare work22 force to deliver trauma-informed and evi23 dence-based services, including— 

24 ‘‘(I) ensuring that staff is quali25 fied to provide services or programs 
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1 that are consistent with the promising, 

2 supported, or well-supported practice 

3 models selected; and 

4 ‘‘(II) developing appropriate pre5 vention plans, and conducting the risk 

6 assessments required under clause (iii). 

7 ‘‘(viii) A description of how the State 

8 will provide training and support for case9 workers in assessing what children and 

10 their families need, connecting to the fami11 lies served, knowing how to access and de12 liver the needed trauma-informed and evi13 dence-based services, and overseeing and 

14 evaluating the continuing appropriateness 

15 of the services. 

16 ‘‘(ix) A description of how caseload size 

17 and type for prevention caseworkers will be 

18 determined, managed, and overseen. 

19 ‘‘(x) An assurance that the State will 

20 report to the Secretary such information 

21 and data as the Secretary may require with 

22 respect to the provision of services and pro23 grams specified in paragraph (1), including 

24 information and data necessary to deter25 mine the performance measures for the 
365 

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1 State under paragraph (6) and compliance 

2 with paragraph (7). 

3 ‘‘(C) REIMBURSEMENT FOR SERVICES

4 UNDER THE PREVENTION PLAN COMPONENT.— 

5 ‘‘(i) LIMITATION.—Except as provided 

6 in subclause (ii), a State may not receive a 

7 Federal payment under this part for a 

8 given promising, supported, or well-sup9 ported practice unless (in accordance with 

10 subparagraph (B)(iii)(V)) the plan includes 

11 a well-designed and rigorous evaluation 

12 strategy for that practice. 

13 ‘‘(ii) WAIVER OF LIMITATION.—The 

14 Secretary may waive the requirement for a 

15 well-designed and rigorous evaluation of 

16 any well-supported practice if the Secretary 

17 deems the evidence of the effectiveness of the 

18 practice to be compelling and the State 

19 meets the continuous quality improvement 

20 requirements included in subparagraph 

21 (B)(iii)(II) with regard to the practice. 

22 ‘‘(6) PREVENTION SERVICES MEASURES.— 

23 ‘‘(A) ESTABLISHMENT; ANNUAL UPDATES.— 

24 Beginning with fiscal year 2021, and annually 

25 thereafter, the Secretary shall establish the fol-
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1 lowing prevention services measures based on in2 formation and data reported by States that elect 

3 to provide services and programs specified in 

4 paragraph (1): 

5 ‘‘(i) PERCENTAGE OF CANDIDATES FOR

6 FOSTER CARE WHO DO NOT ENTER FOSTER

7 CARE.—The percentage of candidates for 

8 foster care for whom, or on whose behalf, the 

9 services or programs are provided who do 

10 not enter foster care, including those placed 

11 with a kin caregiver outside of foster care, 

12 during the 12-month period in which the 

13 services or programs are provided and 

14 through the end of the succeeding 12-month 

15 period. 

16 ‘‘(ii) PER-CHILD SPENDING.—The total 

17 amount of expenditures made for mental 

18 health and substance abuse prevention and 

19 treatment services or in-home parent skill20 based programs, respectively, for, or on be21 half of, each child described in paragraph 

22 (2). 

23 ‘‘(B) DATA.—The Secretary shall establish 

24 and annually update the prevention services 

25 measures— 
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1 ‘‘(i) based on the median State values 

2 of the information reported under each 

3 clause of subparagraph (A) for the 3 then 

4 most recent years; and 

5 ‘‘(ii) taking into account State dif6 ferences in the price levels of consumption 

7 goods and services using the most recent re8 gional price parities published by the Bu9 reau of Economic Analysis of the Depart10 ment of Commerce or such other data as the 

11 Secretary determines appropriate. 

12 ‘‘(C) PUBLICATION OF STATE PREVENTION

13 SERVICES MEASURES.—The Secretary shall an14 nually make available to the public the preven15 tion services measures of each State. 

16 ‘‘(7) MAINTENANCE OF EFFORT FOR STATE FOS17 TER CARE PREVENTION EXPENDITURES.— 

18 ‘‘(A) IN GENERAL.—If a State elects to pro19 vide services and programs specified in para20 graph (1) for a fiscal year, the State foster care 

21 prevention expenditures for the fiscal year shall 

22 not be less than the amount of the expenditures 

23 for fiscal year 2014 (or, at the option of a State 

24 described in subparagraph (E), fiscal year 2015 

25 or fiscal year 2016 (whichever the State elects)). 
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1 ‘‘(B) STATE FOSTER CARE PREVENTION EX2 PENDITURES.—The term ‘State foster care pre3 vention expenditures’ means the following: 

4 ‘‘(i) TANF; IV–B; SSBG.—State ex5 penditures for foster care prevention services 

6 and activities under the State program 

7 funded under part A (including from 

8 amounts made available by the Federal 

9 Government), under the State plan devel10 oped under part B (including any such 

11 amounts), or under the Social Services 

12 Block Grant Programs under subtitle A of 

13 title XX (including any such amounts). 

14 ‘‘(ii) OTHER STATE PROGRAMS.—State 

15 expenditures for foster care prevention serv16 ices and activities under any State program 

17 that is not described in clause (i) (other 

18 than any State expenditures for foster care 

19 prevention services and activities under the 

20 State program under this part (including 

21 under a waiver of the program)). 

22 ‘‘(C) STATE EXPENDITURES.—The term 

23 ‘State expenditures’ means all State or local 

24 funds that are expended by the State or a local 

25 agency including State or local funds that are 
369 

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1 matched or reimbursed by the Federal Govern2 ment and State or local funds that are not 

3 matched or reimbursed by the Federal Govern4 ment. 

5 ‘‘(D) DETERMINATION OF PREVENTION

6 SERVICES AND ACTIVITIES.—The Secretary shall 

7 require each State that elects to provide services 

8 and programs specified in paragraph (1) to re9 port the expenditures specified in subparagraph 

10 (B) for fiscal year 2014 and for such fiscal years 

11 thereafter as are necessary to determine whether 

12 the State is complying with the maintenance of 

13 effort requirement in subparagraph (A). The Sec14 retary shall specify the specific services and ac15 tivities under each program referred to in sub16 paragraph (B) that are ‘prevention services and 

17 activities’ for purposes of the reports. 

18 ‘‘(E) STATE DESCRIBED.—For purposes of 

19 subparagraph (A), a State is described in this 

20 subparagraph if the population of children in the 

21 State in 2014 was less than 200,000 (as deter22 mined by the Bureau of the Census). 

23 ‘‘(8) PROHIBITION AGAINST USE OF STATE FOS24 TER CARE PREVENTION EXPENDITURES AND FEDERAL

25 IV–E PREVENTION FUNDS FOR MATCHING OR EXPEND-
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1 ITURE REQUIREMENT.—A State that elects to provide 

2 services and programs specified in paragraph (1) 

3 shall not use any State foster care prevention expend4 itures for a fiscal year for the State share of expendi5 tures under section 474(a)(6) for a fiscal year. 

6 ‘‘(9) ADMINISTRATIVE COSTS.—Expenditures de7 scribed in section 474(a)(6)(B)— 

8 ‘‘(A) shall not be eligible for payment under 

9 subparagraph (A), (B), or (E) of section 

10 474(a)(3); and 

11 ‘‘(B) shall be eligible for payment under sec12 tion 474(a)(6)(B) without regard to whether the 

13 expenditures are incurred on behalf of a child 

14 who is, or is potentially, eligible for foster care 

15 maintenance payments under this part. 

16 ‘‘(10) APPLICATION.— 

17 ‘‘(A) IN GENERAL.—The provision of serv18 ices or programs under this subsection to or on 

19 behalf of a child described in paragraph (2) shall 

20 not be considered to be receipt of aid or assist21 ance under the State plan under this part for 

22 purposes of eligibility for any other program es23 tablished under this Act. 

24 ‘‘(B) CANDIDATES IN KINSHIP CARE.—A 

25 child described in paragraph (2) for whom such 
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1 services or programs under this subsection are 

2 provided for more than 6 months while in the 

3 home of a kin caregiver, and who would satisfy 

4 the AFDC eligibility requirement of section 

5 472(a)(3)(A)(ii)(II) but for residing in the home 

6 of the caregiver for more than 6 months, is 

7 deemed to satisfy that requirement for purposes 

8 of determining whether the child is eligible for 

9 foster care maintenance payments under section 

10 472.’’. 

11 (b) DEFINITION.—Section 475 of such Act (42 U.S.C. 

12 675) is amended by adding at the end the following: 

13 ‘‘(13) The term ‘child who is a candidate for fos14 ter care’ means, a child who is identified in a preven15 tion plan under section 471(e)(4)(A) as being at im16 minent risk of entering foster care (without regard to 

17 whether the child would be eligible for foster care 

18 maintenance payments under section 472 or is or 

19 would be eligible for adoption assistance or kinship 

20 guardianship assistance payments under section 473) 

21 but who can remain safely in the child’s home or in 

22 a kinship placement as long as services or programs 

23 specified in section 471(e)(1) that are necessary to 

24 prevent the entry of the child into foster care are pro25 vided. The term includes a child whose adoption or 
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1 guardianship arrangement is at risk of a disruption 

2 or dissolution that would result in a foster care place3 ment.’’. 

4 (c) PAYMENTS UNDER TITLE IV–E.—Section 474(a) 

5 of such Act (42 U.S.C. 674(a)) is amended— 

6 (1) in paragraph (5), by striking the period at 

7 the end and inserting ‘‘; plus’’; and 

8 (2) by adding at the end the following: 

9 ‘‘(6) subject to section 471(e)— 

10 ‘‘(A) for each quarter— 

11 ‘‘(i) subject to clause (ii)— 

12 ‘‘(I) beginning after September 

13 30, 2019, and before October 1, 2026, 

14 an amount equal to 50 percent of the 

15 total amount expended during the 

16 quarter for the provision of services or 

17 programs specified in subparagraph 

18 (A) or (B) of section 471(e)(1) that are 

19 provided in accordance with prom20 ising, supported, or well-supported 

21 practices that meet the applicable cri22 teria specified for the practices in sec23 tion 471(e)(4)(C); and 

24 ‘‘(II) beginning after September 

25 30, 2026, an amount equal to the Fed-
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1 eral medical assistance percentage 

2 (which shall be as defined in section 

3 1905(b), in the case of a State other 

4 than the District of Columbia, or 70 

5 percent, in the case of the District of 

6 Columbia) of the total amount ex7 pended during the quarter for the pro8 vision of services or programs specified 

9 in subparagraph (A) or (B) of section 

10 471(e)(1) that are provided in accord11 ance with promising, supported, or 

12 well-supported practices that meet the 

13 applicable criteria specified for the 

14 practices in section 471(e)(4)(C) (or, 

15 with respect to the payments made 

16 during the quarter under a cooperative 

17 agreement or contract entered into by 

18 the State and an Indian tribe, tribal 

19 organization, or tribal consortium for 

20 the administration or payment of 

21 funds under this part, an amount 

22 equal to the Federal medical assistance 

23 percentage that would apply under sec24 tion 479B(d) (in this paragraph re25 ferred to as the ‘tribal FMAP’) if the 
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•HR 1892 EAH 

1 Indian tribe, tribal organization, or 

2 tribal consortium made the payments 

3 under a program operated under that 

4 section, unless the tribal FMAP is less 

5 than the Federal medical assistance 

6 percentage that applies to the State); 

7 except that 

8 ‘‘(ii) not less than 50 percent of the 

9 total amount expended by a State under 

10 clause (i) for a fiscal year shall be for the 

11 provision of services or programs specified 

12 in subparagraph (A) or (B) of section 

13 471(e)(1) that are provided in accordance 

14 with well-supported practices; plus 

15 ‘‘(B) for each quarter specified in subpara16 graph (A), an amount equal to the sum of the 

17 following proportions of the total amount ex18 pended during the quarter— 

19 ‘‘(i) 50 percent of so much of the ex20 penditures as are found necessary by the 

21 Secretary for the proper and efficient ad22 ministration of the State plan for the provi23 sion of services or programs specified in sec24 tion 471(e)(1), including expenditures for 

25 activities approved by the Secretary that 
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1 promote the development of necessary proc2 esses and procedures to establish and imple3 ment the provision of the services and pro4 grams for individuals who are eligible for 

5 the services and programs and expenditures 

6 attributable to data collection and report7 ing; and 

8 ‘‘(ii) 50 percent of so much of the ex9 penditures with respect to the provision of 

10 services and programs specified in section 

11 471(e)(1) as are for training of personnel 

12 employed or preparing for employment by 

13 the State agency or by the local agency ad14 ministering the plan in the political sub15 division and of the members of the staff of 

16 State-licensed or State-approved child wel17 fare agencies providing services to children 

18 described in section 471(e)(2) and their par19 ents or kin caregivers, including on how to 

20 determine who are individuals eligible for 

21 the services or programs, how to identify 

22 and provide appropriate services and pro23 grams, and how to oversee and evaluate the 

24 ongoing appropriateness of the services and 

25 programs.’’. 
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1 (d) TECHNICAL ASSISTANCE AND BEST PRACTICES, 

2 CLEARINGHOUSE, AND DATA COLLECTION AND EVALUA3 TIONS.—Section 476 of such Act (42 U.S.C. 676) is amend4 ed by adding at the end the following: 

5 ‘‘(d) TECHNICAL ASSISTANCE AND BEST PRACTICES, 

6 CLEARINGHOUSE, DATA COLLECTION, AND EVALUATIONS

7 RELATING TO PREVENTION SERVICES AND PROGRAMS.— 

8 ‘‘(1) TECHNICAL ASSISTANCE AND BEST PRAC9 TICES.—The Secretary shall provide to States and, as 

10 applicable, to Indian tribes, tribal organizations, and 

11 tribal consortia, technical assistance regarding the 

12 provision of services and programs described in sec13 tion 471(e)(1) and shall disseminate best practices 

14 with respect to the provision of the services and pro15 grams, including how to plan and implement a well16 designed and rigorous evaluation of a promising, sup17 ported, or well-supported practice. 

18 ‘‘(2) CLEARINGHOUSE OF PROMISING, SUP19 PORTED, AND WELL-SUPPORTED PRACTICES.—The 

20 Secretary shall, directly or through grants, contracts, 

21 or interagency agreements, evaluate research on the 

22 practices specified in clauses (iii), (iv), and (v), re23 spectively, of section 471(e)(4)(C), and programs that 

24 meet the requirements described in section 427(a)(1), 

25 including culturally specific, or location- or popu-
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1 lation-based adaptations of the practices, to identify 

2 and establish a public clearinghouse of the practices 

3 that satisfy each category described by such clauses. 

4 In addition, the clearinghouse shall include informa5 tion on the specific outcomes associated with each 

6 practice, including whether the practice has been 

7 shown to prevent child abuse and neglect and reduce 

8 the likelihood of foster care placement by supporting 

9 birth families and kinship families and improving 

10 targeted supports for pregnant and parenting youth 

11 and their children. 

12 ‘‘(3) DATA COLLECTION AND EVALUATIONS.—The 

13 Secretary, directly or through grants, contracts, or 

14 interagency agreements, may collect data and conduct 

15 evaluations with respect to the provision of services 

16 and programs described in section 471(e)(1) for pur17 poses of assessing the extent to which the provision of 

18 the services and programs— 

19 ‘‘(A) reduces the likelihood of foster care 

20 placement; 

21 ‘‘(B) increases use of kinship care arrange22 ments; or 

23 ‘‘(C) improves child well-being. 

24 ‘‘(4) REPORTS TO CONGRESS.— 
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1 ‘‘(A) IN GENERAL.—The Secretary shall 

2 submit to the Committee on Finance of the Sen3 ate and the Committee on Ways and Means of 

4 the House of Representatives periodic reports 

5 based on the provision of services and programs 

6 described in section 471(e)(1) and the activities 

7 carried out under this subsection. 

8 ‘‘(B) PUBLIC AVAILABILITY.—The Secretary 

9 shall make the reports to the Congress submitted 

10 under this paragraph publicly available. 

11 ‘‘(5) APPROPRIATION.—Out of any money in the 

12 Treasury of the United States not otherwise appro13 priated, there are appropriated to the Secretary 

14 $1,000,000 for fiscal year 2018 and each fiscal year 

15 thereafter to carry out this subsection.’’. 

16 (e) APPLICATION TO PROGRAMS OPERATED BY INDIAN

17 TRIBAL ORGANIZATIONS.— 

18 (1) IN GENERAL.—Section 479B of such Act (42 

19 U.S.C. 679c) is amended— 

20 (A) in subsection (c)(1)— 

21 (i) in subparagraph (C)(i)— 

22 (I) in subclause (II), by striking 

23 ‘‘and’’ after the semicolon; 
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1 (II) in subclause (III), by striking 

2 the period at the end and inserting ‘‘; 

3 and’’; and 

4 (III) by adding at the end the fol5 lowing: 

6 ‘‘(IV) at the option of the tribe, 

7 organization, or consortium, services 

8 and programs specified in section 

9 471(e)(1) to children described in sec10 tion 471(e)(2) and their parents or kin 

11 caregivers, in accordance with section 

12 471(e) and subparagraph (E).’’; and 

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

14 ‘‘(E) PREVENTION SERVICES AND PRO15 GRAMS FOR CHILDREN AND THEIR PARENTS AND

16 KIN CAREGIVERS.— 

17 ‘‘(i) IN GENERAL.—In the case of a 

18 tribe, organization, or consortium that 

19 elects to provide services and programs spec20 ified in section 471(e)(1) to children de21 scribed in section 471(e)(2) and their par22 ents or kin caregivers under the plan, the 

23 Secretary shall specify the requirements ap24 plicable to the provision of the services and 

25 programs. The requirements shall, to the 
380 

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1 greatest extent practicable, be consistent 

2 with the requirements applicable to States 

3 under section 471(e) and shall permit the 

4 provision of the services and programs in 

5 the form of services and programs that are 

6 adapted to the culture and context of the 

7 tribal communities served. 

8 ‘‘(ii) PERFORMANCE MEASURES.—The 

9 Secretary shall establish specific perform10 ance measures for each tribe, organization, 

11 or consortium that elects to provide services 

12 and programs specified in section 471(e)(1). 

13 The performance measures shall, to the 

14 greatest extent practicable, be consistent 

15 with the prevention services measures re16 quired for States under section 471(e)(6) 

17 but shall allow for consideration of factors 

18 unique to the provision of the services by 

19 tribes, organizations, or consortia.’’; and 

20 (B) in subsection (d)(1), by striking ‘‘and 

21 (5)’’ and inserting ‘‘(5), and (6)(A)’’. 

22 (2) CONFORMING AMENDMENT.—The heading for 

23 subsection (d) of section 479B of such Act (42 U.S.C. 

24 679c) is amended by striking ‘‘FOR FOSTER CARE
381 

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1 MAINTENANCE AND ADOPTION ASSISTANCE PAY2 MENTS’’. 

3 (f) APPLICATION TO PROGRAMS OPERATED BY TERRI4 TORIES.—Section 1108(a)(2) of the Social Security Act (42 

5 U.S.C. 1308(a)(2)) is amended by striking ‘‘or 413(f)’’ and 

6 inserting ‘‘413(f), or 474(a)(6)’’. 

7 SEC. 2622. FOSTER CARE MAINTENANCE PAYMENTS FOR 

8 CHILDREN WITH PARENTS IN A LICENSED 

9 RESIDENTIAL FAMILY-BASED TREATMENT FA10 CILITY FOR SUBSTANCE ABUSE. 

11 (a) IN GENERAL.—Section 472 of the Social Security 

12 Act (42 U.S.C. 672) is amended— 

13 (1) in subsection (a)(2)(C), by striking ‘‘or’’ and 

14 inserting ‘‘, with a parent residing in a licensed resi15 dential family-based treatment facility, but only to 

16 the extent permitted under subsection (j), or in a’’; 

17 and 

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

19 ‘‘(j) CHILDREN PLACED WITH A PARENT RESIDING IN

20 A LICENSED RESIDENTIAL FAMILY-BASED TREATMENT FA21 CILITY FOR SUBSTANCE ABUSE.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding the pre23 ceding provisions of this section, a child who is eligi24 ble for foster care maintenance payments under this 

25 section, or who would be eligible for the payments if 
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•HR 1892 EAH 

1 the eligibility were determined without regard to 

2 paragraphs (1)(B) and (3) of subsection (a), shall be 

3 eligible for the payments for a period of not more 

4 than 12 months during which the child is placed with 

5 a parent who is in a licensed residential family-based 

6 treatment facility for substance abuse, but only if— 

7 ‘‘(A) the recommendation for the placement 

8 is specified in the child’s case plan before the 

9 placement; 

10 ‘‘(B) the treatment facility provides, as part 

11 of the treatment for substance abuse, parenting 

12 skills training, parent education, and individual 

13 and family counseling; and 

14 ‘‘(C) the substance abuse treatment, par15 enting skills training, parent education, and in16 dividual and family counseling is provided 

17 under an organizational structure and treatment 

18 framework that involves understanding, recog19 nizing, and responding to the effects of all types 

20 of trauma and in accordance with recognized 

21 principles of a trauma-informed approach and 

22 trauma-specific interventions to address the con23 sequences of trauma and facilitate healing. 

24 ‘‘(2) APPLICATION.—With respect to children for 

25 whom foster care maintenance payments are made 
383 

•HR 1892 EAH 

1 under paragraph (1), only the children who satisfy 

2 the requirements of paragraphs (1)(B) and (3) of sub3 section (a) shall be considered to be children with re4 spect to whom foster care maintenance payments are 

5 made under this section for purposes of subsection (h) 

6 or section 473(b)(3)(B).’’. 

7 (b) CONFORMING AMENDMENT.—Section 474(a)(1) of 

8 such Act (42 U.S.C. 674(a)(1)) is amended by inserting 

9 ‘‘subject to section 472(j),’’ before ‘‘an amount equal to the 

10 Federal’’ the first place it appears. 

11 SEC. 2623. TITLE IV–E PAYMENTS FOR EVIDENCE-BASED 

12 KINSHIP NAVIGATOR PROGRAMS. 

13 Section 474(a) of the Social Security Act (42 U.S.C. 

14 674(a)), as amended by section 2621(c) of this Act, is 

15 amended— 

16 (1) in paragraph (6), by striking the period at 

17 the end and inserting ‘‘; plus’’; and 

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

19 ‘‘(7) an amount equal to 50 percent of the 

20 amounts expended by the State during the quarter as 

21 the Secretary determines are for kinship navigator 

22 programs that meet the requirements described in sec23 tion 427(a)(1) and that the Secretary determines are 

24 operated in accordance with promising, supported, or 

25 well-supported practices that meet the applicable cri-
384 

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1 teria specified for the practices in section 

2 471(e)(4)(C), without regard to whether the expendi3 tures are incurred on behalf of children who are, or 

4 are potentially, eligible for foster care maintenance 

5 payments under this part.’’. 

6 Subchapter B—Enhanced Support Under 

7 Title IV–B 

8 SEC. 2631. ELIMINATION OF TIME LIMIT FOR FAMILY RE9 UNIFICATION SERVICES WHILE IN FOSTER 

10 CARE AND PERMITTING TIME-LIMITED FAM11 ILY REUNIFICATION SERVICES WHEN A 

12 CHILD RETURNS HOME FROM FOSTER CARE. 

13 (a) IN GENERAL.—Section 431(a)(7) of the Social Se14 curity Act (42 U.S.C. 629a(a)(7)) is amended— 

15 (1) in the paragraph heading, by striking 

16 ‘‘TIME-LIMITED FAMILY’’ and inserting ‘‘FAMILY’’; 

17 and 

18 (2) in subparagraph (A)— 

19 (A) by striking ‘‘time-limited family’’ and 

20 inserting ‘‘family’’; 

21 (B) by inserting ‘‘or a child who has been 

22 returned home’’ after ‘‘child care institution’’; 

23 and 

24 (C) by striking ‘‘, but only during the 15- 

25 month period that begins on the date that the 
385 

•HR 1892 EAH 

1 child, pursuant to section 475(5)(F), is consid2 ered to have entered foster care’’ and inserting 

3 ‘‘and to ensure the strength and stability of the 

4 reunification. In the case of a child who has been 

5 returned home, the services and activities shall 

6 only be provided during the 15-month period 

7 that begins on the date that the child returns 

8 home’’. 

9 (b) CONFORMING AMENDMENTS.— 

10 (1) Section 430 of such Act (42 U.S.C. 629) is 

11 amended in the matter preceding paragraph (1), by 

12 striking ‘‘time-limited’’. 

13 (2) Subsections (a)(4), (a)(5)(A), and (b)(1) of 

14 section 432 of such Act (42 U.S.C. 629b) are amended 

15 by striking ‘‘time-limited’’ each place it appears. 

16 SEC. 2632. REDUCING BUREAUCRACY AND UNNECESSARY 

17 DELAYS WHEN PLACING CHILDREN IN HOMES 

18 ACROSS STATE LINES. 

19 (a) STATE PLAN REQUIREMENT.— 

20 (1) IN GENERAL.—Section 471(a)(25) of the So21 cial Security Act (42 U.S.C. 671(a)(25)) is amend22 ed— 

23 (A) by striking ‘‘provide’’ and inserting 

24 ‘‘provides’’; and 
386 

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1 (B) by inserting ‘‘, which, in the case of a 

2 State other than the Commonwealth of Puerto 

3 Rico, the United States Virgin Islands, Guam, 

4 and American Samoa, not later than October 1, 

5 2027, shall include the use of an electronic inter6 state case-processing system’’ before the first 

7 semicolon. 

8 (2) EXEMPTION OF INDIAN TRIBES.—Section 

9 479B(c) of such Act (42 U.S.C. 679c(c)) is amended 

10 by adding at the end the following: 

11 ‘‘(4) INAPPLICABILITY OF STATE PLAN REQUIRE12 MENT TO HAVE IN EFFECT PROCEDURES PROVIDING

13 FOR THE USE OF AN ELECTRONIC INTERSTATE CASE14 PROCESSING SYSTEM.—The requirement in section 

15 471(a)(25) that a State plan provide that the State 

16 shall have in effect procedures providing for the use 

17 of an electronic interstate case-processing system shall 

18 not apply to an Indian tribe, tribal organization, or 

19 tribal consortium that elects to operate a program 

20 under this part.’’. 

21 (b) FUNDING FOR THE DEVELOPMENT OF AN ELEC22 TRONIC INTERSTATE CASE-PROCESSING SYSTEM TO EXPE23 DITE THE INTERSTATE PLACEMENT OF CHILDREN IN FOS24 TER CARE OR GUARDIANSHIP, OR FOR ADOPTION.—Section 
387 

•HR 1892 EAH 

1 437 of such Act (42 U.S.C. 629g) is amended by adding 

2 at the end the following: 

3 ‘‘(g) FUNDING FOR THE DEVELOPMENT OF AN ELEC4 TRONIC INTERSTATE CASE-PROCESSING SYSTEM TO EXPE5 DITE THE INTERSTATE PLACEMENT OF CHILDREN IN FOS6 TER CARE OR GUARDIANSHIP, OR FOR ADOPTION.— 

7 ‘‘(1) PURPOSE.—The purpose of this subsection 

8 is to facilitate the development of an electronic inter9 state case-processing system for the exchange of data 

10 and documents to expedite the placements of children 

11 in foster, guardianship, or adoptive homes across 

12 State lines. 

13 ‘‘(2) REQUIREMENTS.—A State that seeks fund14 ing under this subsection shall submit to the Sec15 retary the following information: 

16 ‘‘(A) A description of the goals and out17 comes to be achieved, which goals and outcomes 

18 must result in— 

19 ‘‘(i) reducing the time it takes for a 

20 child to be provided with a safe and appro21 priate permanent living arrangement across 

22 State lines; 

23 ‘‘(ii) improving administrative proc24 esses and reducing costs in the foster care 

25 system; and 
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•HR 1892 EAH 

1 ‘‘(iii) the secure exchange of relevant 

2 case files and other necessary materials in 

3 real time, and timely communications and 

4 placement decisions regarding interstate 

5 placements of children. 

6 ‘‘(B) A description of the activities to be 

7 funded in whole or in part with the funds, in8 cluding the sequencing of the activities. 

9 ‘‘(C) A description of the strategies for inte10 grating programs and services for children who 

11 are placed across State lines. 

12 ‘‘(D) Such other information as the Sec13 retary may require. 

14 ‘‘(3) FUNDING AUTHORITY.—The Secretary may 

15 provide funds to a State that complies with para16 graph (2). In providing funds under this subsection, 

17 the Secretary shall prioritize States that are not yet 

18 connected with the electronic interstate case-processing 

19 system referred to in paragraph (1). 

20 ‘‘(4) USE OF FUNDS.—A State to which funding 

21 is provided under this subsection shall use the fund22 ing to support the State in connecting with, or en23 hancing or expediting services provided under, the 

24 electronic interstate case-processing system referred to 

25 in paragraph (1). 
389 

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1 ‘‘(5) EVALUATIONS.—Not later than 1 year after 

2 the final year in which funds are awarded under this 

3 subsection, the Secretary shall submit to the Congress, 

4 and make available to the general public by posting 

5 on a website, a report that contains the following in6 formation: 

7 ‘‘(A) How using the electronic interstate 

8 case-processing system developed pursuant to 

9 paragraph (4) has changed the time it takes for 

10 children to be placed across State lines. 

11 ‘‘(B) The number of cases subject to the 

12 Interstate Compact on the Placement of Children 

13 that were processed through the electronic inter14 state case-processing system, and the number of 

15 interstate child placement cases that were proc16 essed outside the electronic interstate case-proc17 essing system, by each State in each year. 

18 ‘‘(C) The progress made by States in imple19 menting the electronic interstate case-processing 

20 system. 

21 ‘‘(D) How using the electronic interstate 

22 case-processing system has affected various 

23 metrics related to child safety and well-being, in24 cluding the time it takes for children to be placed 

25 across State lines. 
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1 ‘‘(E) How using the electronic interstate 

2 case-processing system has affected administra3 tive costs and caseworker time spent on placing 

4 children across State lines. 

5 ‘‘(6) DATA INTEGRATION.—The Secretary, in 

6 consultation with the Secretariat for the Interstate 

7 Compact on the Placement of Children and the States, 

8 shall assess how the electronic interstate case-proc9 essing system developed pursuant to paragraph (4) 

10 could be used to better serve and protect children that 

11 come to the attention of the child welfare system, by— 

12 ‘‘(A) connecting the system with other data 

13 systems (such as systems operated by State law 

14 enforcement and judicial agencies, systems oper15 ated by the Federal Bureau of Investigation for 

16 the purposes of the Innocence Lost National Ini17 tiative, and other systems); 

18 ‘‘(B) simplifying and improving reporting 

19 related to paragraphs (34) and (35) of section 

20 471(a) regarding children or youth who have 

21 been identified as being a sex trafficking victim 

22 or children missing from foster care; and 

23 ‘‘(C) improving the ability of States to 

24 quickly comply with background check require25 ments of section 471(a)(20), including checks of 
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1 child abuse and neglect registries as required by 

2 section 471(a)(20)(B).’’. 

3 (c) RESERVATION OF FUNDS TO IMPROVE THE INTER4 STATE PLACEMENT OF CHILDREN.—Section 437(b) of such 

5 Act (42 U.S.C. 629g(b)) is amended by adding at the end 

6 the following: 

7 ‘‘(4) IMPROVING THE INTERSTATE PLACEMENT

8 OF CHILDREN.—The Secretary shall reserve 

9 $5,000,000 of the amount made available for fiscal 

10 year 2018 for grants under subsection (g), and the 

11 amount so reserved shall remain available through 

12 fiscal year 2022.’’. 

13 SEC. 2633. ENHANCEMENTS TO GRANTS TO IMPROVE WELL14 BEING OF FAMILIES AFFECTED BY SUB15 STANCE ABUSE. 

16 Section 437(f) of the Social Security Act (42 U.S.C. 

17 629g(f)) is amended— 

18 (1) in the subsection heading, by striking ‘‘IN19 CREASE THE WELL-BEING OF, AND TO IMPROVE THE

20 PERMANENCY OUTCOMES FOR, CHILDREN AFFECTED

21 BY’’ and inserting ‘‘IMPLEMENT IV–E PREVENTION

22 SERVICES, AND IMPROVE THE WELL-BEING OF, AND

23 IMPROVE PERMANENCY OUTCOMES FOR, CHILDREN

24 AND FAMILIES AFFECTED BY HEROIN, OPIOIDS, AND

25 OTHER’’; 
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1 (2) by striking paragraph (2) and inserting the 

2 following: 

3 ‘‘(2) REGIONAL PARTNERSHIP DEFINED.—In this 

4 subsection, the term ‘regional partnership’ means a 

5 collaborative agreement (which may be established on 

6 an interstate, State, or intrastate basis) entered into 

7 by the following: 

8 ‘‘(A) MANDATORY PARTNERS FOR ALL PART9 NERSHIP GRANTS.— 

10 ‘‘(i) The State child welfare agency 

11 that is responsible for the administration of 

12 the State plan under this part and part E. 

13 ‘‘(ii) The State agency responsible for 

14 administering the substance abuse preven15 tion and treatment block grant provided 

16 under subpart II of part B of title XIX of 

17 the Public Health Service Act. 

18 ‘‘(B) MANDATORY PARTNERS FOR PARTNER19 SHIP GRANTS PROPOSING TO SERVE CHILDREN

20 IN OUT-OF-HOME PLACEMENTS.—If the partner21 ship proposes to serve children in out-of-home 

22 placements, the Juvenile Court or Administrative 

23 Office of the Court that is most appropriate to 

24 oversee the administration of court programs in 

25 the region to address the population of families 
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1 who come to the attention of the court due to 

2 child abuse or neglect. 

3 ‘‘(C) OPTIONAL PARTNERS.—At the option 

4 of the partnership, any of the following: 

5 ‘‘(i) An Indian tribe or tribal consor6 tium. 

7 ‘‘(ii) Nonprofit child welfare service 

8 providers. 

9 ‘‘(iii) For-profit child welfare service 

10 providers. 

11 ‘‘(iv) Community health service pro12 viders, including substance abuse treatment 

13 providers. 

14 ‘‘(v) Community mental health pro15 viders. 

16 ‘‘(vi) Local law enforcement agencies. 

17 ‘‘(vii) School personnel. 

18 ‘‘(viii) Tribal child welfare agencies 

19 (or a consortia of the agencies). 

20 ‘‘(ix) Any other providers, agencies, 

21 personnel, officials, or entities that are re22 lated to the provision of child and family 

23 services under a State plan approved under 

24 this subpart. 
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1 ‘‘(D) EXCEPTION FOR REGIONAL PARTNER2 SHIPS WHERE THE LEAD APPLICANT IS AN IN3 DIAN TRIBE OR TRIBAL CONSORTIA.—If an In4 dian tribe or tribal consortium enters into a re5 gional partnership for purposes of this sub6 section, the Indian tribe or tribal consortium— 

7 ‘‘(i) may (but is not required to) in8 clude the State child welfare agency as a 

9 partner in the collaborative agreement; 

10 ‘‘(ii) may not enter into a collaborative 

11 agreement only with tribal child welfare 

12 agencies (or a consortium of the agencies); 

13 and 

14 ‘‘(iii) if the condition described in 

15 paragraph (2)(B) applies, may include trib16 al court organizations in lieu of other judi17 cial partners.’’; 

18 (3) in paragraph (3)— 

19 (A) in subparagraph (A)— 

20 (i) by striking ‘‘2012 through 2016’’ 

21 and inserting ‘‘2017 through 2021’’; and 

22 (ii) by striking ‘‘$500,000 and not 

23 more than $1,000,000’’ and inserting 

24 ‘‘$250,000 and not more than $1,000,000’’; 

25 (B) in subparagraph (B)— 
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•HR 1892 EAH 

1 (i) in the subparagraph heading, by 

2 inserting ‘‘; PLANNING’’ after ‘‘APPROVAL’’; 

3 (ii) in clause (i), by striking ‘‘clause 

4 (ii)’’ and inserting ‘‘clauses (ii) and (iii)’’; 

5 and 

6 (iii) by adding at the end the fol7 lowing: 

8 ‘‘(iii) SUFFICIENT PLANNING.—A grant 

9 awarded under this subsection shall be dis10 bursed in two phases: a planning phase (not 

11 to exceed 2 years) and an implementation 

12 phase. The total disbursement to a grantee 

13 for the planning phase may not exceed 

14 $250,000, and may not exceed the total an15 ticipated funding for the implementation 

16 phase.’’; and 

17 (C) by adding at the end the following: 

18 ‘‘(D) LIMITATION ON PAYMENT FOR A FIS19 CAL YEAR.—No payment shall be made under 

20 subparagraph (A) or (C) for a fiscal year until 

21 the Secretary determines that the eligible part22 nership has made sufficient progress in meeting 

23 the goals of the grant and that the members of 

24 the eligible partnership are coordinating to a 
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•HR 1892 EAH 

1 reasonable degree with the other members of the 

2 eligible partnership.’’; 

3 (4) in paragraph (4)— 

4 (A) in subparagraph (B)— 

5 (i) in clause (i), by inserting ‘‘, par6 ents, and families’’ after ‘‘children’’; 

7 (ii) in clause (ii), by striking ‘‘safety 

8 and permanence for such children; and’’ 

9 and inserting ‘‘safe, permanent caregiving 

10 relationships for the children;’’; 

11 (iii) in clause (iii), by striking ‘‘or’’ 

12 and inserting ‘‘increase reunification rates 

13 for children who have been placed in out-of14 home care, or decrease’’; and 

15 (iv) by redesignating clause (iii) as 

16 clause (v) and inserting after clause (ii) the 

17 following: 

18 ‘‘(iii) improve the substance abuse 

19 treatment outcomes for parents including 

20 retention in treatment and successful com21 pletion of treatment; 

22 ‘‘(iv) facilitate the implementation, de23 livery, and effectiveness of prevention serv24 ices and programs under section 471(e); 

25 and’’; 
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•HR 1892 EAH 

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

2 ‘‘where appropriate,’’; and 

3 (C) by striking subparagraphs (E) and (F) 

4 and inserting the following: 

5 ‘‘(E) A description of a plan for sustaining 

6 the services provided by or activities funded 

7 under the grant after the conclusion of the grant 

8 period, including through the use of prevention 

9 services and programs under section 471(e) and 

10 other funds provided to the State for child wel11 fare and substance abuse prevention and treat12 ment services. 

13 ‘‘(F) Additional information needed by the 

14 Secretary to determine that the proposed activi15 ties and implementation will be consistent with 

16 research or evaluations showing which practices 

17 and approaches are most effective.’’; 

18 (5) in paragraph (5)(A), by striking ‘‘abuse 

19 treatment’’ and inserting ‘‘use disorder treatment in20 cluding medication assisted treatment and in-home 

21 substance abuse disorder treatment and recovery’’; 

22 (6) in paragraph (7)— 

23 (A) by striking ‘‘and’’ at the end of sub24 paragraph (C); and 
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•HR 1892 EAH 

1 (B) by redesignating subparagraph (D) as 

2 subparagraph (E) and inserting after subpara3 graph (C) the following: 

4 ‘‘(D) demonstrate a track record of success5 ful collaboration among child welfare, substance 

6 abuse disorder treatment and mental health 

7 agencies; and’’; 

8 (7) in paragraph (8)— 

9 (A) in subparagraph (A)— 

10 (i) by striking ‘‘establish indicators 

11 that will be’’ and inserting ‘‘review indica12 tors that are’’; and 

13 (ii) by striking ‘‘in using funds made 

14 available under such grants to achieve the 

15 purpose of this subsection’’ and inserting 

16 ‘‘and establish a set of core indicators re17 lated to child safety, parental recovery, par18 enting capacity, and family well-being. In 

19 developing the core indicators, to the extent 

20 possible, indicators shall be made consistent 

21 with the outcome measures described in sec22 tion 471(e)(6)’’; and 

23 (B) in subparagraph (B)— 

24 (i) in the matter preceding clause (i), 

25 by inserting ‘‘base the performance meas-
399 

•HR 1892 EAH 

1 ures on lessons learned from prior rounds of 

2 regional partnership grants under this sub3 section, and’’ before ‘‘consult’’; and 

4 (ii) by striking clauses (iii) and (iv) 

5 and inserting the following: 

6 ‘‘(iii) Other stakeholders or constitu7 encies as determined by the Secretary.’’; 

8 (8) in paragraph (9)(A), by striking clause (i) 

9 and inserting the following: 

10 ‘‘(i) SEMIANNUAL REPORTS.—Not later 

11 than September 30 of each fiscal year in 

12 which a recipient of a grant under this sub13 section is paid funds under the grant, and 

14 every 6 months thereafter, the grant recipi15 ent shall submit to the Secretary a report 

16 on the services provided and activities car17 ried out during the reporting period, 

18 progress made in achieving the goals of the 

19 program, the number of children, adults, 

20 and families receiving services, and such 

21 additional information as the Secretary de22 termines is necessary. The report due not 

23 later than September 30 of the last such fis24 cal year shall include, at a minimum, data 

25 on each of the performance indicators in-
400 

•HR 1892 EAH 

1 cluded in the evaluation of the regional 

2 partnership.’’; and 

3 (9) in paragraph (10), by striking ‘‘2012 

4 through 2016’’ and inserting ‘‘2017 through 2021’’. 

5 Subchapter C—Miscellaneous 

6 SEC. 2641. REVIEWING AND IMPROVING LICENSING STAND7 ARDS FOR PLACEMENT IN A RELATIVE FOS8 TER FAMILY HOME. 

9 (a) IDENTIFICATION OF REPUTABLE MODEL LICENS10 ING STANDARDS.—Not later than October 1, 2018, the Sec11 retary of Health and Human Services shall identify rep12 utable model licensing standards with respect to the licens13 ing of foster family homes (as defined in section 472(c)(1) 

14 of the Social Security Act). 

15 (b) STATE PLAN REQUIREMENT.—Section 471(a) of 

16 the Social Security Act (42 U.S.C. 671(a)) is amended— 

17 (1) in paragraph (34)(B), by striking ‘‘and’’ 

18 after the semicolon; 

19 (2) in paragraph (35)(B), by striking the period 

20 at the end and inserting a semicolon; and 

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

22 ‘‘(36) provides that, not later than April 1, 2019, 

23 the State shall submit to the Secretary information 

24 addressing— 
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1 ‘‘(A) whether the State licensing standards 

2 are in accord with model standards identified by 

3 the Secretary, and if not, the reason for the spe4 cific deviation and a description as to why hav5 ing a standard that is reasonably in accord with 

6 the corresponding national model standards is 

7 not appropriate for the State; 

8 ‘‘(B) whether the State has elected to waive 

9 standards established in 471(a)(10)(A) for rel10 ative foster family homes (pursuant to waiver 

11 authority provided by 471(a)(10)(D)), a descrip12 tion of which standards the State most com13 monly waives, and if the State has not elected to 

14 waive the standards, the reason for not waiving 

15 these standards; 

16 ‘‘(C) if the State has elected to waive stand17 ards specified in subparagraph (B), how case18 workers are trained to use the waiver authority 

19 and whether the State has developed a process or 

20 provided tools to assist caseworkers in waiving 

21 nonsafety standards per the authority provided 

22 in 471(a)(10)(D) to quickly place children with 

23 relatives; and 
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1 ‘‘(D) a description of the steps the State is 

2 taking to improve caseworker training or the 

3 process, if any; and’’. 

4 SEC. 2642. DEVELOPMENT OF A STATEWIDE PLAN TO PRE5 VENT CHILD ABUSE AND NEGLECT FATALI6 TIES. 

7 Section 422(b)(19) of the Social Security Act (42 

8 U.S.C. 622(b)(19)) is amended to read as follows: 

9 ‘‘(19) document steps taken to track and prevent 

10 child maltreatment deaths by including— 

11 ‘‘(A) a description of the steps the State is 

12 taking to compile complete and accurate infor13 mation on the deaths required by Federal law to 

14 be reported by the State agency referred to in 

15 paragraph (1), including gathering relevant in16 formation on the deaths from the relevant orga17 nizations in the State including entities such as 

18 State vital statistics department, child death re19 view teams, law enforcement agencies, offices of 

20 medical examiners, or coroners; and 

21 ‘‘(B) a description of the steps the State is 

22 taking to develop and implement a comprehen23 sive, statewide plan to prevent the fatalities that 

24 involves and engages relevant public and private 
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•HR 1892 EAH 

1 agency partners, including those in public 

2 health, law enforcement, and the courts.’’. 

3 SEC. 2643. MODERNIZING THE TITLE AND PURPOSE OF 

4 TITLE IV–E. 

5 (a) PART HEADING.—The heading for part E of title 

6 IV of the Social Security Act (42 U.S.C. 670 et seq.) is 

7 amended to read as follows: 

8 ‘‘PART E—FEDERAL PAYMENTS FOR FOSTER 

9 CARE, PREVENTION, AND PERMANENCY’’. 

10 (b) PURPOSE.—The first sentence of section 470 of 

11 such Act (42 U.S.C. 670) is amended— 

12 (1) by striking ‘‘1995) and’’ and inserting 

13 ‘‘1995),’’; 

14 (2) by inserting ‘‘kinship guardianship assist15 ance, and prevention services or programs specified in 

16 section 471(e)(1),’’ after ‘‘needs,’’; and 

17 (3) by striking ‘‘(commencing with the fiscal 

18 year which begins October 1, 1980)’’. 

19 SEC. 2644. EFFECTIVE DATES. 

20 (a) EFFECTIVE DATES.— 

21 (1) IN GENERAL.—Except as provided in para22 graph (2), subject to subsection (b), the amendments 

23 made by this chapter shall take effect on October 1, 

24 2018. 
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1 (2) EXCEPTIONS.—The amendments made by 

2 sections 2621(d), 2641, and 2643 shall take effect on 

3 the date of enactment of this Act. 

4 (b) TRANSITION RULE.— 

5 (1) IN GENERAL.—In the case of a State plan 

6 under part B or E of title IV of the Social Security 

7 Act which the Secretary of Health and Human Serv8 ices determines requires State legislation (other than 

9 legislation appropriating funds) in order for the plan 

10 to meet the additional requirements imposed by the 

11 amendments made by this chapter, the State plan 

12 shall not be regarded as failing to comply with the re13 quirements of such part solely on the basis of the fail14 ure of the plan to meet such additional requirements 

15 before the first day of the first calendar quarter begin16 ning after the close of the first regular session of the 

17 State legislature that begins after the date of enact18 ment of this Act. For purposes of the previous sen19 tence, in the case of a State that has a 2-year legisla20 tive session, each year of the session shall be deemed 

21 to be a separate regular session of the State legisla22 ture. 

23 (2) APPLICATION TO PROGRAMS OPERATED BY

24 INDIAN TRIBAL ORGANIZATIONS.—In the case of an 

25 Indian tribe, tribal organization, or tribal consortium 
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1 which the Secretary of Health and Human Services 

2 determines requires time to take action necessary to 

3 comply with the additional requirements imposed by 

4 the amendments made by this chapter (whether the 

5 tribe, organization, or tribal consortium has a plan 

6 under section 479B of the Social Security Act or a co7 operative agreement or contract entered into with a 

8 State), the Secretary shall provide the tribe, organiza9 tion, or tribal consortium with such additional time 

10 as the Secretary determines is necessary for the tribe, 

11 organization, or tribal consortium to take the action 

12 to comply with the additional requirements before 

13 being regarded as failing to comply with the require14 ments. 

15 CHAPTER 2—ENSURING THE NECESSITY 

16 OF A PLACEMENT THAT IS NOT IN A 

17 FOSTER FAMILY HOME 

18 SEC. 2651. LIMITATION ON FEDERAL FINANCIAL PARTICIPA19 TION FOR PLACEMENTS THAT ARE NOT IN 

20 FOSTER FAMILY HOMES. 

21 (a) LIMITATION ON FEDERAL FINANCIAL PARTICIPA22 TION.— 

23 (1) IN GENERAL.—Section 472 of the Social Se24 curity Act (42 U.S.C. 672), as amended by section 

25 2622 of this Act, is amended— 
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•HR 1892 EAH 

1 (A) in subsection (a)(2)(C), by inserting ‘‘, 

2 but only to the extent permitted under subsection 

3 (k)’’ after ‘‘institution’’; and 

4 (B) by adding at the end the following: 

5 ‘‘(k) LIMITATION ON FEDERAL FINANCIAL PARTICIPA6 TION.— 

7 ‘‘(1) IN GENERAL.—Beginning with the third 

8 week for which foster care maintenance payments are 

9 made under this section on behalf of a child placed 

10 in a child-care institution, no Federal payment shall 

11 be made to the State under section 474(a)(1) for 

12 amounts expended for foster care maintenance pay13 ments on behalf of the child unless— 

14 ‘‘(A) the child is placed in a child-care in15 stitution that is a setting specified in paragraph 

16 (2) (or is placed in a licensed residential family17 based treatment facility consistent with sub18 section (j)); and 

19 ‘‘(B) in the case of a child placed in a 

20 qualified residential treatment program (as de21 fined in paragraph (4)), the requirements speci22 fied in paragraph (3) and section 475A(c) are 

23 met. 
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•HR 1892 EAH 

1 ‘‘(2) SPECIFIED SETTINGS FOR PLACEMENT.— 

2 The settings for placement specified in this paragraph 

3 are the following: 

4 ‘‘(A) A qualified residential treatment pro5 gram (as defined in paragraph (4)). 

6 ‘‘(B) A setting specializing in providing 

7 prenatal, post-partum, or parenting supports for 

8 youth. 

9 ‘‘(C) In the case of a child who has attained 

10 18 years of age, a supervised setting in which the 

11 child is living independently. 

12 ‘‘(D) A setting providing high-quality resi13 dential care and supportive services to children 

14 and youth who have been found to be, or are at 

15 risk of becoming, sex trafficking victims, in ac16 cordance with section 471(a)(9)(C). 

17 ‘‘(3) ASSESSMENT TO DETERMINE APPROPRIATE18 NESS OF PLACEMENT IN A QUALIFIED RESIDENTIAL

19 TREATMENT PROGRAM.— 

20 ‘‘(A) DEADLINE FOR ASSESSMENT.—In the 

21 case of a child who is placed in a qualified resi22 dential treatment program, if the assessment re23 quired under section 475A(c)(1) is not completed 

24 within 30 days after the placement is made, no 

25 Federal payment shall be made to the State 
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1 under section 474(a)(1) for any amounts ex2 pended for foster care maintenance payments on 

3 behalf of the child during the placement. 

4 ‘‘(B) DEADLINE FOR TRANSITION OUT OF

5 PLACEMENT.—If the assessment required under 

6 section 475A(c)(1) determines that the placement 

7 of a child in a qualified residential treatment 

8 program is not appropriate, a court disapproves 

9 such a placement under section 475A(c)(2), or a 

10 child who has been in an approved placement in 

11 a qualified residential treatment program is 

12 going to return home or be placed with a fit and 

13 willing relative, a legal guardian, or an adoptive 

14 parent, or in a foster family home, Federal pay15 ments shall be made to the State under section 

16 474(a)(1) for amounts expended for foster care 

17 maintenance payments on behalf of the child 

18 while the child remains in the qualified residen19 tial treatment program only during the period 

20 necessary for the child to transition home or to 

21 such a placement. In no event shall a State re22 ceive Federal payments under section 474(a)(1) 

23 for amounts expended for foster care mainte24 nance payments on behalf of a child who re25 mains placed in a qualified residential treat-
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1 ment program after the end of the 30-day period 

2 that begins on the date a determination is made 

3 that the placement is no longer the recommended 

4 or approved placement for the child. 

5 ‘‘(4) QUALIFIED RESIDENTIAL TREATMENT PRO6 GRAM.—For purposes of this part, the term ‘qualified 

7 residential treatment program’ means a program 

8 that— 

9 ‘‘(A) has a trauma-informed treatment 

10 model that is designed to address the needs, in11 cluding clinical needs as appropriate, of children 

12 with serious emotional or behavioral disorders or 

13 disturbances and, with respect to a child, is able 

14 to implement the treatment identified for the 

15 child by the assessment of the child required 

16 under section 475A(c); 

17 ‘‘(B) subject to paragraphs (5) and (6), has 

18 registered or licensed nursing staff and other li19 censed clinical staff who— 

20 ‘‘(i) provide care within the scope of 

21 their practice as defined by State law; 

22 ‘‘(ii) are on-site in accordance with the 

23 treatment model referred to in subpara24 graph (A); and 
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•HR 1892 EAH 

1 ‘‘(iii) are available 24 hours a day and 

2 7 days a week; 

3 ‘‘(C) to extent appropriate, and in accord4 ance with the child’s best interests, facilitates 

5 participation of family members in the child’s 

6 treatment program; 

7 ‘‘(D) facilitates outreach to the family mem8 bers of the child, including siblings, documents 

9 how the outreach is made (including contact in10 formation), and maintains contact information 

11 for any known biological family and fictive kin 

12 of the child; 

13 ‘‘(E) documents how family members are 

14 integrated into the treatment process for the 

15 child, including post-discharge, and how sibling 

16 connections are maintained; 

17 ‘‘(F) provides discharge planning and fam18 ily-based aftercare support for at least 6 months 

19 post-discharge; and 

20 ‘‘(G) is licensed in accordance with section 

21 471(a)(10) and is accredited by any of the fol22 lowing independent, not-for-profit organizations: 

23 ‘‘(i) The Commission on Accreditation 

24 of Rehabilitation Facilities (CARF). 
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1 ‘‘(ii) The Joint Commission on Accred2 itation of Healthcare Organizations 

3 (JCAHO). 

4 ‘‘(iii) The Council on Accreditation 

5 (COA). 

6 ‘‘(iv) Any other independent, not-for7 profit accrediting organization approved by 

8 the Secretary. 

9 ‘‘(5) ADMINISTRATIVE COSTS.—The prohibition 

10 in paragraph (1) on Federal payments under section 

11 474(a)(1) shall not be construed as prohibiting Fed12 eral payments for administrative expenditures in13 curred on behalf of a child placed in a child-care in14 stitution and for which payment is available under 

15 section 474(a)(3). 

16 ‘‘(6) RULE OF CONSTRUCTION.—The require17 ments in paragraph (4)(B) shall not be construed as 

18 requiring a qualified residential treatment program 

19 to acquire nursing and behavioral health staff solely 

20 through means of a direct employer to employee rela21 tionship.’’. 

22 (2) CONFORMING AMENDMENT.—Section 

23 474(a)(1) of such Act (42 U.S.C. 674(a)(1)), as 

24 amended by section 2622(b) of this Act, is amended 
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1 by striking ‘‘section 472(j)’’ and inserting ‘‘sub2 sections (j) and (k) of section 472’’. 

3 (b) DEFINITION OF FOSTER FAMILY HOME, CHILD4 CARE INSTITUTION.—Section 472(c) of such Act (42 U.S.C. 

5 672(c)(1)) is amended to read as follows: 

6 ‘‘(c) DEFINITIONS.—For purposes of this part: 

7 ‘‘(1) FOSTER FAMILY HOME.— 

8 ‘‘(A) IN GENERAL.—The term ‘foster family 

9 home’ means the home of an individual or fam10 ily— 

11 ‘‘(i) that is licensed or approved by the 

12 State in which it is situated as a foster 

13 family home that meets the standards estab14 lished for the licensing or approval; and 

15 ‘‘(ii) in which a child in foster care 

16 has been placed in the care of an indi17 vidual, who resides with the child and who 

18 has been licensed or approved by the State 

19 to be a foster parent— 

20 ‘‘(I) that the State deems capable 

21 of adhering to the reasonable and pru22 dent parent standard; 

23 ‘‘(II) that provides 24-hour sub24 stitute care for children placed away 
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•HR 1892 EAH 

1 from their parents or other caretakers; 

2 and 

3 ‘‘(III) that provides the care for 

4 not more than six children in foster 

5 care. 

6 ‘‘(B) STATE FLEXIBILITY.—The number of 

7 foster children that may be cared for in a home 

8 under subparagraph (A) may exceed the numer9 ical limitation in subparagraph (A)(ii)(III), at 

10 the option of the State, for any of the following 

11 reasons: 

12 ‘‘(i) To allow a parenting youth in fos13 ter care to remain with the child of the par14 enting youth. 

15 ‘‘(ii) To allow siblings to remain to16 gether. 

17 ‘‘(iii) To allow a child with an estab18 lished meaningful relationship with the 

19 family to remain with the family. 

20 ‘‘(iv) To allow a family with special 

21 training or skills to provide care to a child 

22 who has a severe disability. 

23 ‘‘(C) RULE OF CONSTRUCTION.—Subpara24 graph (A) shall not be construed as prohibiting 

25 a foster parent from renting the home in which 
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•HR 1892 EAH 

1 the parent cares for a foster child placed in the 

2 parent’s care. 

3 ‘‘(2) CHILD-CARE INSTITUTION.— 

4 ‘‘(A) IN GENERAL.—The term ‘child-care in5 stitution’ means a private child-care institution, 

6 or a public child-care institution which accom7 modates no more than 25 children, which is li8 censed by the State in which it is situated or has 

9 been approved by the agency of the State respon10 sible for licensing or approval of institutions of 

11 this type as meeting the standards established for 

12 the licensing. 

13 ‘‘(B) SUPERVISED SETTINGS.—In the case 

14 of a child who has attained 18 years of age, the 

15 term shall include a supervised setting in which 

16 the individual is living independently, in ac17 cordance with such conditions as the Secretary 

18 shall establish in regulations. 

19 ‘‘(C) EXCLUSIONS.—The term shall not in20 clude detention facilities, forestry camps, train21 ing schools, or any other facility operated pri22 marily for the detention of children who are de23 termined to be delinquent.’’. 

24 (c) TRAINING FOR STATE JUDGES, ATTORNEYS, AND

25 OTHER LEGAL PERSONNEL IN CHILD WELFARE CASES.— 
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1 Section 438(b)(1) of such Act (42 U.S.C. 629h(b)(1)) is 

2 amended in the matter preceding subparagraph (A) by in3 serting ‘‘shall provide for the training of judges, attorneys, 

4 and other legal personnel in child welfare cases on Federal 

5 child welfare policies and payment limitations with respect 

6 to children in foster care who are placed in settings that 

7 are not a foster family home,’’ after ‘‘with respect to the 

8 child,’’. 

9 (d) ASSURANCE OF NONIMPACT ON JUVENILE JUSTICE

10 SYSTEM.— 

11 (1) STATE PLAN REQUIREMENT.—Section 471(a) 

12 of such Act (42 U.S.C. 671(a)), as amended by section 

13 2641 of this Act, is further amended by adding at the 

14 end the following: 

15 ‘‘(37) includes a certification that, in response to 

16 the limitation imposed under section 472(k) with re17 spect to foster care maintenance payments made on 

18 behalf of any child who is placed in a setting that is 

19 not a foster family home, the State will not enact or 

20 advance policies or practices that would result in a 

21 significant increase in the population of youth in the 

22 State’s juvenile justice system.’’. 

23 (2) GAO STUDY AND REPORT.—The Comptroller 

24 General of the United States shall evaluate the im25 pact, if any, on State juvenile justice systems of the 
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•HR 1892 EAH 

1 limitation imposed under section 472(k) of the Social 

2 Security Act (as added by subsection (a)(1) of this 

3 section) on foster care maintenance payments made 

4 on behalf of any child who is placed in a setting that 

5 is not a foster family home, in accordance with the 

6 amendments made by subsections (a) and (b) of this 

7 section. In particular, the Comptroller General shall 

8 evaluate the extent to which children in foster care 

9 who also are subject to the juvenile justice system of 

10 the State are placed in a facility under the jurisdic11 tion of the juvenile justice system and whether the 

12 lack of available congregate care placements under the 

13 jurisdiction of the child welfare systems is a contrib14 uting factor to that result. Not later than December 

15 31, 2024, the Comptroller General shall submit to 

16 Congress a report on the results of the evaluation. 

17 SEC. 2652. ASSESSMENT AND DOCUMENTATION OF THE 

18 NEED FOR PLACEMENT IN A QUALIFIED RESI19 DENTIAL TREATMENT PROGRAM. 

20 Section 475A of the Social Security Act (42 U.S.C. 

21 675a) is amended by adding at the end the following: 

22 ‘‘(c) ASSESSMENT, DOCUMENTATION, AND JUDICIAL

23 DETERMINATION REQUIREMENTS FOR PLACEMENT IN A

24 QUALIFIED RESIDENTIAL TREATMENT PROGRAM.—In the 

25 case of any child who is placed in a qualified residential 
417 

•HR 1892 EAH 

1 treatment program (as defined in section 472(k)(4)), the fol2 lowing requirements shall apply for purposes of approving 

3 the case plan for the child and the case system review proce4 dure for the child: 

5 ‘‘(1)(A) Within 30 days of the start of each 

6 placement in such a setting, a qualified individual 

7 (as defined in subparagraph (D)) shall— 

8 ‘‘(i) assess the strengths and needs of the 

9 child using an age-appropriate, evidence-based, 

10 validated, functional assessment tool approved by 

11 the Secretary; 

12 ‘‘(ii) determine whether the needs of the 

13 child can be met with family members or 

14 through placement in a foster family home or, if 

15 not, which setting from among the settings speci16 fied in section 472(k)(2) would provide the most 

17 effective and appropriate level of care for the 

18 child in the least restrictive environment and be 

19 consistent with the short- and long-term goals for 

20 the child, as specified in the permanency plan 

21 for the child; and 

22 ‘‘(iii) develop a list of child-specific short23 and long-term mental and behavioral health 

24 goals. 
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1 ‘‘(B)(i) The State shall assemble a family and 

2 permanency team for the child in accordance with the 

3 requirements of clauses (ii) and (iii). The qualified 

4 individual conducting the assessment required under 

5 subparagraph (A) shall work in conjunction with the 

6 family of, and permanency team for, the child while 

7 conducting and making the assessment. 

8 ‘‘(ii) The family and permanency team shall 

9 consist of all appropriate biological family members, 

10 relative, and fictive kin of the child, as well as, as ap11 propriate, professionals who are a resource to the 

12 family of the child, such as teachers, medical or men13 tal health providers who have treated the child, or 

14 clergy. In the case of a child who has attained age 14, 

15 the family and permanency team shall include the 

16 members of the permanency planning team for the 

17 child that are selected by the child in accordance with 

18 section 475(5)(C)(iv). 

19 ‘‘(iii) The State shall document in the child’s 

20 case plan— 

21 ‘‘(I) the reasonable and good faith effort of 

22 the State to identify and include all such indi23 viduals on the family of, and permanency team 

24 for, the child; 
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•HR 1892 EAH 

1 ‘‘(II) all contact information for members of 

2 the family and permanency team, as well as con3 tact information for other family members and 

4 fictive kin who are not part of the family and 

5 permanency team; 

6 ‘‘(III) evidence that meetings of the family 

7 and permanency team, including meetings relat8 ing to the assessment required under subpara9 graph (A), are held at a time and place conven10 ient for family; 

11 ‘‘(IV) if reunification is the goal, evidence 

12 demonstrating that the parent from whom the 

13 child was removed provided input on the mem14 bers of the family and permanency team; 

15 ‘‘(V) evidence that the assessment required 

16 under subparagraph (A) is determined in con17 junction with the family and permanency team; 

18 ‘‘(VI) the placement preferences of the fam19 ily and permanency team relative to the assess20 ment that recognizes children should be placed 

21 with their siblings unless there is a finding by 

22 the court that such placement is contrary to their 

23 best interest; and 

24 ‘‘(VII) if the placement preferences of the 

25 family and permanency team and child are not 
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•HR 1892 EAH 

1 the placement setting recommended by the quali2 fied individual conducting the assessment under 

3 subparagraph (A), the reasons why the pref4 erences of the team and of the child were not rec5 ommended. 

6 ‘‘(C) In the case of a child who the qualified in7 dividual conducting the assessment under subpara8 graph (A) determines should not be placed in a foster 

9 family home, the qualified individual shall specify in 

10 writing the reasons why the needs of the child cannot 

11 be met by the family of the child or in a foster family 

12 home. A shortage or lack of foster family homes shall 

13 not be an acceptable reason for determining that the 

14 needs of the child cannot be met in a foster family 

15 home. The qualified individual also shall specify in 

16 writing why the recommended placement in a quali17 fied residential treatment program is the setting that 

18 will provide the child with the most effective and ap19 propriate level of care in the least restrictive environ20 ment and how that placement is consistent with the 

21 short- and long-term goals for the child, as specified 

22 in the permanency plan for the child. 

23 ‘‘(D)(i) Subject to clause (ii), in this subsection, 

24 the term ‘qualified individual’ means a trained pro25 fessional or licensed clinician who is not an employee 
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1 of the State agency and who is not connected to, or 

2 affiliated with, any placement setting in which chil3 dren are placed by the State. 

4 ‘‘(ii) The Secretary may approve a request of a 

5 State to waive any requirement in clause (i) upon a 

6 submission by the State, in accordance with criteria 

7 established by the Secretary, that certifies that the 

8 trained professionals or licensed clinicians with re9 sponsibility for performing the assessments described 

10 in subparagraph (A) shall maintain objectivity with 

11 respect to determining the most effective and appro12 priate placement for a child. 

13 ‘‘(2) Within 60 days of the start of each place14 ment in a qualified residential treatment program, a 

15 family or juvenile court or another court (including 

16 a tribal court) of competent jurisdiction, or an ad17 ministrative body appointed or approved by the 

18 court, independently, shall— 

19 ‘‘(A) consider the assessment, determination, 

20 and documentation made by the qualified indi21 vidual conducting the assessment under para22 graph (1); 

23 ‘‘(B) determine whether the needs of the 

24 child can be met through placement in a foster 

25 family home or, if not, whether placement of the 
422 

•HR 1892 EAH 

1 child in a qualified residential treatment pro2 gram provides the most effective and appropriate 

3 level of care for the child in the least restrictive 

4 environment and whether that placement is con5 sistent with the short- and long-term goals for 

6 the child, as specified in the permanency plan 

7 for the child; and 

8 ‘‘(C) approve or disapprove the placement. 

9 ‘‘(3) The written documentation made under 

10 paragraph (1)(C) and documentation of the deter11 mination and approval or disapproval of the place12 ment in a qualified residential treatment program by 

13 a court or administrative body under paragraph (2) 

14 shall be included in and made part of the case plan 

15 for the child. 

16 ‘‘(4) As long as a child remains placed in a 

17 qualified residential treatment program, the State 

18 agency shall submit evidence at each status review 

19 and each permanency hearing held with respect to the 

20 child— 

21 ‘‘(A) demonstrating that ongoing assessment 

22 of the strengths and needs of the child continues 

23 to support the determination that the needs of 

24 the child cannot be met through placement in a 

25 foster family home, that the placement in a 
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•HR 1892 EAH 

1 qualified residential treatment program provides 

2 the most effective and appropriate level of care 

3 for the child in the least restrictive environment, 

4 and that the placement is consistent with the 

5 short- and long-term goals for the child, as speci6 fied in the permanency plan for the child; 

7 ‘‘(B) documenting the specific treatment or 

8 service needs that will be met for the child in the 

9 placement and the length of time the child is ex10 pected to need the treatment or services; and 

11 ‘‘(C) documenting the efforts made by the 

12 State agency to prepare the child to return home 

13 or to be placed with a fit and willing relative, 

14 a legal guardian, or an adoptive parent, or in 

15 a foster family home. 

16 ‘‘(5) In the case of any child who is placed in 

17 a qualified residential treatment program for more 

18 than 12 consecutive months or 18 nonconsecutive 

19 months (or, in the case of a child who has not at20 tained age 13, for more than 6 consecutive or non21 consecutive months), the State agency shall submit to 

22 the Secretary— 

23 ‘‘(A) the most recent versions of the evidence 

24 and documentation specified in paragraph (4); 

25 and 
424 

•HR 1892 EAH 

1 ‘‘(B) the signed approval of the head of the 

2 State agency for the continued placement of the 

3 child in that setting.’’. 

4 SEC. 2653. PROTOCOLS TO PREVENT INAPPROPRIATE DIAG5 NOSES. 

6 (a) STATE PLAN REQUIREMENT.—Section 

7 422(b)(15)(A) of the Social Security Act (42 U.S.C. 

8 622(b)(15)(A)) is amended— 

9 (1) in clause (vi), by striking ‘‘and’’ after the 

10 semicolon; 

11 (2) by redesignating clause (vii) as clause (viii); 

12 and 

13 (3) by inserting after clause (vi) the following: 

14 ‘‘(vii) the procedures and protocols the 

15 State has established to ensure that children 

16 in foster care placements are not inappro17 priately diagnosed with mental illness, 

18 other emotional or behavioral disorders, 

19 medically fragile conditions, or develop20 mental disabilities, and placed in settings 

21 that are not foster family homes as a result 

22 of the inappropriate diagnoses; and’’. 

23 (b) EVALUATION.—Section 476 of such Act (42 U.S.C. 

24 676), as amended by section 2621(d) of this Act, is further 

25 amended by adding at the end the following: 
425 

•HR 1892 EAH 

1 ‘‘(e) EVALUATION OF STATE PROCEDURES AND PRO2 TOCOLS TO PREVENT INAPPROPRIATE DIAGNOSES OF MEN3 TAL ILLNESS OR OTHER CONDITIONS.—The Secretary shall 

4 conduct an evaluation of the procedures and protocols estab5 lished by States in accordance with the requirements of sec6 tion 422(b)(15)(A)(vii). The evaluation shall analyze the ex7 tent to which States comply with and enforce the procedures 

8 and protocols and the effectiveness of various State proce9 dures and protocols and shall identify best practices. Not 

10 later than January 1, 2020, the Secretary shall submit a 

11 report on the results of the evaluation to Congress.’’. 

12 SEC. 2654. ADDITIONAL DATA AND REPORTS REGARDING 

13 CHILDREN PLACED IN A SETTING THAT IS 

14 NOT A FOSTER FAMILY HOME. 

15 Section 479A(a)(7)(A) of the Social Security Act (42 

16 U.S.C. 679b(a)(7)(A)) is amended by striking clauses (i) 

17 through (vi) and inserting the following: 

18 ‘‘(i) with respect to each such place19 ment— 

20 ‘‘(I) the type of the placement set21 ting, including whether the placement 

22 is shelter care, a group home and if so, 

23 the range of the child population in the 

24 home, a residential treatment facility, 

25 a hospital or institution providing 
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•HR 1892 EAH 

1 medical, rehabilitative, or psychiatric 

2 care, a setting specializing in pro3 viding prenatal, post-partum, or par4 enting supports, or some other kind of 

5 child-care institution and if so, what 

6 kind; 

7 ‘‘(II) the number of children in 

8 the placement setting and the age, race, 

9 ethnicity, and gender of each of the 

10 children; 

11 ‘‘(III) for each child in the place12 ment setting, the length of the place13 ment of the child in the setting, wheth14 er the placement of the child in the set15 ting is the first placement of the child 

16 and if not, the number and type of 

17 previous placements of the child, and 

18 whether the child has special needs or 

19 another diagnosed mental or physical 

20 illness or condition; and 

21 ‘‘(IV) the extent of any specialized 

22 education, treatment, counseling, or 

23 other services provided in the setting; 

24 and 
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•HR 1892 EAH 

1 ‘‘(ii) separately, the number and ages 

2 of children in the placements who have a 

3 permanency plan of another planned per4 manent living arrangement; and’’. 

5 SEC. 2655. CRIMINAL RECORDS CHECKS AND CHECKS OF 

6 CHILD ABUSE AND NEGLECT REGISTRIES FOR 

7 ADULTS WORKING IN CHILD-CARE INSTITU8 TIONS AND OTHER GROUP CARE SETTINGS. 

9 (a) STATE PLAN REQUIREMENT.—Section 471(a)(20) 

10 of the Social Security Act (42 U.S.C. 671(a)(20)) is amend11 ed— 

12 (1) in each of subparagraphs (A)(ii) and 

13 (B)(iii), by striking ‘‘and’’ after the semicolon; 

14 (2) in subparagraph (C), by adding ‘‘and’’ after 

15 the semicolon; and 

16 (3) by inserting after subparagraph (C) the fol17 lowing: 

18 ‘‘(D) provides procedures for any child care in19 stitution, including a group home, residential treat20 ment center, shelter, or other congregate care setting, 

21 to conduct criminal records checks, including finger22 print-based checks of national crime information 

23 databases (as defined in section 534(f)(3)(A) of title 

24 28, United States Code), and checks described in sub25 paragraph (B) of this paragraph, on any adult work-
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•HR 1892 EAH 

1 ing in a child-care institution, including a group 

2 home, residential treatment center, shelter, or other 

3 congregate care setting, unless the State reports to the 

4 Secretary the alternative criminal records checks and 

5 child abuse registry checks the State conducts on any 

6 adult working in a child-care institution, including a 

7 group home, residential treatment center, shelter, or 

8 other congregate care setting, and why the checks 

9 specified in this subparagraph are not appropriate 

10 for the State;’’. 

11 (b) TECHNICAL AMENDMENTS.—Subparagraphs (A) 

12 and (C) of section 471(a)(20) of the Social Security Act 

13 (42 U.S.C. 671(a)(20)) are each amended by striking ‘‘sec14 tion 534(e)(3)(A)’’ and inserting ‘‘section 534(f)(3)(A)’’. 

15 SEC. 2656. EFFECTIVE DATES; APPLICATION TO WAIVERS. 

16 (a) EFFECTIVE DATES.— 

17 (1) IN GENERAL.—Subject to paragraph (2) and 

18 subsections (b) through (d), the amendments made by 

19 this chapter shall take effect on January 1, 2018. 

20 (2) TRANSITION RULE.—In the case of a State 

21 plan under part B or E of title IV of the Social Secu22 rity Act which the Secretary of Health and Human 

23 Services determines requires State legislation (other 

24 than legislation appropriating funds) in order for the 

25 plan to meet the additional requirements imposed by 
429 

•HR 1892 EAH 

1 the amendments made by this chapter, the State plan 

2 shall not be regarded as failing to comply with the re3 quirements of such part solely on the basis of the fail4 ure of the plan to meet the additional requirements 

5 before the first day of the first calendar quarter begin6 ning after the close of the first regular session of the 

7 State legislature that begins after the date of enact8 ment of this Act. For purposes of the previous sen9 tence, in the case of a State that has a 2-year legisla10 tive session, each year of the session shall be deemed 

11 to be a separate regular session of the State legisla12 ture. 

13 (b) LIMITATION ON FEDERAL FINANCIAL PARTICIPA14 TION FOR PLACEMENTS THAT ARE NOT IN FOSTER FAMILY

15 HOMES AND RELATED PROVISIONS.— 

16 (1) IN GENERAL.—The amendments made by sec17 tions 2651(a), 2651(b), 2651(d), and 2652 shall take 

18 effect on October 1, 2019. 

19 (2) STATE OPTION TO DELAY EFFECTIVE DATE

20 FOR NOT MORE THAN 2 YEARS.—If a State requests 

21 a delay in the effective date provided for in para22 graph (1), the Secretary of Health and Human Serv23 ices shall delay the effective date with respect to the 

24 State for the amount of time requested by the State 

25 not to exceed 2 years. If the effective date is so delayed 
430 

•HR 1892 EAH 

1 for a period with respect to a State under the pre2 ceding sentence, then— 

3 (A) notwithstanding section 2644, the date 

4 that the amendments made by section 2621(c) 

5 take effect with respect to the State shall be de6 layed for the period; and 

7 (B) in applying section 474(a)(6) of the So8 cial Security Act with respect to the State, ‘‘on 

9 or after the date this paragraph takes effect with 

10 respect to the State’’ is deemed to be substituted 

11 for ‘‘after September 30, 2019’’ in subparagraph 

12 (A)(i)(I) of such section. 

13 (c) CRIMINAL RECORDS CHECKS AND CHECKS OF

14 CHILD ABUSE AND NEGLECT REGISTRIES FOR ADULTS

15 WORKING IN CHILD-CARE INSTITUTIONS AND OTHER

16 GROUP CARE SETTINGS.—The amendments made by sec17 tion 2655 shall take effect on October 1, 2018. 

18 (d) APPLICATION TO STATES WITH WAIVERS.—In the 

19 case of a State that, on the date of enactment of this Act, 

20 has in effect a waiver approved under section 1130 of the 

21 Social Security Act (42 U.S.C. 1320a–9), the amendments 

22 made by this chapter shall not apply with respect to the 

23 State before the expiration (determined without regard to 

24 any extensions) of the waiver to the extent the amendments 

25 are inconsistent with the terms of the waiver. 
431 

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1 CHAPTER 3—CONTINUING SUPPORT FOR 

2 CHILD AND FAMILY SERVICES 

3 SEC. 2661. SUPPORTING AND RETAINING FOSTER FAMILIES 

4 FOR CHILDREN. 

5 (a) SUPPORTING AND RETAINING FOSTER PARENTS AS

6 A FAMILY SUPPORT SERVICE.—Section 431(a)(2)(B) of the 

7 Social Security Act (42 U.S.C. 631(a)(2)(B)) is amended 

8 by redesignating clauses (iii) through (vi) as clauses (iv) 

9 through (vii), respectively, and inserting after clause (ii) 

10 the following: 

11 ‘‘(iii) To support and retain foster 

12 families so they can provide quality family13 based settings for children in foster care.’’. 

14 (b) SUPPORT FOR FOSTER FAMILY HOMES.—Section 

15 436 of such Act (42 U.S.C. 629f) is amended by adding 

16 at the end the following: 

17 ‘‘(c) SUPPORT FOR FOSTER FAMILY HOMES.—Out of 

18 any money in the Treasury of the United States not other19 wise appropriated, there are appropriated to the Secretary 

20 for fiscal year 2018, $8,000,000 for the Secretary to make 

21 competitive grants to States, Indian tribes, or tribal con22 sortia to support the recruitment and retention of high23 quality foster families to increase their capacity to place 

24 more children in family settings, focused on States, Indian 

25 tribes, or tribal consortia with the highest percentage of 
432 

•HR 1892 EAH 

1 children in non-family settings. The amount appropriated 

2 under this subparagraph shall remain available through fis3 cal year 2022.’’. 

4 SEC. 2662. EXTENSION OF CHILD AND FAMILY SERVICES 

5 PROGRAMS. 

6 (a) EXTENSION OF STEPHANIE TUBBS JONES CHILD

7 WELFARE SERVICES PROGRAM.—Section 425 of the Social 

8 Security Act (42 U.S.C. 625) is amended by striking ‘‘2012 

9 through 2016’’ and inserting ‘‘2017 through 2021’’. 

10 (b) EXTENSION OF PROMOTING SAFE AND STABLE

11 FAMILIES PROGRAM AUTHORIZATIONS.— 

12 (1) IN GENERAL.—Section 436(a) of such Act 

13 (42 U.S.C. 629f(a)) is amended by striking all that 

14 follows ‘‘$345,000,000’’ and inserting ‘‘for each of fis15 cal years 2017 through 2021.’’. 

16 (2) DISCRETIONARY GRANTS.—Section 437(a) of 

17 such Act (42 U.S.C. 629g(a)) is amended by striking 

18 ‘‘2012 through 2016’’ and inserting ‘‘2017 through 

19 2021’’. 

20 (c) EXTENSION OF FUNDING RESERVATIONS FOR

21 MONTHLY CASEWORKER VISITS AND REGIONAL PARTNER22 SHIP GRANTS.—Section 436(b) of such Act (42 U.S.C. 

23 629f(b)) is amended— 
433 

•HR 1892 EAH 

1 (1) in paragraph (4)(A), by striking ‘‘2012 

2 through 2016’’ and inserting ‘‘2017 through 2021’’; 

3 and 

4 (2) in paragraph (5), by striking ‘‘2012 through 

5 2016’’ and inserting ‘‘2017 through 2021’’. 

6 (d) REAUTHORIZATION OF FUNDING FOR STATE

7 COURTS.— 

8 (1) EXTENSION OF PROGRAM.—Section 438(c)(1) 

9 of such Act (42 U.S.C. 629h(c)(1)) is amended by 

10 striking ‘‘2012 through 2016’’ and inserting ‘‘2017 

11 through 2021’’. 

12 (2) EXTENSION OF FEDERAL SHARE.—Section 

13 438(d) of such Act (42 U.S.C. 629h(d)) is amended by 

14 striking ‘‘2012 through 2016’’ and inserting ‘‘2017 

15 through 2021’’. 

16 (e) REPEAL OF EXPIRED PROVISIONS.—Section 438(e) 

17 of such Act (42 U.S.C. 629h(e)) is repealed. 

18 SEC. 2663. IMPROVEMENTS TO THE JOHN H. CHAFEE FOS19 TER CARE INDEPENDENCE PROGRAM AND 

20 RELATED PROVISIONS. 

21 (a) AUTHORITY TO SERVE FORMER FOSTER YOUTH

22 UP TO AGE 23.—Section 477 of the Social Security Act (42 

23 U.S.C. 677) is amended— 

24 (1) in subsection (a)(5), by inserting ‘‘(or 23 

25 years of age, in the case of a State with a certifi-
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•HR 1892 EAH 

1 cation under subsection (b)(3)(A)(ii) to provide assist2 ance and services to youths who have aged out of fos3 ter care and have not attained such age, in accord4 ance with such subsection)’’ after ‘‘21 years of age’’; 

5 (2) in subsection (b)(3)(A)— 

6 (A) by inserting ‘‘(i)’’ before ‘‘A certifi7 cation’’; 

8 (B) by striking ‘‘children who have left fos9 ter care’’ and all that follows through the period 

10 and inserting ‘‘youths who have aged out of fos11 ter care and have not attained 21 years of age.’’; 

12 and 

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

14 ‘‘(ii) If the State has elected under section 

15 475(8)(B) to extend eligibility for foster care to 

16 all children who have not attained 21 years of 

17 age, or if the Secretary determines that the State 

18 agency responsible for administering the State 

19 plans under this part and part B uses State 

20 funds or any other funds not provided under this 

21 part to provide services and assistance for youths 

22 who have aged out of foster care that are com23 parable to the services and assistance the youths 

24 would receive if the State had made such an elec25 tion, the certification required under clause (i) 
435 

•HR 1892 EAH 

1 may provide that the State will provide assist2 ance and services to youths who have aged out 

3 of foster care and have not attained 23 years of 

4 age.’’; and 

5 (3) in subsection (b)(3)(B), by striking ‘‘children 

6 who have left foster care’’ and all that follows through 

7 the period and inserting ‘‘youths who have aged out 

8 of foster care and have not attained 21 years of age 

9 (or 23 years of age, in the case of a State with a cer10 tification under subparagraph (A)(i) to provide as11 sistance and services to youths who have aged out of 

12 foster care and have not attained such age, in accord13 ance with subparagraph (A)(ii)).’’. 

14 (b) AUTHORITY TO REDISTRIBUTE UNSPENT

15 FUNDS.—Section 477(d) of such Act (42 U.S.C. 677(d)) is 

16 amended— 

17 (1) in paragraph (4), by inserting ‘‘or does not 

18 expend allocated funds within the time period speci19 fied under section 477(d)(3)’’ after ‘‘provided by the 

20 Secretary’’; and 

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

22 ‘‘(5) REDISTRIBUTION OF UNEXPENDED

23 AMOUNTS.— 

24 ‘‘(A) AVAILABILITY OF AMOUNTS.—To the 

25 extent that amounts paid to States under this 
436 

•HR 1892 EAH 

1 section in a fiscal year remain unexpended by 

2 the States at the end of the succeeding fiscal 

3 year, the Secretary may make the amounts 

4 available for redistribution in the second suc5 ceeding fiscal year among the States that apply 

6 for additional funds under this section for that 

7 second succeeding fiscal year. 

8 ‘‘(B) REDISTRIBUTION.— 

9 ‘‘(i) IN GENERAL.—The Secretary shall 

10 redistribute the amounts made available 

11 under subparagraph (A) for a fiscal year 

12 among eligible applicant States. In this 

13 subparagraph, the term ‘eligible applicant 

14 State’ means a State that has applied for 

15 additional funds for the fiscal year under 

16 subparagraph (A) if the Secretary deter17 mines that the State will use the funds for 

18 the purpose for which originally allotted 

19 under this section. 

20 ‘‘(ii) AMOUNT TO BE REDISTRIB21 UTED.—The amount to be redistributed to 

22 each eligible applicant State shall be the 

23 amount so made available multiplied by the 

24 State foster care ratio, (as defined in sub25 section (c)(4), except that, in such sub-
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•HR 1892 EAH 

1 section, ‘all eligible applicant States (as de2 fined in subsection (d)(5)(B)(i))’ shall be 

3 substituted for ‘all States’). 

4 ‘‘(iii) TREATMENT OF REDISTRIBUTED

5 AMOUNT.—Any amount made available to a 

6 State under this paragraph shall be re7 garded as part of the allotment of the State 

8 under this section for the fiscal year in 

9 which the redistribution is made. 

10 ‘‘(C) TRIBES.—For purposes of this para11 graph, the term ‘State’ includes an Indian tribe, 

12 tribal organization, or tribal consortium that re13 ceives an allotment under this section.’’. 

14 (c) EXPANDING AND CLARIFYING THE USE OF EDU15 CATION AND TRAINING VOUCHERS.— 

16 (1) IN GENERAL.—Section 477(i)(3) of such Act 

17 (42 U.S.C. 677(i)(3)) is amended— 

18 (A) by striking ‘‘on the date’’ and all that 

19 follows through ‘‘23’’ and inserting ‘‘to remain 

20 eligible until they attain 26’’; and 

21 (B) by inserting ‘‘, but in no event may a 

22 youth participate in the program for more than 

23 5 years (whether or not consecutive)’’ before the 

24 period. 
438 

•HR 1892 EAH 

1 (2) CONFORMING AMENDMENT.—Section 

2 477(i)(1) of such Act (42 U.S.C. 677(i)(1)) is amend3 ed by inserting ‘‘who have attained 14 years of age’’ 

4 before the period. 

5 (d) OTHER IMPROVEMENTS.—Section 477 of such Act 

6 (42 U.S.C. 677), as amended by subsections (a), (b), and 

7 (c) of this section, is amended— 

8 (1) in the section heading, by striking ‘‘INDE9 PENDENCE PROGRAM’’ and inserting ‘‘PROGRAM

10 FOR SUCCESSFUL TRANSITION TO ADULT11 HOOD’’; 

12 (2) in subsection (a)— 

13 (A) in paragraph (1)— 

14 (i) by striking ‘‘identify children who 

15 are likely to remain in foster care until 18 

16 years of age and to help these children make 

17 the transition to self-sufficiency by pro18 viding services’’ and inserting ‘‘support all 

19 youth who have experienced foster care at 

20 age 14 or older in their transition to adult21 hood through transitional services’’; 

22 (ii) by inserting ‘‘and post-secondary 

23 education’’ after ‘‘high school diploma’’; and 

24 (iii) by striking ‘‘training in daily liv25 ing skills, training in budgeting and finan-
439 

•HR 1892 EAH 

1 cial management skills’’ and inserting 

2 ‘‘training and opportunities to practice 

3 daily living skills (such as financial lit4 eracy training and driving instruction)’’; 

5 (B) in paragraph (2), by striking ‘‘who are 

6 likely to remain in foster care until 18 years of 

7 age receive the education, training, and services 

8 necessary to obtain employment’’ and inserting 

9 ‘‘who have experienced foster care at age 14 or 

10 older achieve meaningful, permanent connections 

11 with a caring adult’’; 

12 (C) in paragraph (3), by striking ‘‘who are 

13 likely to remain in foster care until 18 years of 

14 age prepare for and enter postsecondary training 

15 and education institutions’’ and inserting ‘‘who 

16 have experienced foster care at age 14 or older 

17 engage in age or developmentally appropriate 

18 activities, positive youth development, and expe19 riential learning that reflects what their peers in 

20 intact families experience’’; and 

21 (D) by striking paragraph (4) and redesig22 nating paragraphs (5) through (8) as para23 graphs (4) through (7); 

24 (3) in subsection (b)— 
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•HR 1892 EAH 

1 (A) in paragraph (2)(D), by striking ‘‘ado2 lescents’’ and inserting ‘‘youth’’; and 

3 (B) in paragraph (3)— 

4 (i) in subparagraph (D)— 

5 (I) by inserting ‘‘including train6 ing on youth development’’ after ‘‘to 

7 provide training’’; and 

8 (II) by striking ‘‘adolescents pre9 paring for independent living’’ and all 

10 that follows through the period and in11 serting ‘‘youth preparing for a success12 ful transition to adulthood and making 

13 a permanent connection with a caring 

14 adult.’’; 

15 (ii) in subparagraph (H), by striking 

16 ‘‘adolescents’’ each place it appears and in17 serting ‘‘youth’’; and 

18 (iii) in subparagraph (K)— 

19 (I) by striking ‘‘an adolescent’’ 

20 and inserting ‘‘a youth’’; and 

21 (II) by striking ‘‘the adolescent’’ 

22 each place it appears and inserting 

23 ‘‘the youth’’; and 

24 (4) in subsection (f), by striking paragraph (2) 

25 and inserting the following: 
441 

•HR 1892 EAH 

1 ‘‘(2) REPORT TO CONGRESS.—Not later than Oc2 tober 1, 2019, the Secretary shall submit to the Com3 mittee on Ways and Means of the House of Represent4 atives and the Committee on Finance of the Senate a 

5 report on the National Youth in Transition Database 

6 and any other databases in which States report out7 come measures relating to children in foster care and 

8 children who have aged out of foster care or left foster 

9 care for kinship guardianship or adoption. The report 

10 shall include the following: 

11 ‘‘(A) A description of the reasons for entry 

12 into foster care and of the foster care experiences, 

13 such as length of stay, number of placement set14 tings, case goal, and discharge reason of 17-year15 olds who are surveyed by the National Youth in 

16 Transition Database and an analysis of the com17 parison of that description with the reasons for 

18 entry and foster care experiences of children of 

19 other ages who exit from foster care before at20 taining age 17. 

21 ‘‘(B) A description of the characteristics of 

22 the individuals who report poor outcomes at ages 

23 19 and 21 to the National Youth in Transition 

24 Database. 
442 

•HR 1892 EAH 

1 ‘‘(C) Benchmarks for determining what con2 stitutes a poor outcome for youth who remain in 

3 or have exited from foster care and plans the ex4 ecutive branch will take to incorporate these 

5 benchmarks in efforts to evaluate child welfare 

6 agency performance in providing services to chil7 dren transitioning from foster care. 

8 ‘‘(D) An analysis of the association between 

9 types of placement, number of overall place10 ments, time spent in foster care, and other fac11 tors, and outcomes at ages 19 and 21. 

12 ‘‘(E) An analysis of the differences in out13 comes for children in and formerly in foster care 

14 at age 19 and 21 among States.’’. 

15 (e) CLARIFYING DOCUMENTATION PROVIDED TO FOS16 TER YOUTH LEAVING FOSTER CARE.—Section 475(5)(I) of 

17 such Act (42 U.S.C. 675(5)(I)) is amended by inserting 

18 after ‘‘REAL ID Act of 2005’’ the following: ‘‘, and any 

19 official documentation necessary to prove that the child was 

20 previously in foster care’’. 
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•HR 1892 EAH 

1 CHAPTER 4—CONTINUING INCENTIVES TO 

2 STATES TO PROMOTE ADOPTION AND 

3 LEGAL GUARDIANSHIP 

4 SEC. 2665. REAUTHORIZING ADOPTION AND LEGAL GUARD5 IANSHIP INCENTIVE PROGRAMS. 

6 (a) IN GENERAL.—Section 473A of the Social Security 

7 Act (42 U.S.C. 673b) is amended— 

8 (1) in subsection (b)(4), by striking ‘‘2013 

9 through 2015’’ and inserting ‘‘2016 through 2020’’; 

10 (2) in subsection (h)(1)(D), by striking ‘‘2016’’ 

11 and inserting ‘‘2021’’; and 

12 (3) in subsection (h)(2), by striking ‘‘2016’’ and 

13 inserting ‘‘2021’’. 

14 (b) EFFECTIVE DATE.—The amendments made by sub15 section (a) shall take effect as if enacted on October 1, 2017. 

16 CHAPTER 5—TECHNICAL CORRECTIONS 

17 SEC. 2667. TECHNICAL CORRECTIONS TO DATA EXCHANGE 

18 STANDARDS TO IMPROVE PROGRAM COORDI19 NATION. 

20 (a) IN GENERAL.—Section 440 of the Social Security 

21 Act (42 U.S.C. 629m) is amended to read as follows: 

22 ‘‘SEC. 440. DATA EXCHANGE STANDARDS FOR IMPROVED 

23 INTEROPERABILITY. 

24 ‘‘(a) DESIGNATION.—The Secretary shall, in consulta25 tion with an interagency work group established by the Of-
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1 fice of Management and Budget and considering State gov2 ernment perspectives, by rule, designate data exchange 

3 standards to govern, under this part and part E— 

4 ‘‘(1) necessary categories of information that 

5 State agencies operating programs under State plans 

6 approved under this part are required under applica7 ble Federal law to electronically exchange with an8 other State agency; and 

9 ‘‘(2) Federal reporting and data exchange re10 quired under applicable Federal law. 

11 ‘‘(b) REQUIREMENTS.—The data exchange standards 

12 required by paragraph (1) shall, to the extent practicable— 

13 ‘‘(1) incorporate a widely accepted, non-propri14 etary, searchable, computer-readable format, such as 

15 the Extensible Markup Language; 

16 ‘‘(2) contain interoperable standards developed 

17 and maintained by intergovernmental partnerships, 

18 such as the National Information Exchange Model; 

19 ‘‘(3) incorporate interoperable standards devel20 oped and maintained by Federal entities with author21 ity over contracting and financial assistance; 

22 ‘‘(4) be consistent with and implement applica23 ble accounting principles; 
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•HR 1892 EAH 

1 ‘‘(5) be implemented in a manner that is cost2 effective and improves program efficiency and effec3 tiveness; and 

4 ‘‘(6) be capable of being continually upgraded as 

5 necessary. 

6 ‘‘(c) RULE OF CONSTRUCTION.—Nothing in this sub7 section shall be construed to require a change to existing 

8 data exchange standards found to be effective and effi9 cient.’’. 

10 (b) EFFECTIVE DATE.—Not later than the date that 

11 is 24 months after the date of the enactment of this section, 

12 the Secretary of Health and Human Services shall issue 

13 a proposed rule that— 

14 (1) identifies federally required data exchanges, 

15 include specification and timing of exchanges to be 

16 standardized, and address the factors used in deter17 mining whether and when to standardize data ex18 changes; and 

19 (2) specifies State implementation options and 

20 describes future milestones. 

21 SEC. 2668. TECHNICAL CORRECTIONS TO STATE REQUIRE22 MENT TO ADDRESS THE DEVELOPMENTAL 

23 NEEDS OF YOUNG CHILDREN. 

24 Section 422(b)(18) of the Social Security Act (42 

25 U.S.C. 622(b)(18)) is amended by striking ‘‘such children’’ 
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•HR 1892 EAH 

1 and inserting ‘‘all vulnerable children under 5 years of 

2 age’’. 

3 CHAPTER 6—ENSURING STATES REINVEST 

4 SAVINGS RESULTING FROM INCREASE 

5 IN ADOPTION ASSISTANCE 

6 SEC. 2669. DELAY OF ADOPTION ASSISTANCE PHASE-IN. 

7 (a) IN GENERAL.—The table in section 473(e)(1)(B) 

8 of the Social Security Act (42 U.S.C. 673(e)(1)(B)) is 

9 amended by striking the last 2 rows and inserting the fol10 lowing: 

‘‘2017 through 2023 ................................. 2 

2024 .......................................................... 2 (or, in the case of a child for whom 

an adoption assistance agreement is 

entered into under this section on or 

after July 1, 2024, any age) 

2025 or thereafter .................................... any age.’’. 

11 (b) EFFECTIVE DATE.—The amendment made by this 

12 section shall take effect on January 1, 2018. 

13 SEC. 2670. GAO STUDY AND REPORT ON STATE REINVEST14 MENT OF SAVINGS RESULTING FROM IN15 CREASE IN ADOPTION ASSISTANCE. 

16 (a) STUDY.—The Comptroller General of the United 

17 States shall study the extent to which States are complying 

18 with the requirements of section 473(a)(8) of the Social Se19 curity Act relating to the effects of phasing out the AFDC 

20 income eligibility requirements for adoption assistance pay21 ments under section 473 of the Social Security Act, as en-
447 

•HR 1892 EAH 

1 acted by section 402 of the Fostering Connections to Success 

2 and Increasing Adoptions Act of 2008 (Public Law 110– 

3 351; 122 Stat. 3975) and amended by section 206 of the 

4 Preventing Sex Trafficking and Strengthening Families Act 

5 (Public Law 113–183; 128 Stat. 1919). In particular, the 

6 Comptroller General shall analyze the extent to which 

7 States are complying with the following requirements under 

8 section 473(a)(8)(D) of the Social Security Act: 

9 (1) The requirement to spend an amount equal 

10 to the amount of the savings (if any) in State expend11 itures under part E of title IV of the Social Security 

12 Act resulting from phasing out the AFDC income eli13 gibility requirements for adoption assistance pay14 ments under section 473 of such Act to provide to 

15 children of families any service that may be provided 

16 under part B or E of title IV of such Act. 

17 (2) The requirement that a State shall spend not 

18 less than 30 percent of the amount of any savings de19 scribed in paragraph (1) on post-adoption services, 

20 post-guardianship services, and services to support 

21 and sustain positive permanent outcomes for children 

22 who otherwise might enter into foster care under the 

responsibility of the State, with at least 2 23 ⁄3 of the 

24 spending by the State to comply with the 30 percent 
448 

•HR 1892 EAH 

1 requirement being spent on post-adoption and post2 guardianship services. 

3 (b) REPORT.—The Comptroller General of the United 

4 States shall submit to the Committee on Finance of the Sen5 ate, the Committee on Ways and Means of the House of 

6 Representatives, and the Secretary of Health and Human 

7 Services a report that contains the results of the study re8 quired by subsection (a), including recommendations to en9 sure compliance with laws referred to in subsection (a). 

10 Subtitle B—Supporting Social Im11 pact Partnerships to Pay for Re12 sults 

13 SEC. 2681. SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO 

14 PAY FOR RESULTS. 

15 Title XX of the Social Security Act (42 U.S.C. 1397 

16 et seq.) is amended— 

17 (1) in the title heading, by striking ‘‘TO 

18 STATES’’ and inserting ‘‘AND PROGRAMS’’; and 

19 (2) by adding at the end the following: 

20 ‘‘Subtitle C—Social Impact Demonstration Projects 

21 ‘‘PURPOSES

22 ‘‘SEC. 2051. The purposes of this subtitle are the fol23 lowing: 
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•HR 1892 EAH 

1 ‘‘(1) To improve the lives of families and indi2 viduals in need in the United States by funding so3 cial programs that achieve real results. 

4 ‘‘(2) To redirect funds away from programs that, 

5 based on objective data, are ineffective, and into pro6 grams that achieve demonstrable, measurable results. 

7 ‘‘(3) To ensure Federal funds are used effectively 

8 on social services to produce positive outcomes for 

9 both service recipients and taxpayers. 

10 ‘‘(4) To establish the use of social impact part11 nerships to address some of our Nation’s most press12 ing problems. 

13 ‘‘(5) To facilitate the creation of public-private 

14 partnerships that bundle philanthropic or other pri15 vate resources with existing public spending to scale 

16 up effective social interventions already being imple17 mented by private organizations, nonprofits, chari18 table organizations, and State and local governments 

19 across the country. 

20 ‘‘(6) To bring pay-for-performance to the social 

21 sector, allowing the United States to improve the im22 pact and effectiveness of vital social services programs 

23 while redirecting inefficient or duplicative spending. 
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•HR 1892 EAH 

1 ‘‘(7) To incorporate outcomes measurement and 

2 randomized controlled trials or other rigorous meth3 odologies for assessing program impact. 

4 ‘‘SOCIAL IMPACT PARTNERSHIP APPLICATION

5 ‘‘SEC. 2052. (a) NOTICE.—Not later than 1 year after 

6 the date of the enactment of this subtitle, the Secretary of 

7 the Treasury, in consultation with the Federal Interagency 

8 Council on Social Impact Partnerships, shall publish in the 

9 Federal Register a request for proposals from States or local 

10 governments for social impact partnership projects in ac11 cordance with this section. 

12 ‘‘(b) REQUIRED OUTCOMES FOR SOCIAL IMPACT PART13 NERSHIP PROJECT.—To qualify as a social impact partner14 ship project under this subtitle, a project must produce one 

15 or more measurable, clearly defined outcomes that result in 

16 social benefit and Federal, State, or local savings through 

17 any of the following: 

18 ‘‘(1) Increasing work and earnings by individ19 uals in the United States who are unemployed for 

20 more than 6 consecutive months. 

21 ‘‘(2) Increasing employment and earnings of in22 dividuals who have attained 16 years of age but not 

23 25 years of age. 

24 ‘‘(3) Increasing employment among individuals 

25 receiving Federal disability benefits. 
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•HR 1892 EAH 

1 ‘‘(4) Reducing the dependence of low-income 

2 families on Federal means-tested benefits. 

3 ‘‘(5) Improving rates of high school graduation. 

4 ‘‘(6) Reducing teen and unplanned pregnancies. 

5 ‘‘(7) Improving birth outcomes and early child6 hood health and development among low-income fami7 lies and individuals. 

8 ‘‘(8) Reducing rates of asthma, diabetes, or other 

9 preventable diseases among low-income families and 

10 individuals to reduce the utilization of emergency and 

11 other high-cost care. 

12 ‘‘(9) Increasing the proportion of children living 

13 in two-parent families. 

14 ‘‘(10) Reducing incidences and adverse con15 sequences of child abuse and neglect. 

16 ‘‘(11) Reducing the number of youth in foster 

17 care by increasing adoptions, permanent guardian18 ship arrangements, reunifications, or placements with 

19 a fit and willing relative, or by avoiding placing chil20 dren in foster care by ensuring they can be cared for 

21 safely in their own homes. 

22 ‘‘(12) Reducing the number of children and 

23 youth in foster care residing in group homes, child 

24 care institutions, agency-operated foster homes, or 

25 other non-family foster homes, unless it is determined 
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•HR 1892 EAH 

1 that it is in the interest of the child’s long-term 

2 health, safety, or psychological well-being to not be 

3 placed in a family foster home. 

4 ‘‘(13) Reducing the number of children returning 

5 to foster care. 

6 ‘‘(14) Reducing recidivism among juvenile of7 fenders, individuals released from prison, or other 

8 high-risk populations. 

9 ‘‘(15) Reducing the rate of homelessness among 

10 our most vulnerable populations. 

11 ‘‘(16) Improving the health and well-being of 

12 those with mental, emotional, and behavioral health 

13 needs. 

14 ‘‘(17) Improving the educational outcomes of spe15 cial-needs or low-income children. 

16 ‘‘(18) Improving the employment and well-being 

17 of returning United States military members. 

18 ‘‘(19) Increasing the financial stability of low19 income families. 

20 ‘‘(20) Increasing the independence and employ21 ability of individuals who are physically or mentally 

22 disabled. 

23 ‘‘(21) Other measurable outcomes defined by the 

24 State or local government that result in positive so25 cial outcomes and Federal savings. 
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•HR 1892 EAH 

1 ‘‘(c) APPLICATION REQUIRED.—The notice described 

2 in subsection (a) shall require a State or local government 

3 to submit an application for the social impact partnership 

4 project that addresses the following: 

5 ‘‘(1) The outcome goals of the project. 

6 ‘‘(2) A description of each intervention in the 

7 project and anticipated outcomes of the intervention. 

8 ‘‘(3) Rigorous evidence demonstrating that the 

9 intervention can be expected to produce the desired 

10 outcomes. 

11 ‘‘(4) The target population that will be served by 

12 the project. 

13 ‘‘(5) The expected social benefits to participants 

14 who receive the intervention and others who may be 

15 impacted. 

16 ‘‘(6) Projected Federal, State, and local govern17 ment costs and other costs to conduct the project. 

18 ‘‘(7) Projected Federal, State, and local govern19 ment savings and other savings, including an esti20 mate of the savings to the Federal Government, on a 

21 program-by-program basis and in the aggregate, if 

22 the project is implemented and the outcomes are 

23 achieved as a result of the intervention. 

24 ‘‘(8) If savings resulting from the successful com25 pletion of the project are estimated to accrue to the 
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•HR 1892 EAH 

1 State or local government, the likelihood of the State 

2 or local government to realize those savings. 

3 ‘‘(9) A plan for delivering the intervention 

4 through a social impact partnership model. 

5 ‘‘(10) A description of the expertise of each serv6 ice provider that will administer the intervention, in7 cluding a summary of the experience of the service 

8 provider in delivering the proposed intervention or a 

9 similar intervention, or demonstrating that the serv10 ice provider has the expertise necessary to deliver the 

11 proposed intervention. 

12 ‘‘(11) An explanation of the experience of the 

13 State or local government, the intermediary, or the 

14 service provider in raising private and philanthropic 

15 capital to fund social service investments. 

16 ‘‘(12) The detailed roles and responsibilities of 

17 each entity involved in the project, including any 

18 State or local government entity, intermediary, serv19 ice provider, independent evaluator, investor, or other 

20 stakeholder. 

21 ‘‘(13) A summary of the experience of the service 

22 provider in delivering the proposed intervention or a 

23 similar intervention, or a summary demonstrating 

24 the service provider has the expertise necessary to de25 liver the proposed intervention. 
455 

•HR 1892 EAH 

1 ‘‘(14) A summary of the unmet need in the area 

2 where the intervention will be delivered or among the 

3 target population who will receive the intervention. 

4 ‘‘(15) The proposed payment terms, the method5 ology used to calculate outcome payments, the pay6 ment schedule, and performance thresholds. 

7 ‘‘(16) The project budget. 

8 ‘‘(17) The project timeline. 

9 ‘‘(18) The criteria used to determine the eligi10 bility of an individual for the project, including how 

11 selected populations will be identified, how they will 

12 be referred to the project, and how they will be en13 rolled in the project. 

14 ‘‘(19) The evaluation design. 

15 ‘‘(20) The metrics that will be used in the eval16 uation to determine whether the outcomes have been 

17 achieved as a result of the intervention and how the 

18 metrics will be measured. 

19 ‘‘(21) An explanation of how the metrics used in 

20 the evaluation to determine whether the outcomes 

21 achieved as a result of the intervention are inde22 pendent, objective indicators of impact and are not 

23 subject to manipulation by the service provider, inter24 mediary, or investor. 
456 

•HR 1892 EAH 

1 ‘‘(22) A summary explaining the independence of 

2 the evaluator from the other entities involved in the 

3 project and the evaluator’s experience in conducting 

4 rigorous evaluations of program effectiveness includ5 ing, where available, well-implemented randomized 

6 controlled trials on the intervention or similar inter7 ventions. 

8 ‘‘(23) The capacity of the service provider to de9 liver the intervention to the number of participants 

10 the State or local government proposes to serve in the 

11 project. 

12 ‘‘(24) A description of whether and how the State 

13 or local government and service providers plan to sus14 tain the intervention, if it is timely and appropriate 

15 to do so, to ensure that successful interventions con16 tinue to operate after the period of the social impact 

17 partnership. 

18 ‘‘(d) PROJECT INTERMEDIARY INFORMATION RE19 QUIRED.—The application described in subsection (c) shall 

20 also contain the following information about any inter21 mediary for the social impact partnership project (whether 

22 an intermediary is a service provider or other entity): 

23 ‘‘(1) Experience and capacity for providing or 

24 facilitating the provision of the type of intervention 

25 proposed. 
457 

•HR 1892 EAH 

1 ‘‘(2) The mission and goals. 

2 ‘‘(3) Information on whether the intermediary is 

3 already working with service providers that provide 

4 this intervention or an explanation of the capacity of 

5 the intermediary to begin working with service pro6 viders to provide the intervention. 

7 ‘‘(4) Experience working in a collaborative envi8 ronment across government and nongovernmental en9 tities. 

10 ‘‘(5) Previous experience collaborating with pub11 lic or private entities to implement evidence-based 

12 programs. 

13 ‘‘(6) Ability to raise or provide funding to cover 

14 operating costs (if applicable to the project). 

15 ‘‘(7) Capacity and infrastructure to track out16 comes and measure results, including— 

17 ‘‘(A) capacity to track and analyze program 

18 performance and assess program impact; and 

19 ‘‘(B) experience with performance-based 

20 awards or performance-based contracting and 

21 achieving project milestones and targets. 

22 ‘‘(8) Role in delivering the intervention. 

23 ‘‘(9) How the intermediary would monitor pro24 gram success, including a description of the interim 

25 benchmarks and outcome measures. 
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•HR 1892 EAH 

1 ‘‘(e) FEASIBILITY STUDIES FUNDED THROUGH OTHER

2 SOURCES.—The notice described in subsection (a) shall per3 mit a State or local government to submit an application 

4 for social impact partnership funding that contains infor5 mation from a feasibility study developed for purposes other 

6 than applying for funding under this subtitle. 

7 ‘‘AWARDING SOCIAL IMPACT PARTNERSHIP AGREEMENTS

8 ‘‘SEC. 2053. (a) TIMELINE IN AWARDING AGREE9 MENT.—Not later than 6 months after receiving an applica10 tion in accordance with section 2052, the Secretary, in con11 sultation with the Federal Interagency Council on Social 

12 Impact Partnerships, shall determine whether to enter into 

13 an agreement for a social impact partnership project with 

14 a State or local government. 

15 ‘‘(b) CONSIDERATIONS IN AWARDING AGREEMENT.— 

16 In determining whether to enter into an agreement for a 

17 social impact partnership project (the application for which 

18 was submitted under section 2052) the Secretary, in con19 sultation with the Federal Interagency Council on Social 

20 Impact Partnerships and the head of any Federal agency 

21 administering a similar intervention or serving a popu22 lation similar to that served by the project, shall consider 

23 each of the following: 

24 ‘‘(1) The recommendations made by the Commis25 sion on Social Impact Partnerships. 
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•HR 1892 EAH 

1 ‘‘(2) The value to the Federal Government of the 

2 outcomes expected to be achieved if the outcomes speci3 fied in the agreement are achieved as a result of the 

4 intervention. 

5 ‘‘(3) The likelihood, based on evidence provided 

6 in the application and other evidence, that the State 

7 or local government in collaboration with the inter8 mediary and the service providers will achieve the 

9 outcomes. 

10 ‘‘(4) The savings to the Federal Government if 

11 the outcomes specified in the agreement are achieved 

12 as a result of the intervention. 

13 ‘‘(5) The savings to the State and local govern14 ments if the outcomes specified in the agreement are 

15 achieved as a result of the intervention. 

16 ‘‘(6) The expected quality of the evaluation that 

17 would be conducted with respect to the agreement. 

18 ‘‘(7) The capacity and commitment of the State 

19 or local government to sustain the intervention, if ap20 propriate and timely and if the intervention is suc21 cessful, beyond the period of the social impact part22 nership. 

23 ‘‘(c) AGREEMENT AUTHORITY.— 

24 ‘‘(1) AGREEMENT REQUIREMENTS.—In accord25 ance with this section, the Secretary, in consultation 
460 

•HR 1892 EAH 

1 with the Federal Interagency Council on Social Im2 pact Partnerships and the head of any Federal agen3 cy administering a similar intervention or serving a 

4 population similar to that served by the project, may 

5 enter into an agreement for a social impact partner6 ship project with a State or local government if the 

7 Secretary, in consultation with the Federal Inter8 agency Council on Social Impact Partnerships, deter9 mines that each of the following requirements are met: 

10 ‘‘(A) The State or local government agrees 

11 to achieve one or more outcomes as a result of 

12 the intervention, as specified in the agreement 

13 and validated by independent evaluation, in 

14 order to receive payment. 

15 ‘‘(B) The Federal payment to the State or 

16 local government for each specified outcome 

17 achieved as a result of the intervention is less 

18 than or equal to the value of the outcome to the 

19 Federal Government over a period not to exceed 

20 10 years, as determined by the Secretary, in con21 sultation with the State or local government. 

22 ‘‘(C) The duration of the project does not 

23 exceed 10 years. 

24 ‘‘(D) The State or local government has 

25 demonstrated, through the application submitted 
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•HR 1892 EAH 

1 under section 2052, that, based on prior rigorous 

2 experimental evaluations or rigorous quasi-ex3 perimental studies, the intervention can be ex4 pected to achieve each outcome specified in the 

5 agreement. 

6 ‘‘(E) The State, local government, inter7 mediary, or service provider has experience rais8 ing private or philanthropic capital to fund so9 cial service investments (if applicable to the 

10 project). 

11 ‘‘(F) The State or local government has 

12 shown that each service provider has experience 

13 delivering the intervention, a similar interven14 tion, or has otherwise demonstrated the expertise 

15 necessary to deliver the intervention. 

16 ‘‘(2) PAYMENT.—The Secretary shall pay the 

17 State or local government only if the independent 

18 evaluator described in section 2055 determines that 

19 the social impact partnership project has met the re20 quirements specified in the agreement and achieved 

21 an outcome as a result of the intervention, as speci22 fied in the agreement and validated by independent 

23 evaluation. 

24 ‘‘(d) NOTICE OF AGREEMENT AWARD.—Not later than 

25 30 days after entering into an agreement under this section 
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•HR 1892 EAH 

1 the Secretary shall publish a notice in the Federal Register 

2 that includes, with regard to the agreement, the following: 

3 ‘‘(1) The outcome goals of the social impact part4 nership project. 

5 ‘‘(2) A description of each intervention in the 

6 project. 

7 ‘‘(3) The target population that will be served by 

8 the project. 

9 ‘‘(4) The expected social benefits to participants 

10 who receive the intervention and others who may be 

11 impacted. 

12 ‘‘(5) The detailed roles, responsibilities, and pur13 poses of each Federal, State, or local government enti14 ty, intermediary, service provider, independent eval15 uator, investor, or other stakeholder. 

16 ‘‘(6) The payment terms, the methodology used to 

17 calculate outcome payments, the payment schedule, 

18 and performance thresholds. 

19 ‘‘(7) The project budget. 

20 ‘‘(8) The project timeline. 

21 ‘‘(9) The project eligibility criteria. 

22 ‘‘(10) The evaluation design. 

23 ‘‘(11) The metrics that will be used in the eval24 uation to determine whether the outcomes have been 
463 

•HR 1892 EAH 

1 achieved as a result of each intervention and how 

2 these metrics will be measured. 

3 ‘‘(12) The estimate of the savings to the Federal, 

4 State, and local government, on a program-by-pro5 gram basis and in the aggregate, if the agreement is 

6 entered into and implemented and the outcomes are 

7 achieved as a result of each intervention. 

8 ‘‘(e) AUTHORITY TO TRANSFER ADMINISTRATION OF

9 AGREEMENT.—The Secretary may transfer to the head of 

10 another Federal agency the authority to administer (includ11 ing making payments under) an agreement entered into 

12 under subsection (c), and any funds necessary to do so. 

13 ‘‘(f) REQUIREMENT ON FUNDING USED TO BENEFIT

14 CHILDREN.—Not less than 50 percent of all Federal pay15 ments made to carry out agreements under this section shall 

16 be used for initiatives that directly benefit children. 

17 ‘‘FEASIBILITY STUDY FUNDING

18 ‘‘SEC. 2054. (a) REQUESTS FOR FUNDING FOR FEASI19 BILITY STUDIES.—The Secretary shall reserve a portion of 

20 the amount made available to carry out this subtitle to as21 sist States or local governments in developing feasibility 

22 studies to apply for social impact partnership funding 

23 under section 2052. To be eligible to receive funding to as24 sist with completing a feasibility study, a State or local 

25 government shall submit an application for feasibility 

26 study funding addressing the following: 
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•HR 1892 EAH 

1 ‘‘(1) A description of the outcome goals of the so2 cial impact partnership project. 

3 ‘‘(2) A description of the intervention, including 

4 anticipated program design, target population, an es5 timate regarding the number of individuals to be 

6 served, and setting for the intervention. 

7 ‘‘(3) Evidence to support the likelihood that the 

8 intervention will produce the desired outcomes. 

9 ‘‘(4) A description of the potential metrics to be 

10 used. 

11 ‘‘(5) The expected social benefits to participants 

12 who receive the intervention and others who may be 

13 impacted. 

14 ‘‘(6) Estimated costs to conduct the project. 

15 ‘‘(7) Estimates of Federal, State, and local gov16 ernment savings and other savings if the project is 

17 implemented and the outcomes are achieved as a re18 sult of each intervention. 

19 ‘‘(8) An estimated timeline for implementation 

20 and completion of the project, which shall not exceed 

21 10 years. 

22 ‘‘(9) With respect to a project for which the State 

23 or local government selects an intermediary to operate 

24 the project, any partnerships needed to successfully 
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•HR 1892 EAH 

1 execute the project and the ability of the intermediary 

2 to foster the partnerships. 

3 ‘‘(10) The expected resources needed to complete 

4 the feasibility study for the State or local government 

5 to apply for social impact partnership funding under 

6 section 2052. 

7 ‘‘(b) FEDERAL SELECTION OF APPLICATIONS FOR FEA8 SIBILITY STUDY.—Not later than 6 months after receiving 

9 an application for feasibility study funding under sub10 section (a), the Secretary, in consultation with the Federal 

11 Interagency Council on Social Impact Partnerships and the 

12 head of any Federal agency administering a similar inter13 vention or serving a population similar to that served by 

14 the project, shall select State or local government feasibility 

15 study proposals for funding based on the following: 

16 ‘‘(1) The recommendations made by the Commis17 sion on Social Impact Partnerships. 

18 ‘‘(2) The likelihood that the proposal will achieve 

19 the desired outcomes. 

20 ‘‘(3) The value of the outcomes expected to be 

21 achieved as a result of each intervention. 

22 ‘‘(4) The potential savings to the Federal Gov23 ernment if the social impact partnership project is 

24 successful. 
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•HR 1892 EAH 

1 ‘‘(5) The potential savings to the State and local 

2 governments if the project is successful. 

3 ‘‘(c) PUBLIC DISCLOSURE.—Not later than 30 days 

4 after selecting a State or local government for feasibility 

5 study funding under this section, the Secretary shall cause 

6 to be published on the website of the Federal Interagency 

7 Council on Social Impact Partnerships information ex8 plaining why a State or local government was granted fea9 sibility study funding. 

10 ‘‘(d) FUNDING RESTRICTION.— 

11 ‘‘(1) FEASIBILITY STUDY RESTRICTION.—The 

12 Secretary may not provide feasibility study funding 

13 under this section for more than 50 percent of the es14 timated total cost of the feasibility study reported in 

15 the State or local government application submitted 

16 under subsection (a). 

17 ‘‘(2) AGGREGATE RESTRICTION.—Of the total 

18 amount made available to carry out this subtitle, the 

19 Secretary may not use more than $10,000,000 to pro20 vide feasibility study funding to States or local gov21 ernments under this section. 

22 ‘‘(3) NO GUARANTEE OF FUNDING.—The Sec23 retary shall have the option to award no funding 

24 under this section. 
467 

•HR 1892 EAH 

1 ‘‘(e) SUBMISSION OF FEASIBILITY STUDY RE2 QUIRED.—Not later than 9 months after the receipt of feasi3 bility study funding under this section, a State or local gov4 ernment receiving the funding shall complete the feasibility 

5 study and submit the study to the Federal Interagency 

6 Council on Social Impact Partnerships. 

7 ‘‘(f) DELEGATION OF AUTHORITY.—The Secretary 

8 may transfer to the head of another Federal agency the au9 thorities provided in this section and any funds necessary 

10 to exercise the authorities. 

11 ‘‘EVALUATIONS

12 ‘‘SEC. 2055. (a) AUTHORITY TO ENTER INTO AGREE13 MENTS.—For each State or local government awarded a so14 cial impact partnership project approved by the Secretary 

15 under this subtitle, the head of the relevant agency, as rec16 ommended by the Federal Interagency Council on Social 

17 Impact Partnerships and determined by the Secretary, shall 

18 enter into an agreement with the State or local government 

19 to pay for all or part of the independent evaluation to deter20 mine whether the State or local government project has 

21 achieved a specific outcome as a result of the intervention 

22 in order for the State or local government to receive outcome 

23 payments under this subtitle. 

24 ‘‘(b) EVALUATOR QUALIFICATIONS.—The head of the 

25 relevant agency may not enter into an agreement with a 

26 State or local government unless the head determines that 
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•HR 1892 EAH 

1 the evaluator is independent of the other parties to the 

2 agreement and has demonstrated substantial experience in 

3 conducting rigorous evaluations of program effectiveness in4 cluding, where available and appropriate, well-imple5 mented randomized controlled trials on the intervention or 

6 similar interventions. 

7 ‘‘(c) METHODOLOGIES TO BE USED.—The evaluation 

8 used to determine whether a State or local government will 

9 receive outcome payments under this subtitle shall use ex10 perimental designs using random assignment or other reli11 able, evidence-based research methodologies, as certified by 

12 the Federal Interagency Council on Social Impact Partner13 ships, that allow for the strongest possible causal inferences 

14 when random assignment is not feasible. 

15 ‘‘(d) PROGRESS REPORT.— 

16 ‘‘(1) SUBMISSION OF REPORT.—The independent 

17 evaluator shall— 

18 ‘‘(A) not later than 2 years after a project 

19 has been approved by the Secretary and bian20 nually thereafter until the project is concluded, 

21 submit to the head of the relevant agency and the 

22 Federal Interagency Council on Social Impact 

23 Partnerships a written report summarizing the 

24 progress that has been made in achieving each 

25 outcome specified in the agreement; and 
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•HR 1892 EAH 

1 ‘‘(B) before the scheduled time of the first 

2 outcome payment and before the scheduled time 

3 of each subsequent payment, submit to the head 

4 of the relevant agency and the Federal Inter5 agency Council on Social Impact Partnerships a 

6 written report that includes the results of the 

7 evaluation conducted to determine whether an 

8 outcome payment should be made along with in9 formation on the unique factors that contributed 

10 to achieving or failing to achieve the outcome, 

11 the challenges faced in attempting to achieve the 

12 outcome, and information on the improved fu13 ture delivery of this or similar interventions. 

14 ‘‘(2) SUBMISSION TO THE SECRETARY AND CON15 GRESS.—Not later than 30 days after receipt of the 

16 written report pursuant to paragraph (1)(B), the 

17 Federal Interagency Council on Social Impact Part18 nerships shall submit the report to the Secretary and 

19 each committee of jurisdiction in the House of Rep20 resentatives and the Senate. 

21 ‘‘(e) FINAL REPORT.— 

22 ‘‘(1) SUBMISSION OF REPORT.—Within 6 months 

23 after the social impact partnership project is com24 pleted, the independent evaluator shall— 
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•HR 1892 EAH 

1 ‘‘(A) evaluate the effects of the activities un2 dertaken pursuant to the agreement with regard 

3 to each outcome specified in the agreement; and 

4 ‘‘(B) submit to the head of the relevant 

5 agency and the Federal Interagency Council on 

6 Social Impact Partnerships a written report that 

7 includes the results of the evaluation and the 

8 conclusion of the evaluator as to whether the 

9 State or local government has fulfilled each obli10 gation of the agreement, along with information 

11 on the unique factors that contributed to the suc12 cess or failure of the project, the challenges faced 

13 in attempting to achieve the outcome, and infor14 mation on the improved future delivery of this or 

15 similar interventions. 

16 ‘‘(2) SUBMISSION TO THE SECRETARY AND CON17 GRESS.—Not later than 30 days after receipt of the 

18 written report pursuant to paragraph (1)(B), the 

19 Federal Interagency Council on Social Impact Part20 nerships shall submit the report to the Secretary and 

21 each committee of jurisdiction in the House of Rep22 resentatives and the Senate. 

23 ‘‘(f) LIMITATION ON COST OF EVALUATIONS.—Of the 

24 amount made available under this subtitle for social impact 

25 partnership projects, the Secretary may not obligate more 
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1 than 15 percent to evaluate the implementation and out2 comes of the projects. 

3 ‘‘(g) DELEGATION OF AUTHORITY.—The Secretary 

4 may transfer to the head of another Federal agency the au5 thorities provided in this section and any funds necessary 

6 to exercise the authorities. 

7 ‘‘FEDERAL INTERAGENCY COUNCIL ON SOCIAL IMPACT

8 PARTNERSHIPS

9 ‘‘SEC. 2056. (a) ESTABLISHMENT.—There is estab10 lished the Federal Interagency Council on Social Impact 

11 Partnerships (in this section referred to as the ‘Council’) 

12 to— 

13 ‘‘(1) coordinate with the Secretary on the efforts 

14 of social impact partnership projects funded under 

15 this subtitle; 

16 ‘‘(2) advise and assist the Secretary in the devel17 opment and implementation of the projects; 

18 ‘‘(3) advise the Secretary on specific pro19 grammatic and policy matter related to the projects; 

20 ‘‘(4) provide subject-matter expertise to the Sec21 retary with regard to the projects; 

22 ‘‘(5) certify to the Secretary that each State or 

23 local government that has entered into an agreement 

24 with the Secretary for a social impact partnership 

25 project under this subtitle and each evaluator selected 

26 by the head of the relevant agency under section 2055 
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•HR 1892 EAH 

1 has access to Federal administrative data to assist the 

2 State or local government and the evaluator in evalu3 ating the performance and outcomes of the project; 

4 ‘‘(6) address issues that will influence the future 

5 of social impact partnership projects in the United 

6 States; 

7 ‘‘(7) provide guidance to the executive branch on 

8 the future of social impact partnership projects in the 

9 United States; 

10 ‘‘(8) prior to approval by the Secretary, certify 

11 that each State and local government application for 

12 a social impact partnership contains rigorous, inde13 pendent data and reliable, evidence-based research 

14 methodologies to support the conclusion that the 

15 project will yield savings to the State or local govern16 ment or the Federal Government if the project out17 comes are achieved; 

18 ‘‘(9) certify to the Secretary, in the case of each 

19 approved social impact partnership that is expected 

20 to yield savings to the Federal Government, that the 

21 project will yield a projected savings to the Federal 

22 Government if the project outcomes are achieved, and 

23 coordinate with the relevant Federal agency to 

24 produce an after-action accounting once the project is 

25 complete to determine the actual Federal savings real-
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1 ized, and the extent to which actual savings aligned 

2 with projected savings; and 

3 ‘‘(10) provide periodic reports to the Secretary 

4 and make available reports periodically to Congress 

5 and the public on the implementation of this subtitle. 

6 ‘‘(b) COMPOSITION OF COUNCIL.—The Council shall 

7 have 11 members, as follows: 

8 ‘‘(1) CHAIR.—The Chair of the Council shall be 

9 the Director of the Office of Management and Budget. 

10 ‘‘(2) OTHER MEMBERS.—The head of each of the 

11 following entities shall designate one officer or em12 ployee of the entity to be a Council member: 

13 ‘‘(A) The Department of Labor. 

14 ‘‘(B) The Department of Health and 

15 Human Services. 

16 ‘‘(C) The Social Security Administration. 

17 ‘‘(D) The Department of Agriculture. 

18 ‘‘(E) The Department of Justice. 

19 ‘‘(F) The Department of Housing and 

20 Urban Development. 

21 ‘‘(G) The Department of Education. 

22 ‘‘(H) The Department of Veterans Affairs. 

23 ‘‘(I) The Department of the Treasury. 

24 ‘‘(J) The Corporation for National and 

25 Community Service. 
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1 ‘‘COMMISSION ON SOCIAL IMPACT PARTNERSHIPS

2 ‘‘SEC. 2057. (a) ESTABLISHMENT.—There is estab3 lished the Commission on Social Impact Partnerships (in 

4 this section referred to as the ‘Commission’). 

5 ‘‘(b) DUTIES.—The duties of the Commission shall be 

6 to— 

7 ‘‘(1) assist the Secretary and the Federal Inter8 agency Council on Social Impact Partnerships in re9 viewing applications for funding under this subtitle; 

10 ‘‘(2) make recommendations to the Secretary and 

11 the Federal Interagency Council on Social Impact 

12 Partnerships regarding the funding of social impact 

13 partnership agreements and feasibility studies; and 

14 ‘‘(3) provide other assistance and information as 

15 requested by the Secretary or the Federal Interagency 

16 Council on Social Impact Partnerships. 

17 ‘‘(c) COMPOSITION.—The Commission shall be com18 posed of nine members, of whom— 

19 ‘‘(1) one shall be appointed by the President, 

20 who will serve as the Chair of the Commission; 

21 ‘‘(2) one shall be appointed by the Majority 

22 Leader of the Senate; 

23 ‘‘(3) one shall be appointed by the Minority 

24 Leader of the Senate; 
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1 ‘‘(4) one shall be appointed by the Speaker of the 

2 House of Representatives; 

3 ‘‘(5) one shall be appointed by the Minority 

4 Leader of the House of Representatives; 

5 ‘‘(6) one shall be appointed by the Chairman of 

6 the Committee on Finance of the Senate; 

7 ‘‘(7) one shall be appointed by the ranking mem8 ber of the Committee on Finance of the Senate; 

9 ‘‘(8) one member shall be appointed by the 

10 Chairman of the Committee on Ways and Means of 

11 the House of Representatives; and 

12 ‘‘(9) one shall be appointed by the ranking mem13 ber of the Committee on Ways and Means of the 

14 House of Representatives. 

15 ‘‘(d) QUALIFICATIONS OF COMMISSION MEMBERS.— 

16 The members of the Commission shall— 

17 ‘‘(1) be experienced in finance, economics, pay 

18 for performance, or program evaluation; 

19 ‘‘(2) have relevant professional or personal expe20 rience in a field related to one or more of the out21 comes listed in this subtitle; or 

22 ‘‘(3) be qualified to review applications for social 

23 impact partnership projects to determine whether the 

24 proposed metrics and evaluation methodologies are 
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1 appropriately rigorous and reliant upon independent 

2 data and evidence-based research. 

3 ‘‘(e) TIMING OF APPOINTMENTS.—The appointments of 

4 the members of the Commission shall be made not later than 

5 120 days after the date of the enactment of this subtitle, 

6 or, in the event of a vacancy, not later than 90 days after 

7 the date the vacancy arises. If a member of Congress fails 

8 to appoint a member by that date, the President may select 

9 a member of the President’s choice on behalf of the member 

10 of Congress. Notwithstanding the preceding sentence, if not 

11 all appointments have been made to the Commission as of 

12 that date, the Commission may operate with no fewer than 

13 five members until all appointments have been made. 

14 ‘‘(f) TERM OF APPOINTMENTS.— 

15 ‘‘(1) IN GENERAL.—The members appointed 

16 under subsection (c) shall serve as follows: 

17 ‘‘(A) Three members shall serve for 2 years. 

18 ‘‘(B) Three members shall serve for 3 years. 

19 ‘‘(C) Three members (one of which shall be 

20 Chair of the Commission appointed by the Presi21 dent) shall serve for 4 years. 

22 ‘‘(2) ASSIGNMENT OF TERMS.—The Commission 

23 shall designate the term length that each member ap24 pointed under subsection (c) shall serve by unanimous 

25 agreement. In the event that unanimous agreement 
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1 cannot be reached, term lengths shall be assigned to 

2 the members by a random process. 

3 ‘‘(g) VACANCIES.—Subject to subsection (e), in the 

4 event of a vacancy in the Commission, whether due to the 

5 resignation of a member, the expiration of a member’s term, 

6 or any other reason, the vacancy shall be filled in the man7 ner in which the original appointment was made and shall 

8 not affect the powers of the Commission. 

9 ‘‘(h) APPOINTMENT POWER.—Members of the Commis10 sion appointed under subsection (c) shall not be subject to 

11 confirmation by the Senate. 

12 ‘‘LIMITATION ON USE OF FUNDS

13 ‘‘SEC. 2058. Of the amounts made available to carry 

14 out this subtitle, the Secretary may not use more than 

15 $2,000,000 in any fiscal year to support the review, ap16 proval, and oversight of social impact partnership projects, 

17 including activities conducted by— 

18 ‘‘(1) the Federal Interagency Council on Social 

19 Impact Partnerships; and 

20 ‘‘(2) any other agency consulted by the Secretary 

21 before approving a social impact partnership project 

22 or a feasibility study under section 2054. 

23 ‘‘NO FEDERAL FUNDING FOR CREDIT ENHANCEMENTS

24 ‘‘SEC. 2059. No amount made available to carry out 

25 this subtitle may be used to provide any insurance, guar26 antee, or other credit enhancement to a State or local gov-
478 

•HR 1892 EAH 

1 ernment under which a Federal payment would be made 

2 to a State or local government as the result of a State or 

3 local government failing to achieve an outcome specified in 

4 an agreement. 

5 ‘‘AVAILABILITY OF FUNDS

6 ‘‘SEC. 2060. Amounts made available to carry out this 

7 subtitle shall remain available until 10 years after the date 

8 of the enactment of this subtitle. 

9 ‘‘WEBSITE

10 ‘‘SEC. 2061. The Federal Interagency Council on So11 cial Impact Partnerships shall establish and maintain a 

12 public website that shall display the following: 

13 ‘‘(1) A copy of, or method of accessing, each no14 tice published regarding a social impact partnership 

15 project pursuant to this subtitle. 

16 ‘‘(2) A copy of each feasibility study funded 

17 under this subtitle. 

18 ‘‘(3) For each State or local government that has 

19 entered into an agreement with the Secretary for a so20 cial impact partnership project, the website shall con21 tain the following information: 

22 ‘‘(A) The outcome goals of the project. 

23 ‘‘(B) A description of each intervention in 

24 the project. 

25 ‘‘(C) The target population that will be 

26 served by the project. 
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1 ‘‘(D) The expected social benefits to partici2 pants who receive the intervention and others 

3 who may be impacted. 

4 ‘‘(E) The detailed roles, responsibilities, and 

5 purposes of each Federal, State, or local govern6 ment entity, intermediary, service provider, 

7 independent evaluator, investor, or other stake8 holder. 

9 ‘‘(F) The payment terms, methodology used 

10 to calculate outcome payments, the payment 

11 schedule, and performance thresholds. 

12 ‘‘(G) The project budget. 

13 ‘‘(H) The project timeline. 

14 ‘‘(I) The project eligibility criteria. 

15 ‘‘(J) The evaluation design. 

16 ‘‘(K) The metrics used to determine whether 

17 the proposed outcomes have been achieved and 

18 how these metrics are measured. 

19 ‘‘(4) A copy of the progress reports and the final 

20 reports relating to each social impact partnership 

21 project. 

22 ‘‘(5) An estimate of the savings to the Federal, 

23 State, and local government, on a program-by-pro24 gram basis and in the aggregate, resulting from the 
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1 successful completion of the social impact partnership 

2 project. 

3 ‘‘REGULATIONS

4 ‘‘SEC. 2062. The Secretary, in consultation with the 

5 Federal Interagency Council on Social Impact Partner6 ships, may issue regulations as necessary to carry out this 

7 subtitle. 

8 ‘‘DEFINITIONS

9 ‘‘SEC. 2063. In this subtitle: 

10 ‘‘(1) AGENCY.—The term ‘agency’ has the mean11 ing given that term in section 551 of title 5, United 

12 States Code. 

13 ‘‘(2) INTERVENTION.—The term ‘intervention’ 

14 means a specific service delivered to achieve an im15 pact through a social impact partnership project. 

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

17 the Secretary of the Treasury. 

18 ‘‘(4) SOCIAL IMPACT PARTNERSHIP PROJECT.— 

19 The term ‘social impact partnership project’ means a 

20 project that finances social services using a social im21 pact partnership model. 

22 ‘‘(5) SOCIAL IMPACT PARTNERSHIP MODEL.—The 

23 term ‘social impact partnership model’ means a 

24 method of financing social services in which— 

25 ‘‘(A) Federal funds are awarded to a State 

26 or local government only if a State or local gov-
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1 ernment achieves certain outcomes agreed on by 

2 the State or local government and the Secretary; 

3 and 

4 ‘‘(B) the State or local government coordi5 nates with service providers, investors (if appli6 cable to the project), and (if necessary) an inter7 mediary to identify— 

8 ‘‘(i) an intervention expected to 

9 produce the outcome; 

10 ‘‘(ii) a service provider to deliver the 

11 intervention to the target population; and 

12 ‘‘(iii) investors to fund the delivery of 

13 the intervention. 

14 ‘‘(6) STATE.—The term ‘State’ means each State 

15 of the United States, the District of Columbia, each 

16 commonwealth, territory or possession of the United 

17 States, and each federally recognized Indian tribe. 

18 ‘‘FUNDING

19 ‘‘SEC. 2064. Out of any money in the Treasury of the 

20 United States not otherwise appropriated, there is hereby 

21 appropriated $92,000,000 for fiscal year 2018 to carry out 

22 this subtitle.’’. 
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1 Subtitle C—Modernizing Child 

2 Support Enforcement Fees 

3 SEC. 2691. MODERNIZING CHILD SUPPORT ENFORCEMENT 

4 FEES. 

5 (a) IN GENERAL.— Section 454(6)(B)(ii) of the Social 

6 Security Act (42 U.S.C. 654(6)(B)(ii)) is amended— 

7 (1) by striking ‘‘$25’’ and inserting ‘‘$35’’; and 

8 (2) by striking ‘‘$500’’ each place it appears and 

9 inserting ‘‘$550’’. 

10 (b) EFFECTIVE DATE.— 

11 (1) IN GENERAL.—The amendment made by sub12 section (a) shall take effect on the 1st day of the 1st 

13 fiscal year that begins on or after the date of the en14 actment of this Act, and shall apply to payments 

15 under part D of title IV of the Social Security Act 

16 for calendar quarters beginning on or after such 1st 

17 day. 

18 (2) DELAY PERMITTED IF STATE LEGISLATION

19 REQUIRED.—If the Secretary of Health and Human 

20 Services determines that State legislation (other than 

21 legislation appropriating funds) is required in order 

22 for a State plan developed pursuant to part D of title 

23 IV of the Social Security Act to meet the requirement 

24 imposed by the amendment made by subsection (a), 

25 the plan shall not be regarded as failing to meet the 
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•HR 1892 EAH 

1 requirement before the 1st day of the 1st calendar 

2 quarter beginning after the first regular session of the 

3 State legislature that begins after the date of the en4 actment of this Act. For purposes of the preceding 

5 sentence, if the State has a 2-year legislative session, 

6 each year of the session is deemed to be a separate 

7 regular session of the State legislature. 

8 Subtitle D—Increasing Efficiency of 

9 Prison Data Reporting 

10 SEC. 2699. INCREASING EFFICIENCY OF PRISON DATA RE11 PORTING. 

12 (a) IN GENERAL.—Section 1611(e)(1)(I)(i)(II) of the 

13 Social Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is 

14 amended by striking ‘‘30 days’’ each place it appears and 

15 inserting ‘‘15 days’’. 

16 (b) EFFECTIVE DATE.—The amendments made by sub17 section (a) shall apply with respect to any payment made 

18 by the Commissioner of Social Security pursuant to section 

19 1611(e)(1)(I)(i)(II) of the Social Security Act (as amended 

20 by such subsection) on or after the date that is 6 months 

21 after the date of enactment of this Act. 
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1 TITLE VII—OFFSETS 

2 SEC. 2701. PAYMENT FOR EARLY DISCHARGES TO HOSPICE 

3 CARE. 

4 (a) IN GENERAL.—Section 1886(d)(5)(J) of the Social 

5 Security Act (42 U.S.C. 1395ww(d)(5)(J)) is amended— 

6 (1) in clause (ii)— 

7 (A) in subclause (III), by striking ‘‘or’’ at 

8 the end; 

9 (B) by redesignating subclause (IV) as sub10 clause (V); and 

11 (C) by inserting after subclause (III) the 

12 following new subclause: 

13 ‘‘(IV) for discharges occurring on 

14 or after October 1, 2022, is provided 

15 hospice care by a hospice program; or’’; 

16 and 

17 (2) in clause (iv)— 

18 (A) by inserting after the first sentence the 

19 following new sentence: ‘‘The Secretary shall in20 clude in the proposed rule published for fiscal 

21 year 2023, a description of the effect of clause 

22 (ii)(IV).’’; and 

23 (B) in subclause (I), by striking ‘‘and 

24 (III)’’ and inserting ‘‘(III), and, in the case of 
485 

•HR 1892 EAH 

1 proposed and final rules for fiscal year 2023 and 

2 subsequent fiscal years, (IV)’’. 

3 (b) MEDPAC EVALUATION AND REPORT ON HOSPITAL

4 TO HOSPICE TRANSFERS.— 

5 (1) EVALUATION.—The Medicare Payment Advi6 sory Commission (in this subsection referred to as the 

7 ‘‘Commission’’) shall conduct an evaluation of the ef8 fects of the amendments made by subsection (a), in9 cluding the effects on— 

10 (A) the numbers of discharges of patients 

11 from an inpatient hospital setting to a hospice 

12 program; 

13 (B) the lengths of stays of patients in an in14 patient hospital setting who are discharged to a 

15 hospice program; 

16 (C) spending under the Medicare program 

17 under title XVIII of the Social Security Act; and 

18 (D) other areas determined appropriate by 

19 the Commission. 

20 (2) CONSIDERATION.—In conducting the evalua21 tion under paragraph (1), the Commission shall con22 sider factors such as whether the timely access to hos23 pice care by patients admitted to a hospital has been 

24 affected through changes to hospital policies or behav25 iors made as a result of such amendments. 
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1 (3) PRELIMINARY RESULTS.—Not later than 

2 March 15, 2024, the Commission shall provide Con3 gress with preliminary results on the evaluation being 

4 conducted under paragraph (1). 

5 (4) REPORT.—Not later than March 15, 2025, 

6 the Commission shall submit to Congress a report on 

7 the evaluation conducted under paragraph (1). 

8 SEC. 2702. HOME HEALTH MARKET BASKET REDUCTION. 

9 Section 1895(b)(3)(B) of the Social Security Act (42 

10 U.S.C. 1395fff(b)(3)(B)) is amended— 

11 (1) in clause (iii), in the last sentence, by insert12 ing before the period at the end the following: ‘‘and 

13 for 2020 shall be 1.5 percent’’; and 

14 (2) in clause (vi), by inserting ‘‘and 2020’’ after 

15 ‘‘except 2018’’. 

16 SEC. 2703. REDUCTION FOR NON-EMERGENCY ESRD AMBU17 LANCE TRANSPORTS. 

18 Section 1834(l)(15) of the Social Security Act (42. 

19 U.S.C. 1395m(l)(15)) is amended by striking ‘‘on or after 

20 October 1, 2013’’ and inserting ‘‘during the period begin21 ning on October 1, 2013, and ending on September 30, 

22 2018, and by 23 percent for such services furnished on or 

23 after October 1, 2018’’. 
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1 SEC. 2704. EXTENSION OF TARGET FOR RELATIVE VALUE 

2 ADJUSTMENTS FOR MISVALUED SERVICES 

3 AND TRANSITIONAL PAYMENT RULES FOR 

4 CERTAIN RADIATION THERAPY SERVICES 

5 UNDER THE PHYSICIAN FEE SCHEDULE. 

6 Section 1848 of the Social Security Act (42 U.S.C. 

7 1395w–4) is amended— 

8 (1) in subsection (b)(11), by striking ‘‘2017 and 

9 2018’’ and inserting ‘‘2017, 2018, and 2019’’; and 

10 (2) in subsection (c)(2)— 

11 (A) in subparagraph (K)(iv), by striking 

12 ‘‘2017 and 2018’’ and inserting ‘‘2017, 2018, 

13 and 2019’’; and 

14 (B) in subparagraph (O), by striking 

15 ‘‘2018’’ and inserting ‘‘2019’’. 

16 SEC. 2705. DELAY IN AUTHORITY TO TERMINATE CON17 TRACTS FOR MEDICARE ADVANTAGE PLANS 

18 FAILING TO ACHIEVE MINIMUM QUALITY RAT19 INGS. 

20 Section 1857(h)(3) of the Social Security Act (42 

21 U.S.C. 1395w–27(h)(3)) is amended by striking ‘‘2018’’ and 

22 inserting ‘‘2027’’. 

23 SEC. 2706. MEDICARE IMPROVEMENT FUND. 

24 Section 1898(b)(1) of the Social Security Act (42 

25 U.S.C. 1395iii(b)(1)) is amended by striking ‘‘during and 

26 after fiscal year 2021’’ and all that follows through the pe-
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1 riod at the end and inserting ‘‘during and after fiscal year 

2 2021, $0.’’. 

3 SEC. 2707. PAYMENT FOR OUTPATIENT PHYSICAL THERAPY 

4 SERVICES AND OUTPATIENT OCCUPATIONAL 

5 THERAPY SERVICES FURNISHED BY A THER6 APY ASSISTANT. 

7 Section 1834 of the Social Security Act (42 U.S.C. 

8 1395m), as amended by sections 2204 and 2414, is further 

9 amended by adding at the end the following new subsection: 

10 ‘‘(x) PAYMENT FOR OUTPATIENT PHYSICAL THERAPY

11 SERVICES AND OUTPATIENT OCCUPATIONAL THERAPY

12 SERVICES FURNISHED BY A THERAPY ASSISTANT.— 

13 ‘‘(1) IN GENERAL.—In the case of an outpatient 

14 physical therapy service or outpatient occupational 

15 therapy service furnished on or after January 1, 

16 2022, for which payment is made under section 1848 

17 or subsection (k), that is furnished in whole or in 

18 part by a therapy assistant (as defined by the Sec19 retary), the amount of payment for such service shall 

20 be an amount equal to 85 percent of the amount of 

21 payment otherwise applicable for the service under 

22 this part. Nothing in the preceding sentence shall be 

23 construed to change applicable requirements with re24 spect to such services. 

25 ‘‘(2) USE OF MODIFIER.— 
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1 ‘‘(A) ESTABLISHMENT.—Not later than 

2 January 1, 2019, the Secretary shall establish a 

3 modifier to indicate (in a form and manner 

4 specified by the Secretary), in the case of an out5 patient physical therapy service or outpatient 

6 occupational therapy service furnished in whole 

7 or in part by a therapy assistant (as so defined), 

8 that the service was furnished by a therapy as9 sistant. 

10 ‘‘(B) REQUIRED USE.—Each request for 

11 payment, or bill submitted, for an outpatient 

12 physical therapy service or outpatient occupa13 tional therapy service furnished in whole or in 

14 part by a therapy assistant (as so defined) on or 

15 after January 1, 2020, shall include the modifier 

16 established under subparagraph (A) for each 

17 such service. 

18 ‘‘(3) IMPLEMENTATION.—The Secretary shall im19 plement this subsection through notice and comment 

20 rulemaking.’’. 

21 SEC. 2708. CHANGES TO LONG-TERM CARE HOSPITAL PAY22 MENTS. 

23 (a) EXTENSION.—Section 1886(m)(6)(B)(i) of the So24 cial Security Act (42 U.S.C. 1395ww(m)(6)(B)(i)) is 

25 amended— 
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1 (1) in subclause (I), by striking ‘‘fiscal year 

2 2016 or fiscal year 2017’’ and inserting ‘‘fiscal years 

3 2016 through 2019’’; and 

4 (2) in subclause (II), by striking ‘‘2018’’ and in5 serting ‘‘2020’’. 

6 (b) TEMPORARY ADJUSTMENT TO SITE NEUTRAL PAY7 MENT RATES.—Section 1886(m)(6)(B) of the Social Secu8 rity Act (42 U.S.C. 1395ww(m)(6)(B)) is amended— 

9 (1) in clause (ii), in the matter preceding sub10 clause (I), by striking ‘‘In this paragraph’’ and in11 serting ‘‘Subject to clause (iv), in this paragraph’’; 

12 and 

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

14 clause: 

15 ‘‘(iv) ADJUSTMENT.—For each of fiscal 

16 years 2018 through 2026, the amount that 

17 would otherwise apply under clause (ii)(I) 

18 for the year (determined without regard to 

19 this clause) shall be reduced by 4.6 per20 cent.’’. 

21 SEC. 2709. NON-BUDGET NEUTRAL TRANSITIONAL PASS22 THROUGH PAYMENT CHANGE FOR CERTAIN 

23 PRODUCTS. 

24 (a) IN GENERAL.—Subsection 1833(t)(6)(A)(iv) of the 

25 Social Security Act (42 U.S.C. 1395l(t)(6)(A)(iv)) is 
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1 amended by inserting ‘‘(except, beginning as of April 1, 

2 2018, a biosimilar biological product (as defined under sec3 tion 1847A(c)(6)(H)))’’ after ‘‘biological’’. 

4 (b) APPLICATION.—The amendment made by sub5 section (a) shall apply with respect to biosimilar biological 

6 products beginning on April 1, 2018, regardless of whether 

7 such products were receiving pass-through status for an ad8 ditional payment under section 1833(t)(6) of the Social Se9 curity Act (42 U.S.C. 1395l(t)(6)) before such date. In the 

10 case of a product that was receiving such an additional 

11 payment pursuant to clause (iv) of subparagraph (A) of 

12 such section as of the day before such date and after appli13 cation of the amendment under subsection (a) is not eligible 

14 for such an additional payment as of such date, such prod15 uct may not be eligible for such an additional payment pur16 suant to any other clause of such subparagraph (A). 

17 SEC. 2710. THIRD PARTY LIABILITY IN MEDICAID AND CHIP. 

18 (a) MODIFICATION OF THIRD PARTY LIABILITY RULES

19 RELATED TO SPECIAL TREATMENT OF CERTAIN TYPES OF

20 CARE AND PAYMENTS.— 

21 (1) IN GENERAL.—Section 1902(a)(25)(E) of the 

22 Social Security Act (42 U.S.C. 1396a(a)(25)(E)) is 

23 amended, in the matter preceding clause (i), by strik24 ing ‘‘prenatal or’’. 
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1 (2) EFFECTIVE DATE.—The amendment made by 

2 paragraph (1) shall take effect on the date of enact3 ment of this Act. 

4 (b) DELAY IN EFFECTIVE DATE AND REPEAL OF CER5 TAIN BIPARTISAN BUDGET ACT OF 2013 AMENDMENTS.— 

6 (1) REPEAL.—Effective as of September 30, 

7 2017, subsection (b) of section 202 of the Bipartisan 

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

9 1177; 42 U.S.C. 1396a note) (including any amend10 ments made by such subsection) is repealed and the 

11 provisions amended by such subsection shall be ap12 plied and administered as if such amendments had 

13 never been enacted. 

14 (2) DELAY IN EFFECTIVE DATE.—Subsection (c) 

15 of section 202 of the Bipartisan Budget Act of 2013 

16 (Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 

17 1396a note) is amended to read as follows: 

18 ‘‘(c) EFFECTIVE DATE.—The amendments made by 

19 subsection (a) shall take effect on October 1, 2019.’’. 

20 (3) EFFECTIVE DATE; TREATMENT.—The repeal 

21 and amendment made by this subsection shall take ef22 fect as if enacted on September 30, 2017, and shall 

23 apply with respect to any open claims, including 

24 claims pending, generated, or filed, after such date. 

25 The amendments made by subsections (a) and (b) of 
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1 section 202 of the Bipartisan Budget Act of 2013 

2 (Public Law 113–67; 127 Stat. 1177; 42 U.S.C. 

3 1396a note) that took effect on October 1, 2017, are 

4 null and void and section 1902(a)(25) of the Social 

5 Security Act (42 U.S.C. 1396a(a)(25)) shall be ap6 plied and administered as if such amendments had 

7 not taken effect on such date. 

8 (c) GAO STUDY AND REPORT.—Not later than 18 

9 months after the date of enactment of this Act, the Comp10 troller General of the United States shall submit a report 

11 to the Committee on Energy and Commerce of the House 

12 of Representatives and the Committee on Finance of the 

13 Senate on the impacts of the amendments made by sub14 sections (a)(1) and (b)(2), including— 

15 (1) the impact, or potential effect, of such 

16 amendments on access to prenatal and preventive pe17 diatric care (including early and periodic screening, 

18 diagnostic, and treatment services) covered under 

19 State plans under such title (or waivers of such 

20 plans); 

21 (2) the impact, or potential effect, of such 

22 amendments on access to services covered under such 

23 plans or waivers for individuals on whose behalf child 

24 support enforcement is being carried out by a State 

25 agency under part D of title IV of such Act; and 
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1 (3) the impact, or potential effect, on providers 

2 of services under such plans or waivers of delays in 

3 payment or related issues that result from such 

4 amendments. 

5 (d) APPLICATION TO CHIP.— 

6 (1) IN GENERAL.—Section 2107(e)(1) of the So7 cial Security Act (42 U.S.C. 1397gg(e)(1)) is amend8 ed— 

9 (A) by redesignating subparagraphs (B) 

10 through (R) as subparagraphs (C) through (S), 

11 respectively; and 

12 (B) by inserting after subparagraph (A) the 

13 following new subparagraph: 

14 ‘‘(B) Section 1902(a)(25) (relating to third 

15 party liability).’’. 

16 (2) MANDATORY REPORTING.—Section 

17 1902(a)(25)(I)(i) of the Social Security Act (42 

18 U.S.C. 1396a(a)(25)(I)(i)) is amended— 

19 (A) by striking ‘‘medical assistance under 

20 the State plan’’ and inserting ‘‘medical assist21 ance under a State plan (or under a waiver of 

22 the plan)’’; 

23 (B) by striking ‘‘(and, at State option, 

24 child’’ and inserting ‘‘and child’’; and 
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1 (C) by striking ‘‘title XXI)’’ and inserting 

2 ‘‘title XXI’’. 

3 SEC. 2711. TREATMENT OF LOTTERY WINNINGS AND OTHER 

4 LUMP-SUM INCOME FOR PURPOSES OF IN5 COME ELIGIBILITY UNDER MEDICAID. 

6 (a) IN GENERAL.—Section 1902 of the Social Security 

7 Act (42 U.S.C. 1396a) is amended— 

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

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

10 (2) in subsection (e)(14), by adding at the end 

11 the following new subparagraph: 

12 ‘‘(K) TREATMENT OF CERTAIN LOTTERY

13 WINNINGS AND INCOME RECEIVED AS A LUMP

14 SUM.— 

15 ‘‘(i) IN GENERAL.—In the case of an 

16 individual who is the recipient of qualified 

17 lottery winnings (pursuant to lotteries oc18 curring on or after January 1, 2018) or 

19 qualified lump sum income (received on or 

20 after such date) and whose eligibility for 

21 medical assistance is determined based on 

22 the application of modified adjusted gross 

23 income under subparagraph (A), a State 

24 shall, in determining such eligibility, in-
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1 clude such winnings or income (as applica2 ble) as income received— 

3 ‘‘(I) in the month in which such 

4 winnings or income (as applicable) is 

5 received if the amount of such 

6 winnings or income is less than 

7 $80,000; 

8 ‘‘(II) over a period of 2 months if 

9 the amount of such winnings or income 

10 (as applicable) is greater than or equal 

11 to $80,000 but less than $90,000; 

12 ‘‘(III) over a period of 3 months 

13 if the amount of such winnings or in14 come (as applicable) is greater than or 

15 equal to $90,000 but less than 

16 $100,000; and 

17 ‘‘(IV) over a period of 3 months 

18 plus 1 additional month for each incre19 ment of $10,000 of such winnings or 

20 income (as applicable) received, not to 

21 exceed a period of 120 months (for 

22 winnings or income of $1,260,000 or 

23 more), if the amount of such winnings 

24 or income is greater than or equal to 

25 $100,000. 
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1 ‘‘(ii) COUNTING IN EQUAL INSTALL2 MENTS.—For purposes of subclauses (II), 

3 (III), and (IV) of clause (i), winnings or 

4 income to which such subclause applies 

5 shall be counted in equal monthly install6 ments over the period of months specified 

7 under such subclause. 

8 ‘‘(iii) HARDSHIP EXEMPTION.—An in9 dividual whose income, by application of 

10 clause (i), exceeds the applicable eligibility 

11 threshold established by the State, shall con12 tinue to be eligible for medical assistance to 

13 the extent that the State determines, under 

14 procedures established by the State (in ac15 cordance with standards specified by the 

16 Secretary), that the denial of eligibility of 

17 the individual would cause an undue med18 ical or financial hardship as determined on 

19 the basis of criteria established by the Sec20 retary. 

21 ‘‘(iv) NOTIFICATIONS AND ASSISTANCE

22 REQUIRED IN CASE OF LOSS OF ELIGI23 BILITY.—A State shall, with respect to an 

24 individual who loses eligibility for medical 
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1 assistance under the State plan (or a waiv2 er of such plan) by reason of clause (i)— 

3 ‘‘(I) before the date on which the 

4 individual loses such eligibility, inform 

5 the individual— 

6 ‘‘(aa) of the individual’s op7 portunity to enroll in a qualified 

8 health plan offered through an 

9 Exchange established under title I 

10 of the Patient Protection and Af11 fordable Care Act during the spe12 cial enrollment period specified in 

13 section 9801(f)(3) of the Internal 

14 Revenue Code of 1986 (relating to 

15 loss of Medicaid or CHIP cov16 erage); and 

17 ‘‘(bb) of the date on which 

18 the individual would no longer be 

19 considered ineligible by reason of 

20 clause (i) to receive medical as21 sistance under the State plan or 

22 under any waiver of such plan 

23 and be eligible to reapply to re24 ceive such medical assistance; and 
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1 ‘‘(II) provide technical assistance 

2 to the individual seeking to enroll in 

3 such a qualified health plan. 

4 ‘‘(v) QUALIFIED LOTTERY WINNINGS

5 DEFINED.—In this subparagraph, the term 

6 ‘qualified lottery winnings’ means winnings 

7 from a sweepstakes, lottery, or pool de8 scribed in paragraph (3) of section 4402 of 

9 the Internal Revenue Code of 1986 or a lot10 tery operated by a multistate or multijuris11 dictional lottery association, including 

12 amounts awarded as a lump sum payment. 

13 ‘‘(vi) QUALIFIED LUMP SUM INCOME

14 DEFINED.—In this subparagraph, the term 

15 ‘qualified lump sum income’ means income 

16 that is received as a lump sum from mone17 tary winnings from gambling (as defined by 

18 the Secretary and including gambling ac19 tivities described in section 1955(b)(4) of 

20 title 18, United States Code).’’. 

21 (b) RULES OF CONSTRUCTION.— 

22 (1) INTERCEPTION OF LOTTERY WINNINGS AL23 LOWED.—Nothing in the amendment made by sub24 section (a)(2) shall be construed as preventing a State 

25 from intercepting the State lottery winnings awarded 
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1 to an individual in the State to recover amounts paid 

2 by the State under the State Medicaid plan under 

3 title XIX of the Social Security Act (42 U.S.C. 1396 

4 et seq.) for medical assistance furnished to the indi5 vidual. 

6 (2) APPLICABILITY LIMITED TO ELIGIBILITY OF

7 RECIPIENT OF LOTTERY WINNINGS OR LUMP SUM IN8 COME.—Nothing in the amendment made by sub9 section (a)(2) shall be construed, with respect to a de10 termination of household income for purposes of a de11 termination of eligibility for medical assistance under 

12 the State plan under title XIX of the Social Security 

13 Act (42 U.S.C. 1396 et seq.) (or a waiver of such 

14 plan) made by applying modified adjusted gross in15 come under subparagraph (A) of section 1902(e)(14) 

16 of such Act (42 U.S.C. 1396a(e)(14)), as limiting the 

17 eligibility for such medical assistance of any indi18 vidual that is a member of the household other than 

19 the individual who received qualified lottery winnings 

20 or qualified lump-sum income (as defined in subpara21 graph (K) of such section 1902(e)(14), as added by 

22 subsection (a)(2) of this section). 
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1 SEC. 2712. MODIFYING REDUCTIONS IN MEDICAID DSH AL2 LOTMENTS. 

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

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

5 (1) in clause (i), in the matter preceding sub6 clause (I), by striking ‘‘2018’’ and inserting ‘‘2020’’; 

7 and 

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

9 through (VIII) and inserting the following: 

10 ‘‘(I) $4,000,000,000 for fiscal year 

11 2020; and 

12 ‘‘(II) $8,000,000,000 for each of 

13 fiscal years 2021 through 2025.’’. 

14 SEC. 2713. MEDICAID IMPROVEMENT FUND RESCISSION. 

15 Section 1941(b) of the Social Security Act (42 U.S.C 

16 1396w–1(b)) is amended— 

17 (1) in paragraph (1), by striking ‘‘$5,000,000’’ 

18 and inserting ‘‘$0’’; and 

19 (2) in paragraph (3)(A) (as added by section 

20 3006(2)(B) of the Helping Ensure Access for Little 

21 Ones, Toddlers, and Hopeful Youth by Keeping Insur22 ance Delivery Stable Act (Public Law 115–120)), by 

23 striking ‘‘$980,000,000’’ and inserting ‘‘$0’’. 
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1 SEC. 2714. SUNSETTING EXCLUSION OF BIOSIMILARS FROM 

2 MEDICARE PART D COVERAGE GAP DISCOUNT 

3 PROGRAM. 

4 Section 1860D–14A(g)(2)(A) of the Social Security 

5 Act (42 U.S.C. 1395w–114a(g)(2)(A)) is amended by insert6 ing ‘‘, with respect to a plan year before 2019,’’ after ‘‘other 

7 than’’. 

8 SEC. 2715. PREVENTION AND PUBLIC HEALTH FUND. 

9 Section 4002(b) of the Patient Protection and Afford10 able Care Act (42 U.S.C. 300u–11(b)) is amended by strik11 ing paragraphs (1) through (9) and inserting the following 

12 new paragraphs: 

13 ‘‘(1) for each of fiscal years 2018 and 2019, 

14 $900,000,000; 

15 ‘‘(2) for each of fiscal years 2020 and 2021, 

16 $1,000,000,000; 

17 ‘‘(3) for each of fiscal years 2022 through 2027, 

18 $1,100,000,000; and 

19 ‘‘(4) for fiscal year 2028 and each subsequent fis20 cal year, $2,000,000,000.’’. 

21 DIVISION G—BUDGETARY 

22 EFFECTS 

23 SEC. 3001. BUDGETARY EFFECTS. 

24 (a) IN GENERAL.—The budgetary effects of division D 

25 and each succeeding division shall not be entered on either 
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1 PAYGO scorecard maintained pursuant to section 4(d) of 

2 the Statutory Pay-As-You-Go Act of 2010. 

3 (b) SENATE PAYGO SCORECARDS.—The budgetary ef4 fects of division D and each succeeding division shall not 

5 be entered on any PAYGO scorecard maintained for pur6 poses of section 4106 of H. Con. Res. 71 (115th Congress). 

7 (c) CLASSIFICATION OF BUDGETARY EFFECTS.—Not8 withstanding Rule 3 of the Budget Scorekeeping Guidelines 

9 set forth in the joint explanatory statement of the committee 

10 of conference accompanying Conference Report 105–217 

11 and section 250(c)(8) of the Balanced Budget and Emer12 gency Deficit Control Act of 1985, the budgetary effects of 

13 division D and each succeeding division shall not be esti14 mated— 

15 (1) for purposes of section 251 of such Act; and 

16 (2) for purposes of paragraph (4)(C) of section 

17 3 of the Statutory Pay-As-You-Go Act of 2010 as 

18 being included in an appropriation Act. 

Attest: 

Clerk. 
115TH CONGRESS 

2D SESSION H.R. 1892 

HOUSE AMENDMENT TO 

SENATE AMENDMENT