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[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1892 Engrossed Amendment House (EAH)]

<DOC>
                In the House of Representatives, U. S.,

                                                      February 6, 2018.
    Resolved, That the House agree to the amendment of the Senate to 
the bill (H.R. 1892) entitled ``An Act to amend title 4, United States 
Code, to provide for the flying of the flag at half-staff in the event 
of the death of a first responder in the line of duty.'', with the 
following

                  HOUSE AMENDMENT TO SENATE AMENDMENT:

            At the end of the matter inserted by the Senate amendment, 
      insert the following:

  DIVISION B--FURTHER EXTENSION OF CONTINUING APPROPRIATIONS ACT, 2018

    Sec. 1001.  The Continuing Appropriations Act, 2018 (division D of 
Public Law 115-56) is further amended--
            (1) by striking the date specified in section 106(3) and 
        inserting ``March 23, 2018''; and
            (2) by adding after section 155 the following:
    ``Sec. 156.  Notwithstanding section 101, amounts are provided for 
`Department of Commerce--Bureau of the Census--Periodic Censuses and 
Programs' at a rate for operations of $1,251,000,000, and such amounts 
may be apportioned up to the rate for operations necessary to maintain 
the schedule and deliver the required data according to statutory 
deadlines in the 2020 Decennial Census Program.
    ``Sec. 157.  Notwithstanding section 101, the matter preceding the 
first proviso and the first proviso under the heading `Power Marketing 
Administrations--Operation and Maintenance, Southeastern Power 
Administration' in division D of Public Law 115-31 shall be applied by 
substituting `$6,379,000' for `$1,000,000' each place it appears.
    ``Sec. 158.  As authorized by section 404 of the Bipartisan Budget 
Act of 2015 (Public Law 114-74; 42 U.S.C. 6239 note), the Secretary of 
Energy shall draw down and sell not to exceed $350,000,000 of crude oil 
from the Strategic Petroleum Reserve in fiscal year 2018: Provided, 
That the proceeds from such drawdown and sale shall be deposited into 
the `Energy Security and Infrastructure Modernization Fund' (in this 
section referred to as the `Fund') during fiscal year 2018: Provided 
further, That in addition to amounts otherwise made available by 
section 101, and notwithstanding section 104, any amounts deposited in 
the Fund shall be made available and shall remain available until 
expended at a rate for operations of $350,000,000, for necessary 
expenses in carrying out the Life Extension II project for the 
Strategic Petroleum Reserve.
    ``Sec. 159.  Amounts made available by section 101 for `The 
Judiciary--Courts of Appeals, District Courts, and Other Judicial 
Services--Fees of Jurors and Commissioners' may be apportioned up to 
the rate for operations necessary to accommodate increased juror usage.
    ``Sec. 160. (a) In addition to amounts otherwise made available by 
section 101, there is appropriated for an additional amount for the 
`Small Business Administration--Disaster Loans Program Account' 
$225,000,000, to remain available until expended, for the cost of 
direct loans authorized by section 7(b) of the Small Business Act: 
Provided, That such amount is designated by the Congress as an 
emergency requirement pursuant to section 251(b)(2)(A)(i) of the 
Balanced Budget and Emergency Deficit Control Act of 1985.
    ``(b) The amount designated in subsection (a) by the Congress as an 
emergency requirement pursuant to section 251(b)(2)(A)(i) of the 
Balanced Budget and Emergency Deficit Control Act of 1985 shall be 
available only if the President subsequently so designates such amount 
and transmits such designation to the Congress.''.
     This division may be cited as the ``Further Extension of 
Continuing Appropriations Act, 2018''.

       DIVISION C--DEPARTMENT OF DEFENSE APPROPRIATIONS ACT, 2018

     That the following sums are appropriated, out of any money in the 
Treasury not otherwise appropriated, for the fiscal year ending 
September 30, 2018, for military functions administered by the 
Department of Defense and for other purposes, namely:

                                TITLE I

                           MILITARY PERSONNEL

                        Military Personnel, Army

    For pay, allowances, individual clothing, subsistence, interest on 
deposits, gratuities, permanent change of station travel (including all 
expenses thereof for organizational movements), and expenses of 
temporary duty travel between permanent duty stations, for members of 
the Army on active duty (except members of reserve components provided 
for elsewhere), cadets, and aviation cadets; for members of the Reserve 
Officers' Training Corps; and for payments pursuant to section 156 of 
Public Law 97-377, as amended (42 U.S.C. 402 note), and to the 
Department of Defense Military Retirement Fund, $41,427,054,000.

                        Military Personnel, Navy

    For pay, allowances, individual clothing, subsistence, interest on 
deposits, gratuities, permanent change of station travel (including all 
expenses thereof for organizational movements), and expenses of 
temporary duty travel between permanent duty stations, for members of 
the Navy on active duty (except members of the Reserve provided for 
elsewhere), midshipmen, and aviation cadets; for members of the Reserve 
Officers' Training Corps; and for payments pursuant to section 156 of 
Public Law 97-377, as amended (42 U.S.C. 402 note), and to the 
Department of Defense Military Retirement Fund, $28,707,918,000 
(reduced by $2,000,000) (increased by $2,000,000).

                    Military Personnel, Marine Corps

    For pay, allowances, individual clothing, subsistence, interest on 
deposits, gratuities, permanent change of station travel (including all 
expenses thereof for organizational movements), and expenses of 
temporary duty travel between permanent duty stations, for members of 
the Marine Corps on active duty (except members of the Reserve provided 
for elsewhere); and for payments pursuant to section 156 of Public Law 
97-377, as amended (42 U.S.C. 402 note), and to the Department of 
Defense Military Retirement Fund, $13,165,714,000.

                     Military Personnel, Air Force

    For pay, allowances, individual clothing, subsistence, interest on 
deposits, gratuities, permanent change of station travel (including all 
expenses thereof for organizational movements), and expenses of 
temporary duty travel between permanent duty stations, for members of 
the Air Force on active duty (except members of reserve components 
provided for elsewhere), cadets, and aviation cadets; for members of 
the Reserve Officers' Training Corps; and for payments pursuant to 
section 156 of Public Law 97-377, as amended (42 U.S.C. 402 note), and 
to the Department of Defense Military Retirement Fund, $28,738,320,000.

                        Reserve Personnel, Army

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Army Reserve on active duty under 
sections 10211, 10302, and 3038 of title 10, United States Code, or 
while serving on active duty under section 12301(d) of title 10, United 
States Code, in connection with performing duty specified in section 
12310(a) of title 10, United States Code, or while undergoing reserve 
training, or while performing drills or equivalent duty or other duty, 
and expenses authorized by section 16131 of title 10, United States 
Code; and for payments to the Department of Defense Military Retirement 
Fund, $4,721,128,000.

                        Reserve Personnel, Navy

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Navy Reserve on active duty under 
section 10211 of title 10, United States Code, or while serving on 
active duty under section 12301(d) of title 10, United States Code, in 
connection with performing duty specified in section 12310(a) of title 
10, United States Code, or while undergoing reserve training, or while 
performing drills or equivalent duty, and expenses authorized by 
section 16131 of title 10, United States Code; and for payments to the 
Department of Defense Military Retirement Fund, $1,987,662,000.

                    Reserve Personnel, Marine Corps

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Marine Corps Reserve on active 
duty under section 10211 of title 10, United States Code, or while 
serving on active duty under section 12301(d) of title 10, United 
States Code, in connection with performing duty specified in section 
12310(a) of title 10, United States Code, or while undergoing reserve 
training, or while performing drills or equivalent duty, and for 
members of the Marine Corps platoon leaders class, and expenses 
authorized by section 16131 of title 10, United States Code; and for 
payments to the Department of Defense Military Retirement Fund, 
$762,793,000.

                      Reserve Personnel, Air Force

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Air Force Reserve on active duty 
under sections 10211, 10305, and 8038 of title 10, United States Code, 
or while serving on active duty under section 12301(d) of title 10, 
United States Code, in connection with performing duty specified in 
section 12310(a) of title 10, United States Code, or while undergoing 
reserve training, or while performing drills or equivalent duty or 
other duty, and expenses authorized by section 16131 of title 10, 
United States Code; and for payments to the Department of Defense 
Military Retirement Fund, $1,808,434,000.

                     National Guard Personnel, Army

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Army National Guard while on duty 
under sections 10211, 10302, or 12402 of title 10 or section 708 of 
title 32, United States Code, or while serving on duty under section 
12301(d) of title 10 or section 502(f) of title 32, United States Code, 
in connection with performing duty specified in section 12310(a) of 
title 10, United States Code, or while undergoing training, or while 
performing drills or equivalent duty or other duty, and expenses 
authorized by section 16131 of title 10, United States Code; and for 
payments to the Department of Defense Military Retirement Fund, 
$8,252,426,000.

                  National Guard Personnel, Air Force

    For pay, allowances, clothing, subsistence, gratuities, travel, and 
related expenses for personnel of the Air National Guard on duty under 
sections 10211, 10305, or 12402 of title 10 or section 708 of title 32, 
United States Code, or while serving on duty under section 12301(d) of 
title 10 or section 502(f) of title 32, United States Code, in 
connection with performing duty specified in section 12310(a) of title 
10, United States Code, or while undergoing training, or while 
performing drills or equivalent duty or other duty, and expenses 
authorized by section 16131 of title 10, United States Code; and for 
payments to the Department of Defense Military Retirement Fund, 
$3,406,137,000.

                                TITLE II

                       OPERATION AND MAINTENANCE

                    Operation and Maintenance, Army

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance of the Army, as authorized by law, 
$38,483,846,000 (reduced by $5,000,000) (reduced by $5,600,000) 
(reduced by $6,000,000):  Provided, That not to exceed $12,478,000 can 
be used for emergencies and extraordinary expenses, to be expended on 
the approval or authority of the Secretary of the Army, and payments 
may be made on his certificate of necessity for confidential military 
purposes.

                    Operation and Maintenance, Navy

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance of the Navy and the Marine Corps, as 
authorized by law, $45,980,133,000 (reduced by $598,000) (reduced by 
$7,000,000):  Provided, That not to exceed $15,055,000 can be used for 
emergencies and extraordinary expenses, to be expended on the approval 
or authority of the Secretary of the Navy, and payments may be made on 
his certificate of necessity for confidential military purposes.

                Operation and Maintenance, Marine Corps

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance of the Marine Corps, as authorized by law, 
$6,885,884,000.

                  Operation and Maintenance, Air Force

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance of the Air Force, as authorized by law, 
$38,592,745,000:  Provided, That not to exceed $7,699,000 can be used 
for emergencies and extraordinary expenses, to be expended on the 
approval or authority of the Secretary of the Air Force, and payments 
may be made on his certificate of necessity for confidential military 
purposes.

                Operation and Maintenance, Defense-Wide

                     (including transfer of funds)

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance of activities and agencies of the Department 
of Defense (other than the military departments), as authorized by law, 
$33,771,769,000 (increased by $5,000,000) (reduced by $10,000,000) 
(reduced by $100,000) (increased by $100,000) (reduced by $194,897,000) 
(increased by $194,897,000) (reduced by $26,200,000) (reduced by 
$20,000,000) (reduced by $6,000,000) (reduced by $4,000,000) (reduced 
by $20,000,000) (reduced by $1,000,000) (reduced by $10,000,000) 
(reduced by $2,500,000) (reduced by $2,000,000) (reduced by $8,000,000) 
(reduced by $6,250,000) (reduced by $10,000,000) (reduced by 
$10,000,000) (reduced by $30,000,000) (reduced by $34,734,000) (reduced 
by $60,000,000):  Provided, That not more than $15,000,000 may be used 
for the Combatant Commander Initiative Fund authorized under section 
166a of title 10, United States Code:  Provided further, That not to 
exceed $36,000,000 can be used for emergencies and extraordinary 
expenses, to be expended on the approval or authority of the Secretary 
of Defense, and payments may be made on his certificate of necessity 
for confidential military purposes:  Provided further, That of the 
funds provided under this heading, not less than $38,458,000 shall be 
made available for the Procurement Technical Assistance Cooperative 
Agreement Program, of which not less than $3,600,000 shall be available 
for centers defined in 10 U.S.C. 2411(1)(D):  Provided further, That 
none of the funds appropriated or otherwise made available by this Act 
may be used to plan or implement the consolidation of a budget or 
appropriations liaison office of the Office of the Secretary of 
Defense, the office of the Secretary of a military department, or the 
service headquarters of one of the Armed Forces into a legislative 
affairs or legislative liaison office:  Provided further, That 
$9,385,000, to remain available until expended, is available only for 
expenses relating to certain classified activities, and may be 
transferred as necessary by the Secretary of Defense to operation and 
maintenance appropriations or research, development, test and 
evaluation appropriations, to be merged with and to be available for 
the same time period as the appropriations to which transferred:  
Provided further, That any ceiling on the investment item unit cost of 
items that may be purchased with operation and maintenance funds shall 
not apply to the funds described in the preceding proviso:  Provided 
further, That of the funds provided under this heading, $415,000,000, 
of which $100,000,000 to remain available until September 30, 2019, 
shall be available to provide support and assistance to foreign 
security forces or other groups or individuals to conduct, support or 
facilitate counterterrorism, crisis response, or other Department of 
Defense security cooperation programs:  Provided further, That the 
transfer authority provided under this heading is in addition to any 
other transfer authority provided elsewhere in this Act.

                Operation and Maintenance, Army Reserve

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance, including training, organization, and 
administration, of the Army Reserve; repair of facilities and 
equipment; hire of passenger motor vehicles; travel and transportation; 
care of the dead; recruiting; procurement of services, supplies, and 
equipment; and communications, $2,870,163,000.

                Operation and Maintenance, Navy Reserve

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance, including training, organization, and 
administration, of the Navy Reserve; repair of facilities and 
equipment; hire of passenger motor vehicles; travel and transportation; 
care of the dead; recruiting; procurement of services, supplies, and 
equipment; and communications, $1,038,507,000.

            Operation and Maintenance, Marine Corps Reserve

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance, including training, organization, and 
administration, of the Marine Corps Reserve; repair of facilities and 
equipment; hire of passenger motor vehicles; travel and transportation; 
care of the dead; recruiting; procurement of services, supplies, and 
equipment; and communications, $282,337,000.

              Operation and Maintenance, Air Force Reserve

    For expenses, not otherwise provided for, necessary for the 
operation and maintenance, including training, organization, and 
administration, of the Air Force Reserve; repair of facilities and 
equipment; hire of passenger motor vehicles; travel and transportation; 
care of the dead; recruiting; procurement of services, supplies, and 
equipment; and communications, $3,233,745,000.

             Operation and Maintenance, Army National Guard

    For expenses of training, organizing, and administering the Army 
National Guard, including medical and hospital treatment and related 
expenses in non-Federal hospitals; maintenance, operation, and repairs 
to structures and facilities; hire of passenger motor vehicles; 
personnel services in the National Guard Bureau; travel expenses (other 
than mileage), as authorized by law for Army personnel on active duty, 
for Army National Guard division, regimental, and battalion commanders 
while inspecting units in compliance with National Guard Bureau 
regulations when specifically authorized by the Chief, National Guard 
Bureau; supplying and equipping the Army National Guard as authorized 
by law; and expenses of repair, modification, maintenance, and issue of 
supplies and equipment (including aircraft), $7,275,820,000.

             Operation and Maintenance, Air National Guard

    For expenses of training, organizing, and administering the Air 
National Guard, including medical and hospital treatment and related 
expenses in non-Federal hospitals; maintenance, operation, and repairs 
to structures and facilities; transportation of things, hire of 
passenger motor vehicles; supplying and equipping the Air National 
Guard, as authorized by law; expenses for repair, modification, 
maintenance, and issue of supplies and equipment, including those 
furnished from stocks under the control of agencies of the Department 
of Defense; travel expenses (other than mileage) on the same basis as 
authorized by law for Air National Guard personnel on active Federal 
duty, for Air National Guard commanders while inspecting units in 
compliance with National Guard Bureau regulations when specifically 
authorized by the Chief, National Guard Bureau, $6,735,930,000.

          United States Court of Appeals for the Armed Forces

    For salaries and expenses necessary for the United States Court of 
Appeals for the Armed Forces, $14,538,000, of which not to exceed 
$5,000 may be used for official representation purposes.

                    Environmental Restoration, Army

                     (including transfer of funds)

    For the Department of the Army, $215,809,000, to remain available 
until transferred:  Provided, That the Secretary of the Army shall, 
upon determining that such funds are required for environmental 
restoration, reduction and recycling of hazardous waste, removal of 
unsafe buildings and debris of the Department of the Army, or for 
similar purposes, transfer the funds made available by this 
appropriation to other appropriations made available to the Department 
of the Army, to be merged with and to be available for the same 
purposes and for the same time period as the appropriations to which 
transferred:  Provided further, That upon a determination that all or 
part of the funds transferred from this appropriation are not necessary 
for the purposes provided herein, such amounts may be transferred back 
to this appropriation:  Provided further, That the transfer authority 
provided under this heading is in addition to any other transfer 
authority provided elsewhere in this Act.

                    Environmental Restoration, Navy

                     (including transfer of funds)

    For the Department of the Navy, $288,915,000 (increased by 
$34,734,000) (increased by $30,000,000), to remain available until 
transferred:  Provided, That the Secretary of the Navy shall, upon 
determining that such funds are required for environmental restoration, 
reduction and recycling of hazardous waste, removal of unsafe buildings 
and debris of the Department of the Navy, or for similar purposes, 
transfer the funds made available by this appropriation to other 
appropriations made available to the Department of the Navy, to be 
merged with and to be available for the same purposes and for the same 
time period as the appropriations to which transferred:  Provided 
further, That upon a determination that all or part of the funds 
transferred from this appropriation are not necessary for the purposes 
provided herein, such amounts may be transferred back to this 
appropriation:  Provided further, That the transfer authority provided 
under this heading is in addition to any other transfer authority 
provided elsewhere in this Act.

                  Environmental Restoration, Air Force

                     (including transfer of funds)

    For the Department of the Air Force, $308,749,000 (increased by 
$30,000,000), to remain available until transferred:  Provided, That 
the Secretary of the Air Force shall, upon determining that such funds 
are required for environmental restoration, reduction and recycling of 
hazardous waste, removal of unsafe buildings and debris of the 
Department of the Air Force, or for similar purposes, transfer the 
funds made available by this appropriation to other appropriations made 
available to the Department of the Air Force, to be merged with and to 
be available for the same purposes and for the same time period as the 
appropriations to which transferred:  Provided further, That upon a 
determination that all or part of the funds transferred from this 
appropriation are not necessary for the purposes provided herein, such 
amounts may be transferred back to this appropriation:  Provided 
further, That the transfer authority provided under this heading is in 
addition to any other transfer authority provided elsewhere in this 
Act.

                Environmental Restoration, Defense-Wide

                     (including transfer of funds)

    For the Department of Defense, $9,002,000 (increased by 
$10,000,000), to remain available until transferred:  Provided, That 
the Secretary of Defense shall, upon determining that such funds are 
required for environmental restoration, reduction and recycling of 
hazardous waste, removal of unsafe buildings and debris of the 
Department of Defense, or for similar purposes, transfer the funds made 
available by this appropriation to other appropriations made available 
to the Department of Defense, to be merged with and to be available for 
the same purposes and for the same time period as the appropriations to 
which transferred:  Provided further, That upon a determination that 
all or part of the funds transferred from this appropriation are not 
necessary for the purposes provided herein, such amounts may be 
transferred back to this appropriation:  Provided further, That the 
transfer authority provided under this heading is in addition to any 
other transfer authority provided elsewhere in this Act.

         Environmental Restoration, Formerly Used Defense Sites

                     (including transfer of funds)

    For the Department of the Army, $233,673,000, to remain available 
until transferred:  Provided, That the Secretary of the Army shall, 
upon determining that such funds are required for environmental 
restoration, reduction and recycling of hazardous waste, removal of 
unsafe buildings and debris at sites formerly used by the Department of 
Defense, transfer the funds made available by this appropriation to 
other appropriations made available to the Department of the Army, to 
be merged with and to be available for the same purposes and for the 
same time period as the appropriations to which transferred:  Provided 
further, That upon a determination that all or part of the funds 
transferred from this appropriation are not necessary for the purposes 
provided herein, such amounts may be transferred back to this 
appropriation:  Provided further, That the transfer authority provided 
under this heading is in addition to any other transfer authority 
provided elsewhere in this Act.

             Overseas Humanitarian, Disaster, and Civic Aid

    For expenses relating to the Overseas Humanitarian, Disaster, and 
Civic Aid programs of the Department of Defense (consisting of the 
programs provided under sections 401, 402, 404, 407, 2557, and 2561 of 
title 10, United States Code), $107,900,000, to remain available until 
September 30, 2018.

                  Cooperative Threat Reduction Account

    For assistance, including assistance provided by contract or by 
grants, under programs and activities of the Department of Defense 
Cooperative Threat Reduction Program authorized under the Department of 
Defense Cooperative Threat Reduction Act, $324,600,000, to remain 
available until September 30, 2019.

      Operation and Maintenance, National Defense Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $5,000,000,000, for the ``Operation and Maintenance, 
National Defense Restoration Fund'': Provided, That such funds provided 
under this heading shall only be available for programs, projects and 
activities necessary to implement the 2018 National Defense Strategy: 
Provided further, That such funds shall not be available for transfer 
until 30 days after the Secretary has submitted, and the congressional 
defense committees have approved, the proposed allocation plan for the 
use of such funds to implement such strategy: Provided further, That 
such allocation plan shall include a detailed justification for the use 
of such funds and a description of how such investments are necessary 
to implement the strategy: Provided further, That the Secretary of 
Defense may transfer these funds only to operation and maintenance 
accounts: Provided further, That the funds transferred shall be merged 
with and shall be available for the same purposes and for the same time 
period, as the appropriation to which transferred: Provided further, 
That none of the funds made available under this heading may be 
transferred to any program, project, or activity specifically limited 
or denied by this Act: Provided further, That the transfer authority 
provided under this heading is in addition to any other transfer 
authority available to the Department of Defense.

                               TITLE III

                              PROCUREMENT

                       Aircraft Procurement, Army

    For construction, procurement, production, modification, and 
modernization of aircraft, equipment, including ordnance, ground 
handling equipment, spare parts, and accessories therefor; specialized 
equipment and training devices; expansion of public and private plants, 
including the land necessary therefor, for the foregoing purposes, and 
such lands and interests therein, may be acquired, and construction 
prosecuted thereon prior to approval of title; and procurement and 
installation of equipment, appliances, and machine tools in public and 
private plants; reserve plant and Government and contractor-owned 
equipment layaway; and other expenses necessary for the foregoing 
purposes, $4,456,533,000, to remain available for obligation until 
September 30, 2020.

                       Missile Procurement, Army

    For construction, procurement, production, modification, and 
modernization of missiles, equipment, including ordnance, ground 
handling equipment, spare parts, and accessories therefor; specialized 
equipment and training devices; expansion of public and private plants, 
including the land necessary therefor, for the foregoing purposes, and 
such lands and interests therein, may be acquired, and construction 
prosecuted thereon prior to approval of title; and procurement and 
installation of equipment, appliances, and machine tools in public and 
private plants; reserve plant and Government and contractor-owned 
equipment layaway; and other expenses necessary for the foregoing 
purposes, $2,581,600,000, to remain available for obligation until 
September 30, 2020.

        Procurement of Weapons and Tracked Combat Vehicles, Army

    For construction, procurement, production, and modification of 
weapons and tracked combat vehicles, equipment, including ordnance, 
spare parts, and accessories therefor; specialized equipment and 
training devices; expansion of public and private plants, including the 
land necessary therefor, for the foregoing purposes, and such lands and 
interests therein, may be acquired, and construction prosecuted thereon 
prior to approval of title; and procurement and installation of 
equipment, appliances, and machine tools in public and private plants; 
reserve plant and Government and contractor-owned equipment layaway; 
and other expenses necessary for the foregoing purposes, 
$3,556,175,000, to remain available for obligation until September 30, 
2020.

                    Procurement of Ammunition, Army

    For construction, procurement, production, and modification of 
ammunition, and accessories therefor; specialized equipment and 
training devices; expansion of public and private plants, including 
ammunition facilities, authorized by section 2854 of title 10, United 
States Code, and the land necessary therefor, for the foregoing 
purposes, and such lands and interests therein, may be acquired, and 
construction prosecuted thereon prior to approval of title; and 
procurement and installation of equipment, appliances, and machine 
tools in public and private plants; reserve plant and Government and 
contractor-owned equipment layaway; and other expenses necessary for 
the foregoing purposes, $1,811,808,000, to remain available for 
obligation until September 30, 2020.

                        Other Procurement, Army

    For construction, procurement, production, and modification of 
vehicles, including tactical, support, and non-tracked combat vehicles; 
the purchase of passenger motor vehicles for replacement only; 
communications and electronic equipment; other support equipment; spare 
parts, ordnance, and accessories therefor; specialized equipment and 
training devices; expansion of public and private plants, including the 
land necessary therefor, for the foregoing purposes, and such lands and 
interests therein, may be acquired, and construction prosecuted thereon 
prior to approval of title; and procurement and installation of 
equipment, appliances, and machine tools in public and private plants; 
reserve plant and Government and contractor-owned equipment layaway; 
and other expenses necessary for the foregoing purposes, $6,356,044,000 
(increased by $30,000,000), to remain available for obligation until 
September 30, 2020.

                       Aircraft Procurement, Navy

    For construction, procurement, production, modification, and 
modernization of aircraft, equipment, including ordnance, spare parts, 
and accessories therefor; specialized equipment; expansion of public 
and private plants, including the land necessary therefor, and such 
lands and interests therein, may be acquired, and construction 
prosecuted thereon prior to approval of title; and procurement and 
installation of equipment, appliances, and machine tools in public and 
private plants; reserve plant and Government and contractor-owned 
equipment layaway, $17,908,270,000, to remain available for obligation 
until September 30, 2020.

                       Weapons Procurement, Navy

    For construction, procurement, production, modification, and 
modernization of missiles, torpedoes, other weapons, and related 
support equipment including spare parts, and accessories therefor; 
expansion of public and private plants, including the land necessary 
therefor, and such lands and interests therein, may be acquired, and 
construction prosecuted thereon prior to approval of title; and 
procurement and installation of equipment, appliances, and machine 
tools in public and private plants; reserve plant and Government and 
contractor-owned equipment layaway, $3,387,826,000 (increased by 
$26,200,000), to remain available for obligation until September 30, 
2020.

            Procurement of Ammunition, Navy and Marine Corps

    For construction, procurement, production, and modification of 
ammunition, and accessories therefor; specialized equipment and 
training devices; expansion of public and private plants, including 
ammunition facilities, authorized by section 2854 of title 10, United 
States Code, and the land necessary therefor, for the foregoing 
purposes, and such lands and interests therein, may be acquired, and 
construction prosecuted thereon prior to approval of title; and 
procurement and installation of equipment, appliances, and machine 
tools in public and private plants; reserve plant and Government and 
contractor-owned equipment layaway; and other expenses necessary for 
the foregoing purposes, $735,651,000, to remain available for 
obligation until September 30, 2020.

                   Shipbuilding and Conversion, Navy

    For expenses necessary for the construction, acquisition, or 
conversion of vessels as authorized by law, including armor and 
armament thereof, plant equipment, appliances, and machine tools and 
installation thereof in public and private plants; reserve plant and 
Government and contractor-owned equipment layaway; procurement of 
critical, long lead time components and designs for vessels to be 
constructed or converted in the future; and expansion of public and 
private plants, including land necessary therefor, and such lands and 
interests therein, may be acquired, and construction prosecuted thereon 
prior to approval of title, as follows:
            Ohio Replacement Submarine (AP), $842,853,000;
            Carrier Replacement Program, $1,869,646,000;
            Carrier Replacement Program (AP), $2,561,058,000;
            Virginia Class Submarine, $3,305,315,000;
            Virginia Class Submarine (AP), $1,920,596,000;
            CVN Refueling Overhauls, $1,569,669,000;
            CVN Refueling Overhauls (AP), $75,897,000;
            DDG-1000 Program, $164,976,000;
            DDG-51 Destroyer, $3,499,079,000;
            DDG-51 Destroyer (AP), $90,336,000;
            Littoral Combat Ship, $1,566,971,000;
            Expeditionary Sea Base, $635,000,000;
            LHA Replacement, $1,695,077,000;
            TAO Fleet Oiler, $449,415,000;
            TAO Fleet Oiler (AP), $75,068,000;
            Ship to Shore Connector, $390,554,000;
            Service Craft, $23,994,000;
            Towing, Salvage, and Rescue Ship, $76,204,000;
            LCU 1700, $31,850,000;
            For outfitting, post delivery, conversions, and first 
        destination transportation, $542,626,000; and
            Completion of Prior Year Shipbuilding Programs, 
        $117,542,000.
    In all: $21,503,726,000, to remain available for obligation until 
September 30, 2022:  Provided, That additional obligations may be 
incurred after September 30, 2022, for engineering services, tests, 
evaluations, and other such budgeted work that must be performed in the 
final stage of ship construction:  Provided further, That none of the 
funds provided under this heading for the construction or conversion of 
any naval vessel to be constructed in shipyards in the United States 
shall be expended in foreign facilities for the construction of major 
components of such vessel:  Provided further, That none of the funds 
provided under this heading shall be used for the construction of any 
naval vessel in foreign shipyards:  Provided further, That funds 
appropriated or otherwise made available by this Act for production of 
the common missile compartment of nuclear-powered vessels may be 
available for multiyear procurement of critical components to support 
continuous production of such compartments only in accordance with the 
provisions of subsection (i) of section 2218a of title 10, United 
States Code (as added by section 1023 of the National Defense 
Authorization Act for Fiscal Year 2017 (Public Law 114-328)).

                        Other Procurement, Navy

    For procurement, production, and modernization of support equipment 
and materials not otherwise provided for, Navy ordnance (except 
ordnance for new aircraft, new ships, and ships authorized for 
conversion); the purchase of passenger motor vehicles for replacement 
only; expansion of public and private plants, including the land 
necessary therefor, and such lands and interests therein, may be 
acquired, and construction prosecuted thereon prior to approval of 
title; and procurement and installation of equipment, appliances, and 
machine tools in public and private plants; reserve plant and 
Government and contractor-owned equipment layaway, $7,852,952,000, to 
remain available for obligation until September 30, 2020.

                       Procurement, Marine Corps

    For expenses necessary for the procurement, manufacture, and 
modification of missiles, armament, military equipment, spare parts, 
and accessories therefor; plant equipment, appliances, and machine 
tools, and installation thereof in public and private plants; reserve 
plant and Government and contractor-owned equipment layaway; vehicles 
for the Marine Corps, including the purchase of passenger motor 
vehicles for replacement only; and expansion of public and private 
plants, including land necessary therefor, and such lands and interests 
therein, may be acquired, and construction prosecuted thereon prior to 
approval of title, $1,818,846,000 (increased by $20,000,000), to remain 
available for obligation until September 30, 2020.

                    Aircraft Procurement, Air Force

    For construction, procurement, and modification of aircraft and 
equipment, including armor and armament, specialized ground handling 
equipment, and training devices, spare parts, and accessories therefor; 
specialized equipment; expansion of public and private plants, 
Government-owned equipment and installation thereof in such plants, 
erection of structures, and acquisition of land, for the foregoing 
purposes, and such lands and interests therein, may be acquired, and 
construction prosecuted thereon prior to approval of title; reserve 
plant and Government and contractor-owned equipment layaway; and other 
expenses necessary for the foregoing purposes including rents and 
transportation of things, $16,553,196,000 (increased by $16,000,000), 
to remain available for obligation until September 30, 2020.

                     Missile Procurement, Air Force

    For construction, procurement, and modification of missiles, 
rockets, and related equipment, including spare parts and accessories 
therefor; ground handling equipment, and training devices; expansion of 
public and private plants, Government-owned equipment and installation 
thereof in such plants, erection of structures, and acquisition of 
land, for the foregoing purposes, and such lands and interests therein, 
may be acquired, and construction prosecuted thereon prior to approval 
of title; reserve plant and Government and contractor-owned equipment 
layaway; and other expenses necessary for the foregoing purposes 
including rents and transportation of things, $2,203,101,000, to remain 
available for obligation until September 30, 2020.

                      Space Procurement, Air Force

    For construction, procurement, and modification of spacecraft, 
rockets, and related equipment, including spare parts and accessories 
therefor; ground handling equipment, and training devices; expansion of 
public and private plants, Government-owned equipment and installation 
thereof in such plants, erection of structures, and acquisition of 
land, for the foregoing purposes, and such lands and interests therein, 
may be acquired, and construction prosecuted thereon prior to approval 
of title; reserve plant and Government and contractor-owned equipment 
layaway; and other expenses necessary for the foregoing purposes 
including rents and transportation of things, $3,210,355,000, to remain 
available for obligation until September 30, 2020.

                  Procurement of Ammunition, Air Force

    For construction, procurement, production, and modification of 
ammunition, and accessories therefor; specialized equipment and 
training devices; expansion of public and private plants, including 
ammunition facilities, authorized by section 2854 of title 10, United 
States Code, and the land necessary therefor, for the foregoing 
purposes, and such lands and interests therein, may be acquired, and 
construction prosecuted thereon prior to approval of title; and 
procurement and installation of equipment, appliances, and machine 
tools in public and private plants; reserve plant and Government and 
contractor-owned equipment layaway; and other expenses necessary for 
the foregoing purposes, $1,316,977,000, to remain available for 
obligation until September 30, 2020.

                      Other Procurement, Air Force

    For procurement and modification of equipment (including ground 
guidance and electronic control equipment, and ground electronic and 
communication equipment), and supplies, materials, and spare parts 
therefor, not otherwise provided for; the purchase of passenger motor 
vehicles for replacement only; lease of passenger motor vehicles; and 
expansion of public and private plants, Government-owned equipment and 
installation thereof in such plants, erection of structures, and 
acquisition of land, for the foregoing purposes, and such lands and 
interests therein, may be acquired, and construction prosecuted 
thereon, prior to approval of title; reserve plant and Government and 
contractor-owned equipment layaway, $19,318,814,000, to remain 
available for obligation until September 30, 2020.

                       Procurement, Defense-Wide

    For expenses of activities and agencies of the Department of 
Defense (other than the military departments) necessary for 
procurement, production, and modification of equipment, supplies, 
materials, and spare parts therefor, not otherwise provided for; the 
purchase of passenger motor vehicles for replacement only; expansion of 
public and private plants, equipment, and installation thereof in such 
plants, erection of structures, and acquisition of land for the 
foregoing purposes, and such lands and interests therein, may be 
acquired, and construction prosecuted thereon prior to approval of 
title; reserve plant and Government and contractor-owned equipment 
layaway, $5,239,239,000 (reduced by $10,000,000), to remain available 
for obligation until September 30, 2020.

                    Defense Production Act Purchases

    For activities by the Department of Defense pursuant to sections 
108, 301, 302, and 303 of the Defense Production Act of 1950 (50 U.S.C. 
4518, 4531, 4532, and 4533), $67,401,000, to remain available until 
expended.

             Procurement, National Defense Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $12,622,931,000, for the ``Procurement, National Defense 
Restoration Fund'': Provided, That such funds provided under this 
heading shall only be available for programs, projects and activities 
necessary to implement the 2018 National Defense Strategy: Provided 
further, That such funds shall not be available for transfer until 30 
days after the Secretary has submitted, and the congressional defense 
committees have approved, the proposed allocation plan for the use of 
such funds to implement such strategy: Provided further, That such 
allocation plan shall include a detailed justification for the use of 
such funds and a description of how such investments are necessary to 
implement the strategy: Provided further, That the Secretary of Defense 
may transfer these funds only to procurement accounts: Provided 
further, That the funds transferred shall be merged with and shall be 
available for the same purposes and for the same time period, as the 
appropriation to which transferred: Provided further, That none of the 
funds made available under this heading may be transferred to any 
program, project, or activity specifically limited or denied by this 
Act, except for missile defense requirements resulting from urgent or 
emergent operational needs: Provided further, That the transfer 
authority provided under this heading is in addition to any other 
transfer authority available to the Department of Defense.

                                TITLE IV

               RESEARCH, DEVELOPMENT, TEST AND EVALUATION

            Research, Development, Test and Evaluation, Army

    For expenses necessary for basic and applied scientific research, 
development, test and evaluation, including maintenance, 
rehabilitation, lease, and operation of facilities and equipment, 
$9,674,222,000 (increased by $6,000,000) (increased by $4,000,000) 
(increased by $12,000,000) (increased by $5,000,000), to remain 
available for obligation until September 30, 2019.

            Research, Development, Test and Evaluation, Navy

    For expenses necessary for basic and applied scientific research, 
development, test and evaluation, including maintenance, 
rehabilitation, lease, and operation of facilities and equipment, 
$17,196,521,000 (increased by $598,000) (increased by $20,000,000) 
(reduced by $2,500,000) (increased by $24,000,000), to remain available 
for obligation until September 30, 2019:  Provided, That funds 
appropriated in this paragraph which are available for the V-22 may be 
used to meet unique operational requirements of the Special Operations 
Forces.

         Research, Development, Test and Evaluation, Air Force

    For expenses necessary for basic and applied scientific research, 
development, test and evaluation, including maintenance, 
rehabilitation, lease, and operation of facilities and equipment, 
$33,874,980,000 (increased by $5,000,000) (increased by $6,000,000) 
(increased by $10,000,000) (reduced by $30,000,000) (increased by 
$30,000,000), to remain available for obligation until September 30, 
2019.

        Research, Development, Test and Evaluation, Defense-Wide

                     (including transfer of funds)

    For expenses of activities and agencies of the Department of 
Defense (other than the military departments), necessary for basic and 
applied scientific research, development, test and evaluation; advanced 
research projects as may be designated and determined by the Secretary 
of Defense, pursuant to law; maintenance, rehabilitation, lease, and 
operation of facilities and equipment, $20,698,353,000 (reduced by 
$16,000,000) (reduced by $12,000,000) (reduced by $2,500,000) (reduced 
by $12,500,000) (increased by $20,000,000) (reduced by $20,000,000) 
(reduced by $4,135,000) (increased by $4,135,000) (reduced by 
$27,500,000) (increased by $10,000,000), to remain available for 
obligation until September 30, 2019:  Provided, That, of the funds made 
available in this paragraph, $250,000,000 for the Defense Rapid 
Innovation Program shall only be available for expenses, not otherwise 
provided for, to include program management and oversight, to conduct 
research, development, test and evaluation to include proof of concept 
demonstration; engineering, testing, and validation; and transition to 
full-scale production:  Provided further, That the Secretary of Defense 
may transfer funds provided herein for the Defense Rapid Innovation 
Program to appropriations for research, development, test and 
evaluation to accomplish the purpose provided herein:  Provided 
further, That this transfer authority is in addition to any other 
transfer authority available to the Department of Defense:  Provided 
further, That the Secretary of Defense shall, not fewer than 30 days 
prior to making transfers from this appropriation, notify the 
congressional defense committees in writing of the details of any such 
transfer.

                Operational Test and Evaluation, Defense

    For expenses, not otherwise provided for, necessary for the 
independent activities of the Director, Operational Test and 
Evaluation, in the direction and supervision of operational test and 
evaluation, including initial operational test and evaluation which is 
conducted prior to, and in support of, production decisions; joint 
operational testing and evaluation; and administrative expenses in 
connection therewith, $210,900,000, to remain available for obligation 
until September 30, 2019.

     Research, Development, Test and Evaluation, National Defense 
                            Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $1,000,000,000, for the ``Research, Development, Test and 
Evaluation, National Defense Restoration Fund'': Provided, That such 
funds provided under this heading shall only be available for programs, 
projects and activities necessary to implement the 2018 National 
Defense Strategy: Provided further, That such funds shall not be 
available for transfer until 30 days after the Secretary has submitted, 
and the congressional defense committees have approved, the proposed 
allocation plan for the use of such funds to implement such strategy: 
Provided further, That such allocation plan shall include a detailed 
justification for the use of such funds and a description of how such 
investments are necessary to implement the strategy: Provided further, 
That the Secretary of Defense may transfer these funds only to 
research, development, test and evaluation accounts: Provided further, 
That the funds transferred shall be merged with and shall be available 
for the same purposes and for the same time period, as the 
appropriation to which transferred: Provided further, That none of the 
funds made available under this heading may be transferred to any 
program, project, or activity specifically limited or denied by this 
Act, except for missile defense requirements resulting from urgent or 
emergent operational needs: Provided further, That the transfer 
authority provided under this heading is in addition to any other 
transfer authority available to the Department of Defense.

                                TITLE V

                     REVOLVING AND MANAGEMENT FUNDS

                     Defense Working Capital Funds

    For the Defense Working Capital Funds, $1,586,596,000.

                                TITLE VI

                  OTHER DEPARTMENT OF DEFENSE PROGRAMS

                         Defense Health Program

    For expenses, not otherwise provided for, for medical and health 
care programs of the Department of Defense as authorized by law, 
$33,931,566,000 (increased by $7,000,000) (increased by $1,000,000) 
(increased by $10,000,000) (increased by $2,000,000) (increased by 
$2,000,000) (increased by $10,000,000) (increased by $5,000,000) 
(increased by $10,000,000); of which $31,735,923,000 (increased by 
$2,000,000) (increased by $5,000,000) shall be for operation and 
maintenance, of which not to exceed one percent shall remain available 
for obligation until September 30, 2019, and of which up to 
$15,349,700,000 may be available for contracts entered into under the 
TRICARE program; of which $895,328,000, to remain available for 
obligation until September 30, 2020, shall be for procurement; and of 
which $1,300,315,000 (increased by $7,000,000) (increased by 
$1,000,000) (increased by $10,000,000) (increased by $2,000,000) 
(increased by $10,000,000) (increased by $10,000,000), to remain 
available for obligation until September 30, 2019, shall be for 
research, development, test and evaluation:  Provided, That, 
notwithstanding any other provision of law, of the amount made 
available under this heading for research, development, test and 
evaluation, not less than $8,000,000 shall be available for HIV 
prevention educational activities undertaken in connection with United 
States military training, exercises, and humanitarian assistance 
activities conducted primarily in African nations:  Provided further, 
That of the funds provided under this heading for research, 
development, test and evaluation, not less than $627,100,000 shall be 
made available to the United States Army Medical Research and Materiel 
Command to carry out the congressionally directed medical research 
programs.

           Chemical Agents and Munitions Destruction, Defense

    For expenses, not otherwise provided for, necessary for the 
destruction of the United States stockpile of lethal chemical agents 
and munitions in accordance with the provisions of section 1412 of the 
Department of Defense Authorization Act, 1986 (50 U.S.C. 1521), and for 
the destruction of other chemical warfare materials that are not in the 
chemical weapon stockpile, $961,732,000, of which $104,237,000 shall be 
for operation and maintenance, of which no less than $49,401,000 shall 
be for the Chemical Stockpile Emergency Preparedness Program, 
consisting of $21,045,000 for activities on military installations and 
$28,356,000, to remain available until September 30, 2019, to assist 
State and local governments; $18,081,000 shall be for procurement, to 
remain available until September 30, 2020, of which $18,081,000 shall 
be for the Chemical Stockpile Emergency Preparedness Program to assist 
State and local governments; and $839,414,000, to remain available 
until September 30, 2019, shall be for research, development, test and 
evaluation, of which $750,700,000 shall only be for the Assembled 
Chemical Weapons Alternatives program.

         Drug Interdiction and Counter-Drug Activities, Defense

                     (including transfer of funds)

    For drug interdiction and counter-drug activities of the Department 
of Defense, for transfer to appropriations available to the Department 
of Defense for military personnel of the reserve components serving 
under the provisions of title 10 and title 32, United States Code; for 
operation and maintenance; for procurement; and for research, 
development, test and evaluation, $854,814,000, of which $532,648,000 
shall be for counter-narcotics support; $120,813,000 shall be for the 
drug demand reduction program; and $201,353,000 shall be for the 
National Guard counter-drug program:  Provided, That the funds 
appropriated under this heading shall be available for obligation for 
the same time period and for the same purpose as the appropriation to 
which transferred:  Provided further, That upon a determination that 
all or part of the funds transferred from this appropriation are not 
necessary for the purposes provided herein, such amounts may be 
transferred back to this appropriation:  Provided further, That the 
transfer authority provided under this heading is in addition to any 
other transfer authority contained elsewhere in this Act.

                    Office of the Inspector General

    For expenses and activities of the Office of the Inspector General 
in carrying out the provisions of the Inspector General Act of 1978, as 
amended, $336,887,000, of which $334,087,000 shall be for operation and 
maintenance, of which not to exceed $700,000 is available for 
emergencies and extraordinary expenses to be expended on the approval 
or authority of the Inspector General, and payments may be made on the 
Inspector General's certificate of necessity for confidential military 
purposes; and of which $2,800,000, to remain available until September 
30, 2019, shall be for research, development, test and evaluation.

                               TITLE VII

                            RELATED AGENCIES

   Central Intelligence Agency Retirement and Disability System Fund

    For payment to the Central Intelligence Agency Retirement and 
Disability System Fund, to maintain the proper funding level for 
continuing the operation of the Central Intelligence Agency Retirement 
and Disability System, $514,000,000.

               Intelligence Community Management Account

    For necessary expenses of the Intelligence Community Management 
Account, $522,100,000.

                               TITLE VIII

                           GENERAL PROVISIONS

    Sec. 1101.  No part of any appropriation contained in this Act 
shall be used for publicity or propaganda purposes not authorized by 
the Congress.
    Sec. 1102.  During the current fiscal year, provisions of law 
prohibiting the payment of compensation to, or employment of, any 
person not a citizen of the United States shall not apply to personnel 
of the Department of Defense:  Provided, That salary increases granted 
to direct and indirect hire foreign national employees of the 
Department of Defense funded by this Act shall not be at a rate in 
excess of the percentage increase authorized by law for civilian 
employees of the Department of Defense whose pay is computed under the 
provisions of section 5332 of title 5, United States Code, or at a rate 
in excess of the percentage increase provided by the appropriate host 
nation to its own employees, whichever is higher:  Provided further, 
That this section shall not apply to Department of Defense foreign 
service national employees serving at United States diplomatic missions 
whose pay is set by the Department of State under the Foreign Service 
Act of 1980:  Provided further, That the limitations of this provision 
shall not apply to foreign national employees of the Department of 
Defense in the Republic of Turkey.
    Sec. 1103.  No part of any appropriation contained in this Act 
shall remain available for obligation beyond the current fiscal year, 
unless expressly so provided herein.
    Sec. 1104.  No more than 20 percent of the appropriations in this 
Act which are limited for obligation during the current fiscal year 
shall be obligated during the last 2 months of the fiscal year:  
Provided, That this section shall not apply to obligations for support 
of active duty training of reserve components or summer camp training 
of the Reserve Officers' Training Corps.

                          (transfer of funds)

    Sec. 1105.  Upon determination by the Secretary of Defense that 
such action is necessary in the national interest, he may, with the 
approval of the Office of Management and Budget, transfer not to exceed 
$4,500,000,000 of working capital funds of the Department of Defense or 
funds made available in this Act to the Department of Defense for 
military functions (except military construction) between such 
appropriations or funds or any subdivision thereof, to be merged with 
and to be available for the same purposes, and for the same time 
period, as the appropriation or fund to which transferred:  Provided, 
That such authority to transfer may not be used unless for higher 
priority items, based on unforeseen military requirements, than those 
for which originally appropriated and in no case where the item for 
which funds are requested has been denied by the Congress:  Provided 
further, That the Secretary of Defense shall notify the Congress 
promptly of all transfers made pursuant to this authority or any other 
authority in this Act:  Provided further, That no part of the funds in 
this Act shall be available to prepare or present a request to the 
Committees on Appropriations for reprogramming of funds, unless for 
higher priority items, based on unforeseen military requirements, than 
those for which originally appropriated and in no case where the item 
for which reprogramming is requested has been denied by the Congress:  
Provided further, That a request for multiple reprogrammings of funds 
using authority provided in this section shall be made prior to June 
30, 2017:  Provided further, That transfers among military personnel 
appropriations shall not be taken into account for purposes of the 
limitation on the amount of funds that may be transferred under this 
section.
    Sec. 1106. (a) With regard to the list of specific programs, 
projects, and activities (and the dollar amounts and adjustments to 
budget activities corresponding to such programs, projects, and 
activities) contained in the tables titled Explanation of Project Level 
Adjustments in the explanatory statement regarding this Act, the 
obligation and expenditure of amounts appropriated or otherwise made 
available in this Act for those programs, projects, and activities for 
which the amounts appropriated exceed the amounts requested are hereby 
required by law to be carried out in the manner provided by such tables 
to the same extent as if the tables were included in the text of this 
Act.
    (b) Amounts specified in the referenced tables described in 
subsection (a) shall not be treated as subdivisions of appropriations 
for purposes of section 8005 of this Act:  Provided, That section 8005 
shall apply when transfers of the amounts described in subsection (a) 
occur between appropriation accounts.
    Sec. 1107. (a) Not later than 60 days after enactment of this Act, 
the Department of Defense shall submit a report to the congressional 
defense committees to establish the baseline for application of 
reprogramming and transfer authorities for fiscal year 2018:  Provided, 
That the report shall include--
            (1) a table for each appropriation with a separate column 
        to display the President's budget request, adjustments made by 
        Congress, adjustments due to enacted rescissions, if 
        appropriate, and the fiscal year enacted level;
            (2) a delineation in the table for each appropriation both 
        by budget activity and program, project, and activity as 
        detailed in the Budget Appendix; and
            (3) an identification of items of special congressional 
        interest.
    (b) Notwithstanding section 8005 of this Act, none of the funds 
provided in this Act shall be available for reprogramming or transfer 
until the report identified in subsection (a) is submitted to the 
congressional defense committees, unless the Secretary of Defense 
certifies in writing to the congressional defense committees that such 
reprogramming or transfer is necessary as an emergency requirement:  
Provided, That this subsection shall not apply to transfers from the 
following appropriations accounts:
            (1) ``Environmental Restoration, Army'';
            (2) ``Environmental Restoration, Navy'' ;
            (3) ``Environmental Restoration, Air Force'';
            (4) ``Environmental Restoration, Defense-Wide''
            (5) ``Environmental Restoration, Formerly Used Defense 
        Sites''; and
            (6) ``Drug Interdiction and Counter-drug Activities, 
        Defense''.

                          (transfer of funds)

    Sec. 1108.  During the current fiscal year, cash balances in 
working capital funds of the Department of Defense established pursuant 
to section 2208 of title 10, United States Code, may be maintained in 
only such amounts as are necessary at any time for cash disbursements 
to be made from such funds:  Provided, That transfers may be made 
between such funds:  Provided further, That transfers may be made 
between working capital funds and the ``Foreign Currency Fluctuations, 
Defense'' appropriation and the ``Operation and Maintenance'' 
appropriation accounts in such amounts as may be determined by the 
Secretary of Defense, with the approval of the Office of Management and 
Budget, except that such transfers may not be made unless the Secretary 
of Defense has notified the Congress of the proposed transfer:  
Provided further, That except in amounts equal to the amounts 
appropriated to working capital funds in this Act, no obligations may 
be made against a working capital fund to procure or increase the value 
of war reserve material inventory, unless the Secretary of Defense has 
notified the Congress prior to any such obligation.
    Sec. 1109.  Funds appropriated by this Act may not be used to 
initiate a special access program without prior notification 30 
calendar days in advance to the congressional defense committees.
    Sec. 1110.  None of the funds provided in this Act shall be 
available to initiate: (1) a multiyear contract that employs economic 
order quantity procurement in excess of $20,000,000 in any one year of 
the contract or that includes an unfunded contingent liability in 
excess of $20,000,000; or (2) a contract for advance procurement 
leading to a multiyear contract that employs economic order quantity 
procurement in excess of $20,000,000 in any one year, unless the 
congressional defense committees have been notified at least 30 days in 
advance of the proposed contract award:  Provided, That no part of any 
appropriation contained in this Act shall be available to initiate a 
multiyear contract for which the economic order quantity advance 
procurement is not funded at least to the limits of the Government's 
liability:  Provided further, That no part of any appropriation 
contained in this Act shall be available to initiate multiyear 
procurement contracts for any systems or component thereof if the value 
of the multiyear contract would exceed $500,000,000 unless specifically 
provided in this Act:  Provided further, That no multiyear procurement 
contract can be terminated without 30-day prior notification to the 
congressional defense committees:  Provided further, That the execution 
of multiyear authority shall require the use of a present value 
analysis to determine lowest cost compared to an annual procurement:  
Provided further, That none of the funds provided in this Act may be 
used for a multiyear contract executed after the date of the enactment 
of this Act unless in the case of any such contract--
            (1) the Secretary of Defense has submitted to Congress a 
        budget request for full funding of units to be procured through 
        the contract and, in the case of a contract for procurement of 
        aircraft, that includes, for any aircraft unit to be procured 
        through the contract for which procurement funds are requested 
        in that budget request for production beyond advance 
        procurement activities in the fiscal year covered by the 
        budget, full funding of procurement of such unit in that fiscal 
        year;
            (2) cancellation provisions in the contract do not include 
        consideration of recurring manufacturing costs of the 
        contractor associated with the production of unfunded units to 
        be delivered under the contract;
            (3) the contract provides that payments to the contractor 
        under the contract shall not be made in advance of incurred 
        costs on funded units; and
            (4) the contract does not provide for a price adjustment 
        based on a failure to award a follow-on contract.
Funds appropriated in title III of this Act may be used, subject to 
section 2306b of title 10 , United States Code, for multiyear 
procurement contracts as follows: V-22 Osprey aircraft variants; up to 
13 SSN Virginia Class Submarines and Government-furnished equipment; 
and DDG-51 Arleigh Burke class Flight III guided missile destroyers, 
the MK 41 Vertical Launching Systems, and associated Government-
furnished systems and subsystems.
    Sec. 1111.  Within the funds appropriated for the operation and 
maintenance of the Armed Forces, funds are hereby appropriated pursuant 
to section 401 of title 10, United States Code, for humanitarian and 
civic assistance costs under chapter 20 of title 10, United States 
Code. Such funds may also be obligated for humanitarian and civic 
assistance costs incidental to authorized operations and pursuant to 
authority granted in section 401 of chapter 20 of title 10, United 
States Code, and these obligations shall be reported as required by 
section 401(d) of title 10, United States Code:  Provided, That funds 
available for operation and maintenance shall be available for 
providing humanitarian and similar assistance by using Civic Action 
Teams in the Trust Territories of the Pacific Islands and freely 
associated states of Micronesia, pursuant to the Compact of Free 
Association as authorized by Public Law 99-239:  Provided further, That 
upon a determination by the Secretary of the Army that such action is 
beneficial for graduate medical education programs conducted at Army 
medical facilities located in Hawaii, the Secretary of the Army may 
authorize the provision of medical services at such facilities and 
transportation to such facilities, on a nonreimbursable basis, for 
civilian patients from American Samoa, the Commonwealth of the Northern 
Mariana Islands, the Marshall Islands, the Federated States of 
Micronesia, Palau, and Guam.
    Sec. 1112. (a) During the current fiscal year, the civilian 
personnel of the Department of Defense may not be managed on the basis 
of any end-strength, and the management of such personnel during that 
fiscal year shall not be subject to any constraint or limitation (known 
as an end-strength) on the number of such personnel who may be employed 
on the last day of such fiscal year.
    (b) The fiscal year 2019 budget request for the Department of 
Defense as well as all justification material and other documentation 
supporting the fiscal year 2019 Department of Defense budget request 
shall be prepared and submitted to the Congress as if subsections (a) 
and (b) of this provision were effective with regard to fiscal year 
2019.
    (c) As required by section 1107 of the National Defense 
Authorization Act for Fiscal Year 2014 (Public Law 113-66; 10 U.S.C. 
2358 note) civilian personnel at the Department of Army Science and 
Technology Reinvention Laboratories may not be managed on the basis of 
the Table of Distribution and Allowances, and the management of the 
workforce strength shall be done in a manner consistent with the budget 
available with respect to such Laboratories.
    (d) Nothing in this section shall be construed to apply to military 
(civilian) technicians.
    Sec. 1113.  None of the funds made available by this Act shall be 
used in any way, directly or indirectly, to influence congressional 
action on any legislation or appropriation matters pending before the 
Congress.
    Sec. 1114.  None of the funds appropriated by this Act shall be 
available for the basic pay and allowances of any member of the Army 
participating as a full-time student and receiving benefits paid by the 
Secretary of Veterans Affairs from the Department of Defense Education 
Benefits Fund when time spent as a full-time student is credited toward 
completion of a service commitment:  Provided, That this section shall 
not apply to those members who have reenlisted with this option prior 
to October 1, 1987:  Provided further, That this section applies only 
to active components of the Army.

                          (transfer of funds)

    Sec. 1115.  Funds appropriated in title III of this Act for the 
Department of Defense Pilot Mentor-Protege Program may be transferred 
to any other appropriation contained in this Act solely for the purpose 
of implementing a Mentor-Protege Program developmental assistance 
agreement pursuant to section 831 of the National Defense Authorization 
Act for Fiscal Year 1991 (Public Law 101-510; 10 U.S.C. 2302 note), as 
amended, under the authority of this provision or any other transfer 
authority contained in this Act.
    Sec. 1116.  None of the funds in this Act may be available for the 
purchase by the Department of Defense (and its departments and 
agencies) of welded shipboard anchor and mooring chain 4 inches in 
diameter and under unless the anchor and mooring chain are manufactured 
in the United States from components which are substantially 
manufactured in the United States:  Provided, That for the purpose of 
this section, the term ``manufactured'' shall include cutting, heat 
treating, quality control, testing of chain and welding (including the 
forging and shot blasting process):  Provided further, That for the 
purpose of this section substantially all of the components of anchor 
and mooring chain shall be considered to be produced or manufactured in 
the United States if the aggregate cost of the components produced or 
manufactured in the United States exceeds the aggregate cost of the 
components produced or manufactured outside the United States:  
Provided further, That when adequate domestic supplies are not 
available to meet Department of Defense requirements on a timely basis, 
the Secretary of the service responsible for the procurement may waive 
this restriction on a case-by-case basis by certifying in writing to 
the Committees on Appropriations that such an acquisition must be made 
in order to acquire capability for national security purposes.
    Sec. 1117.  None of the funds available to the Department of 
Defense may be used to demilitarize or dispose of M-1 Carbines, M-1 
Garand rifles, M-14 rifles, .22 caliber rifles, .30 caliber rifles, or 
M-1911 pistols, or to demilitarize or destroy small arms ammunition or 
ammunition components that are not otherwise prohibited from commercial 
sale under Federal law, unless the small arms ammunition or ammunition 
components are certified by the Secretary of the Army or designee as 
unserviceable or unsafe for further use.
    Sec. 1118.  No more than $500,000 of the funds appropriated or made 
available in this Act shall be used during a single fiscal year for any 
single relocation of an organization, unit, activity or function of the 
Department of Defense into or within the National Capital Region:  
Provided, That the Secretary of Defense may waive this restriction on a 
case-by-case basis by certifying in writing to the congressional 
defense committees that such a relocation is required in the best 
interest of the Government.
    Sec. 1119.  Of the funds made available in this Act, $20,000,000 
shall be available for incentive payments authorized by section 504 of 
the Indian Financing Act of 1974 (25 U.S.C. 1544):  Provided, That a 
prime contractor or a subcontractor at any tier that makes a 
subcontract award to any subcontractor or supplier as defined in 
section 1544 of title 25, United States Code, or a small business owned 
and controlled by an individual or individuals defined under section 
4221(9) of title 25, United States Code, shall be considered a 
contractor for the purposes of being allowed additional compensation 
under section 504 of the Indian Financing Act of 1974 (25 U.S.C. 1544) 
whenever the prime contract or subcontract amount is over $500,000 and 
involves the expenditure of funds appropriated by an Act making 
appropriations for the Department of Defense with respect to any fiscal 
year:  Provided further, That notwithstanding section 1906 of title 41, 
United States Code, this section shall be applicable to any Department 
of Defense acquisition of supplies or services, including any contract 
and any subcontract at any tier for acquisition of commercial items 
produced or manufactured, in whole or in part, by any subcontractor or 
supplier defined in section 1544 of title 25, United States Code, or a 
small business owned and controlled by an individual or individuals 
defined under section 4221(9) of title 25, United States Code.
    Sec. 1120.  Funds appropriated by this Act for the Defense Media 
Activity shall not be used for any national or international political 
or psychological activities.
    Sec. 1121.  During the current fiscal year, the Department of 
Defense is authorized to incur obligations of not to exceed 
$350,000,000 for purposes specified in section 2350j(c) of title 10, 
United States Code, in anticipation of receipt of contributions, only 
from the Government of Kuwait, under that section:  Provided, That, 
upon receipt, such contributions from the Government of Kuwait shall be 
credited to the appropriations or fund which incurred such obligations.
    Sec. 1122. (a) Of the funds made available in this Act, not less 
than $43,100,000 shall be available for the Civil Air Patrol 
Corporation, of which--
            (1) $30,800,000 shall be available from ``Operation and 
        Maintenance, Air Force'' to support Civil Air Patrol 
        Corporation operation and maintenance, readiness, counter-drug 
        activities, and drug demand reduction activities involving 
        youth programs;
            (2) $10,600,000 shall be available from ``Aircraft 
        Procurement, Air Force''; and
            (3) $1,700,000 shall be available from ``Other Procurement, 
        Air Force'' for vehicle procurement.
    (b) The Secretary of the Air Force should waive reimbursement for 
any funds used by the Civil Air Patrol for counter-drug activities in 
support of Federal, State, and local government agencies.
    Sec. 1123. (a) None of the funds appropriated in this Act are 
available to establish a new Department of Defense (department) 
federally funded research and development center (FFRDC), either as a 
new entity, or as a separate entity administrated by an organization 
managing another FFRDC, or as a nonprofit membership corporation 
consisting of a consortium of other FFRDCs and other nonprofit 
entities.
    (b) No member of a Board of Directors, Trustees, Overseers, 
Advisory Group, Special Issues Panel, Visiting Committee, or any 
similar entity of a defense FFRDC, and no paid consultant to any 
defense FFRDC, except when acting in a technical advisory capacity, may 
be compensated for his or her services as a member of such entity, or 
as a paid consultant by more than one FFRDC in a fiscal year:  
Provided, That a member of any such entity referred to previously in 
this subsection shall be allowed travel expenses and per diem as 
authorized under the Federal Joint Travel Regulations, when engaged in 
the performance of membership duties.
    (c) Notwithstanding any other provision of law, none of the funds 
available to the department from any source during the current fiscal 
year may be used by a defense FFRDC, through a fee or other payment 
mechanism, for construction of new buildings not located on a military 
installation, for payment of cost sharing for projects funded by 
Government grants, for absorption of contract overruns, or for certain 
charitable contributions, not to include employee participation in 
community service and/or development.
    (d) Notwithstanding any other provision of law, of the funds 
available to the department during fiscal year 2018, not more than 
6,000 staff years of technical effort (staff years) may be funded for 
defense FFRDCs:  Provided, That, of the specific amount referred to 
previously in this subsection, not more than 1,180 staff years may be 
funded for the defense studies and analysis FFRDCs:  Provided further, 
That this subsection shall not apply to staff years funded in the 
National Intelligence Program (NIP) and the Military Intelligence 
Program (MIP).
    (e) The Secretary of Defense shall, with the submission of the 
department's fiscal year 2019 budget request, submit a report 
presenting the specific amounts of staff years of technical effort to 
be allocated for each defense FFRDC during that fiscal year and the 
associated budget estimates.
    (f) Notwithstanding any other provision of this Act, the total 
amount appropriated in this Act for FFRDCs is hereby reduced by 
$210,000,000.
    Sec. 1124.  None of the funds appropriated or made available in 
this Act shall be used to procure carbon, alloy, or armor steel plate 
for use in any Government-owned facility or property under the control 
of the Department of Defense which were not melted and rolled in the 
United States or Canada:  Provided, That these procurement restrictions 
shall apply to any and all Federal Supply Class 9515, American Society 
of Testing and Materials (ASTM) or American Iron and Steel Institute 
(AISI) specifications of carbon, alloy or armor steel plate:  Provided 
further, That the Secretary of the military department responsible for 
the procurement may waive this restriction on a case-by-case basis by 
certifying in writing to the Committees on Appropriations of the House 
of Representatives and the Senate that adequate domestic supplies are 
not available to meet Department of Defense requirements on a timely 
basis and that such an acquisition must be made in order to acquire 
capability for national security purposes:  Provided further, That 
these restrictions shall not apply to contracts which are in being as 
of the date of the enactment of this Act.
    Sec. 1125.  For the purposes of this Act, the term ``congressional 
defense committees'' means the Armed Services Committee of the House of 
Representatives, the Armed Services Committee of the Senate, the 
Subcommittee on Defense of the Committee on Appropriations of the 
Senate, and the Subcommittee on Defense of the Committee on 
Appropriations of the House of Representatives.
    Sec. 1126.  During the current fiscal year, the Department of 
Defense may acquire the modification, depot maintenance and repair of 
aircraft, vehicles and vessels as well as the production of components 
and other Defense-related articles, through competition between 
Department of Defense depot maintenance activities and private firms:  
Provided, That the Senior Acquisition Executive of the military 
department or Defense Agency concerned, with power of delegation, shall 
certify that successful bids include comparable estimates of all direct 
and indirect costs for both public and private bids:  Provided further, 
That Office of Management and Budget Circular A-76 shall not apply to 
competitions conducted under this section.
    Sec. 1127. (a)(1) If the Secretary of Defense, after consultation 
with the United States Trade Representative, determines that a foreign 
country which is party to an agreement described in paragraph (2) has 
violated the terms of the agreement by discriminating against certain 
types of products produced in the United States that are covered by the 
agreement, the Secretary of Defense shall rescind the Secretary's 
blanket waiver of the Buy American Act with respect to such types of 
products produced in that foreign country.
    (2) An agreement referred to in paragraph (1) is any reciprocal 
defense procurement memorandum of understanding, between the United 
States and a foreign country pursuant to which the Secretary of Defense 
has prospectively waived the Buy American Act for certain products in 
that country.
    (b) The Secretary of Defense shall submit to the Congress a report 
on the amount of Department of Defense purchases from foreign entities 
in fiscal year 2018. Such report shall separately indicate the dollar 
value of items for which the Buy American Act was waived pursuant to 
any agreement described in subsection (a)(2), the Trade Agreement Act 
of 1979 (19 U.S.C. 2501 et seq.), or any international agreement to 
which the United States is a party.
    (c) For purposes of this section, the term Buy American Act means 
chapter 83 of title 41, United States Code.
    Sec. 1128.  During the current fiscal year, amounts contained in 
the Department of Defense Overseas Military Facility Investment 
Recovery Account established by section 2921(c)(1) of the National 
Defense Authorization Act of 1991 (Public Law 101-510; 10 U.S.C. 2687 
note) shall be available until expended for the payments specified by 
section 2921(c)(2) of that Act.
    Sec. 1129. (a) Notwithstanding any other provision of law, the 
Secretary of the Air Force may convey at no cost to the Air Force, 
without consideration, to Indian tribes located in the States of 
Nevada, Idaho, North Dakota, South Dakota, Montana, Oregon, Minnesota, 
and Washington relocatable military housing units located at Grand 
Forks Air Force Base, Malmstrom Air Force Base, Mountain Home Air Force 
Base, Ellsworth Air Force Base, and Minot Air Force Base that are 
excess to the needs of the Air Force.
    (b) The Secretary of the Air Force shall convey, at no cost to the 
Air Force, military housing units under subsection (a) in accordance 
with the request for such units that are submitted to the Secretary by 
the Operation Walking Shield Program on behalf of Indian tribes located 
in the States of Nevada, Idaho, North Dakota, South Dakota, Montana, 
Oregon, Minnesota, and Washington. Any such conveyance shall be subject 
to the condition that the housing units shall be removed within a 
reasonable period of time, as determined by the Secretary.
    (c) The Operation Walking Shield Program shall resolve any 
conflicts among requests of Indian tribes for housing units under 
subsection (a) before submitting requests to the Secretary of the Air 
Force under subsection (b).
    (d) In this section, the term Indian tribe means any recognized 
Indian tribe included on the current list published by the Secretary of 
the Interior under section 104 of the Federally Recognized Indian Tribe 
Act of 1994 (Public Law 103-454; 108 Stat. 4792; 25 U.S.C. 479a-1).
    Sec. 1130.  During the current fiscal year, appropriations which 
are available to the Department of Defense for operation and 
maintenance may be used to purchase items having an investment item 
unit cost of not more than $250,000.
    Sec. 1131.  None of the funds made available by this Act may be 
used to--
            (1) disestablish, or prepare to disestablish, a Senior 
        Reserve Officers' Training Corps program in accordance with 
        Department of Defense Instruction Number 1215.08, dated June 
        26, 2006; or
            (2) close, downgrade from host to extension center, or 
        place on probation a Senior Reserve Officers' Training Corps 
        program in accordance with the information paper of the 
        Department of the Army titled ``Army Senior Reserve Officers' 
        Training Corps (SROTC) Program Review and Criteria'', dated 
        January 27, 2014.
    Sec. 1132.  The Secretary of Defense shall issue regulations to 
prohibit the sale of any tobacco or tobacco-related products in 
military resale outlets in the United States, its territories and 
possessions at a price below the most competitive price in the local 
community:  Provided, That such regulations shall direct that the 
prices of tobacco or tobacco-related products in overseas military 
retail outlets shall be within the range of prices established for 
military retail system stores located in the United States.
    Sec. 1133. (a) During the current fiscal year, none of the 
appropriations or funds available to the Department of Defense Working 
Capital Funds shall be used for the purchase of an investment item for 
the purpose of acquiring a new inventory item for sale or anticipated 
sale during the current fiscal year or a subsequent fiscal year to 
customers of the Department of Defense Working Capital Funds if such an 
item would not have been chargeable to the Department of Defense 
Business Operations Fund during fiscal year 1994 and if the purchase of 
such an investment item would be chargeable during the current fiscal 
year to appropriations made to the Department of Defense for 
procurement.
    (b) The fiscal year 2019 budget request for the Department of 
Defense as well as all justification material and other documentation 
supporting the fiscal year 2019 Department of Defense budget shall be 
prepared and submitted to the Congress on the basis that any equipment 
which was classified as an end item and funded in a procurement 
appropriation contained in this Act shall be budgeted for in a proposed 
fiscal year 2019 procurement appropriation and not in the supply 
management business area or any other area or category of the 
Department of Defense Working Capital Funds.
    Sec. 1134.  None of the funds appropriated by this Act for programs 
of the Central Intelligence Agency shall remain available for 
obligation beyond the current fiscal year, except for funds 
appropriated for the Reserve for Contingencies, which shall remain 
available until September 30, 2019:  Provided, That funds appropriated, 
transferred, or otherwise credited to the Central Intelligence Agency 
Central Services Working Capital Fund during this or any prior or 
subsequent fiscal year shall remain available until expended:  Provided 
further, That any funds appropriated or transferred to the Central 
Intelligence Agency for advanced research and development acquisition, 
for agent operations, and for covert action programs authorized by the 
President under section 503 of the National Security Act of 1947 (50 
U.S.C. 3093) shall remain available until September 30, 2019.
    Sec. 1135.  Notwithstanding any other provision of law, funds made 
available in this Act and hereafter for the Defense Intelligence Agency 
may be used for the design, development, and deployment of General 
Defense Intelligence Program intelligence communications and 
intelligence information systems for the Services, the Unified and 
Specified Commands, and the component commands.
    Sec. 1136.  Of the funds appropriated to the Department of Defense 
under the heading ``Operation and Maintenance, Defense-Wide'', not less 
than $12,000,000 shall be made available only for the mitigation of 
environmental impacts, including training and technical assistance to 
tribes, related administrative support, the gathering of information, 
documenting of environmental damage, and developing a system for 
prioritization of mitigation and cost to complete estimates for 
mitigation, on Indian lands resulting from Department of Defense 
activities.
    Sec. 1137. (a) None of the funds appropriated in this Act may be 
expended by an entity of the Department of Defense unless the entity, 
in expending the funds, complies with the Buy American Act. For 
purposes of this subsection, the term Buy American Act means chapter 83 
of title 41, United States Code.
    (b) If the Secretary of Defense determines that a person has been 
convicted of intentionally affixing a label bearing a ``Made in 
America'' inscription to any product sold in or shipped to the United 
States that is not made in America, the Secretary shall determine, in 
accordance with section 2410f of title 10, United States Code, whether 
the person should be debarred from contracting with the Department of 
Defense.
    (c) In the case of any equipment or products purchased with 
appropriations provided under this Act, it is the sense of the Congress 
that any entity of the Department of Defense, in expending the 
appropriation, purchase only American-made equipment and products, 
provided that American-made equipment and products are cost-
competitive, quality competitive, and available in a timely fashion.
    Sec. 1138. (a) Except as provided in subsections (b) and (c), none 
of the funds made available by this Act may be used--
            (1) to establish a field operating agency; or
            (2) to pay the basic pay of a member of the Armed Forces or 
        civilian employee of the department who is transferred or 
        reassigned from a headquarters activity if the member or 
        employee's place of duty remains at the location of that 
        headquarters.
    (b) The Secretary of Defense or Secretary of a military department 
may waive the limitations in subsection (a), on a case-by-case basis, 
if the Secretary determines, and certifies to the Committees on 
Appropriations of the House of Representatives and the Senate that the 
granting of the waiver will reduce the personnel requirements or the 
financial requirements of the department.
    (c) This section does not apply to--
            (1) field operating agencies funded within the National 
        Intelligence Program;
            (2) an Army field operating agency established to 
        eliminate, mitigate, or counter the effects of improvised 
        explosive devices, and, as determined by the Secretary of the 
        Army, other similar threats;
            (3) an Army field operating agency established to improve 
        the effectiveness and efficiencies of biometric activities and 
        to integrate common biometric technologies throughout the 
        Department of Defense; or
            (4) an Air Force field operating agency established to 
        administer the Air Force Mortuary Affairs Program and Mortuary 
        Operations for the Department of Defense and authorized Federal 
        entities.
    Sec. 1139. (a) None of the funds appropriated by this Act shall be 
available to convert to contractor performance an activity or function 
of the Department of Defense that, on or after the date of the 
enactment of this Act, is performed by Department of Defense civilian 
employees unless--
            (1) the conversion is based on the result of a public-
        private competition that includes a most efficient and cost 
        effective organization plan developed by such activity or 
        function;
            (2) the Competitive Sourcing Official determines that, over 
        all performance periods stated in the solicitation of offers 
        for performance of the activity or function, the cost of 
        performance of the activity or function by a contractor would 
        be less costly to the Department of Defense by an amount that 
        equals or exceeds the lesser of--
                    (A) 10 percent of the most efficient organization's 
                personnel-related costs for performance of that 
                activity or function by Federal employees; or
                    (B) $10,000,000; and
            (3) the contractor does not receive an advantage for a 
        proposal that would reduce costs for the Department of Defense 
        by--
                    (A) not making an employer-sponsored health 
                insurance plan available to the workers who are to be 
                employed in the performance of that activity or 
                function under the contract; or
                    (B) offering to such workers an employer-sponsored 
                health benefits plan that requires the employer to 
                contribute less towards the premium or subscription 
                share than the amount that is paid by the Department of 
                Defense for health benefits for civilian employees 
                under chapter 89 of title 5, United States Code.
    (b)(1) The Department of Defense, without regard to subsection (a) 
of this section or subsection (a), (b), or (c) of section 2461 of title 
10, United States Code, and notwithstanding any administrative 
regulation, requirement, or policy to the contrary shall have full 
authority to enter into a contract for the performance of any 
commercial or industrial type function of the Department of Defense 
that--
            (A) is included on the procurement list established 
        pursuant to section 2 of the Javits-Wagner-O'Day Act (section 
        8503 of title 41, United States Code);
            (B) is planned to be converted to performance by a 
        qualified nonprofit agency for the blind or by a qualified 
        nonprofit agency for other severely handicapped individuals in 
        accordance with that Act; or
            (C) is planned to be converted to performance by a 
        qualified firm under at least 51 percent ownership by an Indian 
        tribe, as defined in section 4(e) of the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450b(e)), 
        or a Native Hawaiian Organization, as defined in section 
        8(a)(15) of the Small Business Act (15 U.S.C. 637(a)(15)).
    (2) This section shall not apply to depot contracts or contracts 
for depot maintenance as provided in sections 2469 and 2474 of title 
10, United States Code.
    (c) The conversion of any activity or function of the Department of 
Defense under the authority provided by this section shall be credited 
toward any competitive or outsourcing goal, target, or measurement that 
may be established by statute, regulation, or policy and is deemed to 
be awarded under the authority of, and in compliance with, subsection 
(h) of section 2304 of title 10, United States Code, for the 
competition or outsourcing of commercial activities.

                             (rescissions)

    Sec. 1140.  Of the funds appropriated in Department of Defense 
Appropriations Acts, the following funds are hereby rescinded from the 
following accounts and programs in the specified amounts:  Provided, 
That no amounts may be rescinded from amounts that were designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism or as an emergency requirement pursuant to the Concurrent 
Resolution on the Budget or the Balanced Budget and Emergency Deficit 
Control Act of 1985, as amended:
            ``Aircraft Procurement, Navy'', 2016/2018, $274,000,000;
            ``Aircraft Procurement, Air Force'', 2016/2018, 
        $82,700,000;
            ``Missile Procurement, Army'', 2017/2019, $19,319,000;
            ``Procurement of Weapons and Tracked Combat Vehicles, 
        Army'', 2017/2019, $9,764,000;
            ``Other Procurement, Army'', 2017/2019, $10,000,000;
            ``Aircraft Procurement, Navy'', 2017/2019, $105,600,000;
            ``Weapons Procurement, Navy'', 2017/2019, $54,122,000;
            ``Shipbuilding and Conversion, Navy'', 2017/2021, 
        $45,116,000;
            ``Aircraft Procurement, Air Force'', 2017/2019, 
        $63,293,000;
            ``Missile Procurement, Air Force'', 2017/2019, $31,639,000;
            ``Space Procurement, Air Force'', 2017/2019, $15,000,000;
            ``Other Procurement, Air Force'', 2017/2019, $105,000,000;
            ``Research, Development, Test and Evaluation, Navy'', 2017/
        2018, $34,128,000;
            ``Research, Development, Test and Evaluation, Air Force'', 
        2017/2018, $41,700,000.
    Sec. 1141.  None of the funds available in this Act may be used to 
reduce the authorized positions for military technicians (dual status) 
of the Army National Guard, Air National Guard, Army Reserve and Air 
Force Reserve for the purpose of applying any administratively imposed 
civilian personnel ceiling, freeze, or reduction on military 
technicians (dual status), unless such reductions are a direct result 
of a reduction in military force structure.
    Sec. 1142.  None of the funds appropriated or otherwise made 
available in this Act may be obligated or expended for assistance to 
the Democratic People's Republic of Korea unless specifically 
appropriated for that purpose.
    Sec. 1143.  Funds appropriated in this Act for operation and 
maintenance of the Military Departments, Combatant Commands and Defense 
Agencies shall be available for reimbursement of pay, allowances and 
other expenses which would otherwise be incurred against appropriations 
for the National Guard and Reserve when members of the National Guard 
and Reserve provide intelligence or counterintelligence support to 
Combatant Commands, Defense Agencies and Joint Intelligence Activities, 
including the activities and programs included within the National 
Intelligence Program and the Military Intelligence Program:  Provided, 
That nothing in this section authorizes deviation from established 
Reserve and National Guard personnel and training procedures.
    Sec. 1144. (a) None of the funds available to the Department of 
Defense for any fiscal year for drug interdiction or counter-drug 
activities may be transferred to any other department or agency of the 
United States except as specifically provided in an appropriations law.
    (b) None of the funds available to the Central Intelligence Agency 
for any fiscal year for drug interdiction or counter-drug activities 
may be transferred to any other department or agency of the United 
States except as specifically provided in an appropriations law.
    Sec. 1145.  None of the funds appropriated by this Act may be used 
for the procurement of ball and roller bearings other than those 
produced by a domestic source and of domestic origin:  Provided, That 
the Secretary of the military department responsible for such 
procurement may waive this restriction on a case-by-case basis by 
certifying in writing to the Committees on Appropriations of the House 
of Representatives and the Senate, that adequate domestic supplies are 
not available to meet Department of Defense requirements on a timely 
basis and that such an acquisition must be made in order to acquire 
capability for national security purposes:  Provided further, That this 
restriction shall not apply to the purchase of ``commercial items'', as 
defined by section 103 of title 41, United States Code, except that the 
restriction shall apply to ball or roller bearings purchased as end 
items.
    Sec. 1146.  None of the funds made available by this Act for 
Evolved Expendable Launch Vehicle service competitive procurements may 
be used unless the competitive procurements are open for award to all 
certified providers of Evolved Expendable Launch Vehicle-class systems: 
 Provided, That the award shall be made to the provider that offers the 
best value to the government.
    Sec. 1147.  In addition to the amounts appropriated or otherwise 
made available elsewhere in this Act, $44,000,000 is hereby 
appropriated to the Department of Defense:  Provided, That upon the 
determination of the Secretary of Defense that it shall serve the 
national interest, the Secretary shall make grants in the amounts 
specified as follows: $20,000,000 to the United Service Organizations 
and $24,000,000 to the Red Cross.
    Sec. 1148.  None of the funds in this Act may be used to purchase 
any supercomputer which is not manufactured in the United States, 
unless the Secretary of Defense certifies to the congressional defense 
committees that such an acquisition must be made in order to acquire 
capability for national security purposes that is not available from 
United States manufacturers.
    Sec. 1149.  Notwithstanding any other provision in this Act, the 
Small Business Innovation Research program and the Small Business 
Technology Transfer program set-asides shall be taken proportionally 
from all programs, projects, or activities to the extent they 
contribute to the extramural budget.
    Sec. 1150.  None of the funds available to the Department of 
Defense under this Act shall be obligated or expended to pay a 
contractor under a contract with the Department of Defense for costs of 
any amount paid by the contractor to an employee when--
            (1) such costs are for a bonus or otherwise in excess of 
        the normal salary paid by the contractor to the employee; and
            (2) such bonus is part of restructuring costs associated 
        with a business combination.

                     (including transfer of funds)

    Sec. 1151.  During the current fiscal year, no more than 
$30,000,000 of appropriations made in this Act under the heading 
``Operation and Maintenance, Defense-Wide'' may be transferred to 
appropriations available for the pay of military personnel, to be 
merged with, and to be available for the same time period as the 
appropriations to which transferred, to be used in support of such 
personnel in connection with support and services for eligible 
organizations and activities outside the Department of Defense pursuant 
to section 2012 of title 10, United States Code.
    Sec. 1152.  During the current fiscal year, in the case of an 
appropriation account of the Department of Defense for which the period 
of availability for obligation has expired or which has closed under 
the provisions of section 1552 of title 31, United States Code, and 
which has a negative unliquidated or unexpended balance, an obligation 
or an adjustment of an obligation may be charged to any current 
appropriation account for the same purpose as the expired or closed 
account if--
            (1) the obligation would have been properly chargeable 
        (except as to amount) to the expired or closed account before 
        the end of the period of availability or closing of that 
        account;
            (2) the obligation is not otherwise properly chargeable to 
        any current appropriation account of the Department of Defense; 
        and
            (3) in the case of an expired account, the obligation is 
        not chargeable to a current appropriation of the Department of 
        Defense under the provisions of section 1405(b)(8) of the 
        National Defense Authorization Act for Fiscal Year 1991, Public 
        Law 101-510, as amended (31 U.S.C. 1551 note):  Provided, That 
        in the case of an expired account, if subsequent review or 
        investigation discloses that there was not in fact a negative 
        unliquidated or unexpended balance in the account, any charge 
        to a current account under the authority of this section shall 
        be reversed and recorded against the expired account:  Provided 
        further, That the total amount charged to a current 
        appropriation under this section may not exceed an amount equal 
        to 1 percent of the total appropriation for that account.
    Sec. 1153. (a) Notwithstanding any other provision of law, the 
Chief of the National Guard Bureau may permit the use of equipment of 
the National Guard Distance Learning Project by any person or entity on 
a space-available, reimbursable basis. The Chief of the National Guard 
Bureau shall establish the amount of reimbursement for such use on a 
case-by-case basis.
    (b) Amounts collected under subsection (a) shall be credited to 
funds available for the National Guard Distance Learning Project and be 
available to defray the costs associated with the use of equipment of 
the project under that subsection. Such funds shall be available for 
such purposes without fiscal year limitation.
    Sec. 1154.  None of the funds available to the Department of 
Defense may be obligated to modify command and control relationships to 
give Fleet Forces Command operational and administrative control of 
United States Navy forces assigned to the Pacific fleet:  Provided, 
That the command and control relationships which existed on October 1, 
2004, shall remain in force until a written modification has been 
proposed to the House and Senate Appropriations Committees:  Provided 
further, That the proposed modification may be implemented 30 days 
after the notification unless an objection is received from either the 
House or Senate Appropriations Committees:  Provided further, That any 
proposed modification shall not preclude the ability of the commander 
of United States Pacific Command to meet operational requirements.

                     (including transfer of funds)

    Sec. 1155.  Of the funds appropriated in this Act under the heading 
``Operation and Maintenance, Defense-Wide'', $25,000,000 (increased by 
$10,000,000) shall be for continued implementation and expansion of the 
Sexual Assault Special Victims' Counsel Program:  Provided, That the 
funds are made available for transfer to the Department of the Army, 
the Department of the Navy, and the Department of the Air Force:  
Provided further, That funds transferred shall be merged with and 
available for the same purposes and for the same time period as the 
appropriations to which the funds are transferred:  Provided further, 
That this transfer authority is in addition to any other transfer 
authority provided in this Act.
    Sec. 1156.  None of the funds appropriated in title IV of this Act 
may be used to procure end-items for delivery to military forces for 
operational training, operational use or inventory requirements:  
Provided, That this restriction does not apply to end-items used in 
development, prototyping, and test activities preceding and leading to 
acceptance for operational use:  Provided further, That this 
restriction does not apply to programs funded within the National 
Intelligence Program:  Provided further, That the Secretary of Defense 
may waive this restriction on a case-by-case basis by certifying in 
writing to the Committees on Appropriations of the House of 
Representatives and the Senate that it is in the national security 
interest to do so.
    Sec. 1157. (a) The Secretary of Defense may, on a case-by-case 
basis, waive with respect to a foreign country each limitation on the 
procurement of defense items from foreign sources provided in law if 
the Secretary determines that the application of the limitation with 
respect to that country would invalidate cooperative programs entered 
into between the Department of Defense and the foreign country, or 
would invalidate reciprocal trade agreements for the procurement of 
defense items entered into under section 2531 of title 10, United 
States Code, and the country does not discriminate against the same or 
similar defense items produced in the United States for that country.
    (b) Subsection (a) applies with respect to--
            (1) contracts and subcontracts entered into on or after the 
        date of the enactment of this Act; and
            (2) options for the procurement of items that are exercised 
        after such date under contracts that are entered into before 
        such date if the option prices are adjusted for any reason 
        other than the application of a waiver granted under subsection 
        (a).
    (c) Subsection (a) does not apply to a limitation regarding 
construction of public vessels, ball and roller bearings, food, and 
clothing or textile materials as defined by section XI (chapters 50-65) 
of the Harmonized Tariff Schedule of the United States and products 
classified under headings 4010, 4202, 4203, 6401 through 6406, 6505, 
7019, 7218 through 7229, 7304.41 through 7304.49, 7306.40, 7502 through 
7508, 8105, 8108, 8109, 8211, 8215, and 9404.
    Sec. 1158.  None of the funds appropriated or otherwise made 
available by this or other Department of Defense Appropriations Acts 
may be obligated or expended for the purpose of performing repairs or 
maintenance to military family housing units of the Department of 
Defense, including areas in such military family housing units that may 
be used for the purpose of conducting official Department of Defense 
business.
    Sec. 1159.  Notwithstanding any other provision of law, funds 
appropriated in this Act under the heading ``Research, Development, 
Test and Evaluation, Defense-Wide'' for any new start advanced concept 
technology demonstration project or joint capability demonstration 
project may only be obligated 45 days after a report, including a 
description of the project, the planned acquisition and transition 
strategy and its estimated annual and total cost, has been provided in 
writing to the congressional defense committees:  Provided, That the 
Secretary of Defense may waive this restriction on a case-by-case basis 
by certifying to the congressional defense committees that it is in the 
national interest to do so.
    Sec. 1160.  The Secretary of Defense shall continue to provide a 
classified quarterly report to the House and Senate Appropriations 
Committees, Subcommittees on Defense on certain matters as directed in 
the classified annex accompanying this Act.
    Sec. 1161.  Notwithstanding section 12310(b) of title 10, United 
States Code, a Reserve who is a member of the National Guard serving on 
full-time National Guard duty under section 502(f) of title 32, United 
States Code, may perform duties in support of the ground-based elements 
of the National Ballistic Missile Defense System.
    Sec. 1162.  None of the funds provided in this Act may be used to 
transfer to any nongovernmental entity ammunition held by the 
Department of Defense that has a center-fire cartridge and a United 
States military nomenclature designation of ``armor penetrator'', 
``armor piercing (AP)'', ``armor piercing incendiary (API)'', or 
``armor-piercing incendiary tracer (API-T)'', except to an entity 
performing demilitarization services for the Department of Defense 
under a contract that requires the entity to demonstrate to the 
satisfaction of the Department of Defense that armor piercing 
projectiles are either:
            (1) rendered incapable of reuse by the demilitarization 
        process; or
            (2) used to manufacture ammunition pursuant to a contract 
        with the Department of Defense or the manufacture of ammunition 
        for export pursuant to a License for Permanent Export of 
        Unclassified Military Articles issued by the Department of 
        State.
    Sec. 1163.  Notwithstanding any other provision of law, the Chief 
of the National Guard Bureau, or his designee, may waive payment of all 
or part of the consideration that otherwise would be required under 
section 2667 of title 10, United States Code, in the case of a lease of 
personal property for a period not in excess of 1 year to any 
organization specified in section 508(d) of title 32, United States 
Code, or any other youth, social, or fraternal nonprofit organization 
as may be approved by the Chief of the National Guard Bureau, or his 
designee, on a case-by-case basis.

                     (including transfer of funds)

    Sec. 1164.  Of the amounts appropriated in this Act under the 
heading ``Operation and Maintenance, Army'', $66,881,780 shall remain 
available until expended:  Provided, That, notwithstanding any other 
provision of law, the Secretary of Defense is authorized to transfer 
such funds to other activities of the Federal Government:  Provided 
further, That the Secretary of Defense is authorized to enter into and 
carry out contracts for the acquisition of real property, construction, 
personal services, and operations related to projects carrying out the 
purposes of this section:  Provided further, That contracts entered 
into under the authority of this section may provide for such 
indemnification as the Secretary determines to be necessary:  Provided 
further, That projects authorized by this section shall comply with 
applicable Federal, State, and local law to the maximum extent 
consistent with the national security, as determined by the Secretary 
of Defense.
    Sec. 1165. (a) None of the funds appropriated in this or any other 
Act may be used to take any action to modify--
            (1) the appropriations account structure for the National 
        Intelligence Program budget, including through the creation of 
        a new appropriation or new appropriation account;
            (2) how the National Intelligence Program budget request is 
        presented in the unclassified P-1, R-1, and O-1 documents 
        supporting the Department of Defense budget request;
            (3) the process by which the National Intelligence Program 
        appropriations are apportioned to the executing agencies; or
            (4) the process by which the National Intelligence Program 
        appropriations are allotted, obligated and disbursed.
    (b) Nothing in section (a) shall be construed to prohibit the 
merger of programs or changes to the National Intelligence Program 
budget at or below the Expenditure Center level, provided such change 
is otherwise in accordance with paragraphs (a)(1)-(3).
    (c) The Director of National Intelligence and the Secretary of 
Defense may jointly, only for the purposes of achieving auditable 
financial statements and improving fiscal reporting, study and develop 
detailed proposals for alternative financial management processes. Such 
study shall include a comprehensive counterintelligence risk assessment 
to ensure that none of the alternative processes will adversely affect 
counterintelligence.
    (d) Upon development of the detailed proposals defined under 
subsection (c), the Director of National Intelligence and the Secretary 
of Defense shall--
            (1) provide the proposed alternatives to all affected 
        agencies;
            (2) receive certification from all affected agencies 
        attesting that the proposed alternatives will help achieve 
        auditability, improve fiscal reporting, and will not adversely 
        affect counterintelligence; and
            (3) not later than 30 days after receiving all necessary 
        certifications under paragraph (2), present the proposed 
        alternatives and certifications to the congressional defense 
        and intelligence committees.
    Sec. 1166.  In addition to amounts provided elsewhere in this Act, 
$5,000,000 (increased by $5,000,000) is hereby appropriated to the 
Department of Defense, to remain available for obligation until 
expended:  Provided, That notwithstanding any other provision of law, 
that upon the determination of the Secretary of Defense that it shall 
serve the national interest, these funds shall be available only for a 
grant to the Fisher House Foundation, Inc., only for the construction 
and furnishing of additional Fisher Houses to meet the needs of 
military family members when confronted with the illness or 
hospitalization of an eligible military beneficiary.

                     (including transfer of funds)

    Sec. 1167.  Of the amounts appropriated in this Act under the 
headings ``Procurement, Defense-Wide'' and ``Research, Development, 
Test and Evaluation, Defense-Wide'', $705,800,000 shall be for the 
Israeli Cooperative Programs:  Provided, That of this amount, 
$92,000,000 shall be for the Secretary of Defense to provide to the 
Government of Israel for the procurement of the Iron Dome defense 
system to counter short-range rocket threats, subject to the U.S.-
Israel Iron Dome Procurement Agreement, as amended; $221,500,000 shall 
be for the Short Range Ballistic Missile Defense (SRBMD) program, 
including cruise missile defense research and development under the 
SRBMD program, of which $120,000,000 shall be for co-production 
activities of SRBMD missiles in the United States and in Israel to meet 
Israel's defense requirements consistent with each nation's laws, 
regulations, and procedures, subject to the U.S.-Israeli co-production 
agreement for SRBMD, as amended; $205,000,000 shall be for an upper-
tier component to the Israeli Missile Defense Architecture, of which 
$120,000,000 shall be for co-production activities of Arrow 3 Upper 
Tier missiles in the United States and in Israel to meet Israel's 
defense requirements consistent with each nation's laws, regulations, 
and procedures, subject to the U.S.-Israeli co-production agreement for 
Arrow 3 Upper Tier, as amended; $105,000,000 shall be for testing of 
the upper-tier component to the Israeli Missile Defense Architecture in 
the United States; and $82,300,000 shall be for the Arrow System 
Improvement Program including development of a long range, ground and 
airborne, detection suite:  Provided further, That the transfer 
authority provided under this provision is in addition to any other 
transfer authority contained in this Act.

                     (including transfer of funds)

    Sec. 1168.  Of the amounts appropriated in this Act under the 
heading ``Shipbuilding and Conversion, Navy'', $117,542,000 shall be 
available until September 30, 2018, to fund prior year shipbuilding 
cost increases:  Provided, That upon enactment of this Act, the 
Secretary of the Navy shall transfer funds to the following 
appropriations in the amounts specified:  Provided further, That the 
amounts transferred shall be merged with and be available for the same 
purposes as the appropriations to which transferred to:
            (1) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2012/2018: Carrier Replacement Program $20,000,000;
            (2) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2008/2018: DDG-51 Destroyer $19,436,000;
            (3) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2012/2018: Littoral Combat Ship $6,394,000;
            (4) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2012/2018: LHA Replacement $14,200,000;
            (5) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2013/2018: DDG-51 Destroyer $31,941,000;
            (6) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2014/2018: Litoral Combat Ship $20,471,000; and
            (7) Under the heading ``Shipbuilding and Conversion, 
        Navy'', 2015/2018: LCAC $5,100,000.
    Sec. 1169.  Funds appropriated by this Act, or made available by 
the transfer of funds in this Act, for intelligence activities are 
deemed to be specifically authorized by the Congress for purposes of 
section 504 of the National Security Act of 1947 (50 U.S.C. 3094) 
during fiscal year 2018 until the enactment of the Intelligence 
Authorization Act for Fiscal Year 2018.
    Sec. 1170.  None of the funds provided in this Act shall be 
available for obligation or expenditure through a reprogramming of 
funds that creates or initiates a new program, project, or activity 
unless such program, project, or activity must be undertaken 
immediately in the interest of national security and only after written 
prior notification to the congressional defense committees.
    Sec. 1171.  The budget of the President for fiscal year 2018 
submitted to the Congress pursuant to section 1105 of title 31, United 
States Code, shall include separate budget justification documents for 
costs of United States Armed Forces' participation in contingency 
operations for the Military Personnel accounts, the Operation and 
Maintenance accounts, the Procurement accounts, and the Research, 
Development, Test and Evaluation accounts:  Provided, That these 
documents shall include a description of the funding requested for each 
contingency operation, for each military service, to include all Active 
and Reserve components, and for each appropriations account:  Provided 
further, That these documents shall include estimated costs for each 
element of expense or object class, a reconciliation of increases and 
decreases for each contingency operation, and programmatic data 
including, but not limited to, troop strength for each Active and 
Reserve component, and estimates of the major weapons systems deployed 
in support of each contingency:  Provided further, That these documents 
shall include budget exhibits OP-5 and OP-32 (as defined in the 
Department of Defense Financial Management Regulation) for all 
contingency operations for the budget year and the two preceding fiscal 
years.
    Sec. 1172.  None of the funds in this Act may be used for research, 
development, test, evaluation, procurement or deployment of nuclear 
armed interceptors of a missile defense system.
    Sec. 1173.  Notwithstanding any other provision of this Act, to 
reflect savings due to favorable foreign exchange rates, the total 
amount appropriated in this Act is hereby reduced by $289,000,000.
    Sec. 1174.  None of the funds appropriated or made available in 
this Act shall be used to reduce or disestablish the operation of the 
53rd Weather Reconnaissance Squadron of the Air Force Reserve, if such 
action would reduce the WC-130 Weather Reconnaissance mission below the 
levels funded in this Act:  Provided, That the Air Force shall allow 
the 53rd Weather Reconnaissance Squadron to perform other missions in 
support of national defense requirements during the non-hurricane 
season.
    Sec. 1175.  None of the funds provided in this Act shall be 
available for integration of foreign intelligence information unless 
the information has been lawfully collected and processed during the 
conduct of authorized foreign intelligence activities:  Provided, That 
information pertaining to United States persons shall only be handled 
in accordance with protections provided in the Fourth Amendment of the 
United States Constitution as implemented through Executive Order No. 
12333.
    Sec. 1176. (a) None of the funds appropriated by this Act may be 
used to transfer research and development, acquisition, or other 
program authority relating to current tactical unmanned aerial vehicles 
(TUAVs) from the Army.
    (b) The Army shall retain responsibility for and operational 
control of the MQ-1C Gray Eagle Unmanned Aerial Vehicle (UAV) in order 
to support the Secretary of Defense in matters relating to the 
employment of unmanned aerial vehicles.
    Sec. 1177.  None of the funds appropriated by this Act for programs 
of the Office of the Director of National Intelligence shall remain 
available for obligation beyond the current fiscal year, except for 
funds appropriated for research and technology, which shall remain 
available until September 30, 2019.
    Sec. 1178.  For purposes of section 1553(b) of title 31, United 
States Code, any subdivision of appropriations made in this Act under 
the heading ``Shipbuilding and Conversion, Navy'' shall be considered 
to be for the same purpose as any subdivision under the heading 
``Shipbuilding and Conversion, Navy'' appropriations in any prior 
fiscal year, and the 1 percent limitation shall apply to the total 
amount of the appropriation.
    Sec. 1179. (a) Not later than 60 days after the date of enactment 
of this Act, the Director of National Intelligence shall submit a 
report to the congressional intelligence committees to establish the 
baseline for application of reprogramming and transfer authorities for 
fiscal year 2018:  Provided, That the report shall include--
            (1) a table for each appropriation with a separate column 
        to display the President's budget request, adjustments made by 
        Congress, adjustments due to enacted rescissions, if 
        appropriate, and the fiscal year enacted level;
            (2) a delineation in the table for each appropriation by 
        Expenditure Center and project; and
            (3) an identification of items of special congressional 
        interest.
    (b) None of the funds provided for the National Intelligence 
Program in this Act shall be available for reprogramming or transfer 
until the report identified in subsection (a) is submitted to the 
congressional intelligence committees, unless the Director of National 
Intelligence certifies in writing to the congressional intelligence 
committees that such reprogramming or transfer is necessary as an 
emergency requirement.
    Sec. 1180.  None of the funds made available by this Act may be 
used to eliminate, restructure, or realign Army Contracting Command--
New Jersey or make disproportionate personnel reductions at any Army 
Contracting Command--New Jersey sites without 30-day prior notification 
to the congressional defense committees.

                              (rescission)

    Sec. 1181.  Of the unobligated balances available to the Department 
of Defense, the following funds are permanently rescinded from the 
following accounts and programs in the specified amounts to reflect 
excess cash balances in the Department of Defense Acquisition Workforce 
Development Fund:
            From ``Department of Defense Acquisition Workforce 
        Development Fund, Defense'', $10,000,000.
    Sec. 1182.  None of the funds made available by this Act for excess 
defense articles, assistance under section 333 of title 10, United 
States Code, or peacekeeping operations for the countries designated 
annually to be in violation of the standards of the Child Soldiers 
Prevention Act of 2008 (Public Law 110-457; 22 U.S.C. 2370c-1) may be 
used to support any military training or operation that includes child 
soldiers, as defined by the Child Soldiers Prevention Act of 2008, 
unless such assistance is otherwise permitted under section 404 of the 
Child Soldiers Prevention Act of 2008.
    Sec. 1183. (a) None of the funds provided for the National 
Intelligence Program in this or any prior appropriations Act shall be 
available for obligation or expenditure through a reprogramming or 
transfer of funds in accordance with section 102A(d) of the National 
Security Act of 1947 (50 U.S.C. 3024(d)) that--
            (1) creates a new start effort;
            (2) terminates a program with appropriated funding of 
        $10,000,000 or more;
            (3) transfers funding into or out of the National 
        Intelligence Program; or
            (4) transfers funding between appropriations, unless the 
        congressional intelligence committees are notified 30 days in 
        advance of such reprogramming of funds; this notification 
        period may be reduced for urgent national security 
        requirements.
    (b) None of the funds provided for the National Intelligence 
Program in this or any prior appropriations Act shall be available for 
obligation or expenditure through a reprogramming or transfer of funds 
in accordance with section 102A(d) of the National Security Act of 1947 
(50 U.S.C. 3024(d)) that results in a cumulative increase or decrease 
of the levels specified in the classified annex accompanying the Act 
unless the congressional intelligence committees are notified 30 days 
in advance of such reprogramming of funds; this notification period may 
be reduced for urgent national security requirements.
    Sec. 1184.  The Director of National Intelligence shall submit to 
Congress each year, at or about the time that the President's budget is 
submitted to Congress that year under section 1105(a) of title 31, 
United States Code, a future-years intelligence program (including 
associated annexes) reflecting the estimated expenditures and proposed 
appropriations included in that budget. Any such future-years 
intelligence program shall cover the fiscal year with respect to which 
the budget is submitted and at least the four succeeding fiscal years.
    Sec. 1185.  For the purposes of this Act, the term ``congressional 
intelligence committees'' means the Permanent Select Committee on 
Intelligence of the House of Representatives, the Select Committee on 
Intelligence of the Senate, the Subcommittee on Defense of the 
Committee on Appropriations of the House of Representatives, and the 
Subcommittee on Defense of the Committee on Appropriations of the 
Senate.

                     (including transfer of funds)

    Sec. 1186.  During the current fiscal year, not to exceed 
$11,000,000 from each of the appropriations made in title II of this 
Act for ``Operation and Maintenance, Army'', ``Operation and 
Maintenance, Navy'', and ``Operation and Maintenance, Air Force'' may 
be transferred by the military department concerned to its central fund 
established for Fisher Houses and Suites pursuant to section 2493(d) of 
title 10, United States Code.

                     (including transfer of funds)

    Sec. 1187.  Not to exceed $500,000,000 appropriated by this Act for 
operation and maintenance may be available for the purpose of making 
remittances and transfer to the Defense Acquisition Workforce 
Development Fund in accordance with section 1705 of title 10, United 
States Code.
    Sec. 1188. (a) Any agency receiving funds made available in this 
Act, shall, subject to subsections (b) and (c), post on the public 
website of that agency any report required to be submitted by the 
Congress in this or any other Act, upon the determination by the head 
of the agency that it shall serve the national interest.
    (b) Subsection (a) shall not apply to a report if--
            (1) the public posting of the report compromises national 
        security; or
            (2) the report contains proprietary information.
    (c) The head of the agency posting such report shall do so only 
after such report has been made available to the requesting Committee 
or Committees of Congress for no less than 45 days.
    Sec. 1189. (a) None of the funds appropriated or otherwise made 
available by this Act may be expended for any Federal contract for an 
amount in excess of $1,000,000, unless the contractor agrees not to--
            (1) enter into any agreement with any of its employees or 
        independent contractors that requires, as a condition of 
        employment, that the employee or independent contractor agree 
        to resolve through arbitration any claim under title VII of the 
        Civil Rights Act of 1964 or any tort related to or arising out 
        of sexual assault or harassment, including assault and battery, 
        intentional infliction of emotional distress, false 
        imprisonment, or negligent hiring, supervision, or retention; 
        or
            (2) take any action to enforce any provision of an existing 
        agreement with an employee or independent contractor that 
        mandates that the employee or independent contractor resolve 
        through arbitration any claim under title VII of the Civil 
        Rights Act of 1964 or any tort related to or arising out of 
        sexual assault or harassment, including assault and battery, 
        intentional infliction of emotional distress, false 
        imprisonment, or negligent hiring, supervision, or retention.
    (b) None of the funds appropriated or otherwise made available by 
this Act may be expended for any Federal contract unless the contractor 
certifies that it requires each covered subcontractor to agree not to 
enter into, and not to take any action to enforce any provision of, any 
agreement as described in paragraphs (1) and (2) of subsection (a), 
with respect to any employee or independent contractor performing work 
related to such subcontract. For purposes of this subsection, a 
``covered subcontractor'' is an entity that has a subcontract in excess 
of $1,000,000 on a contract subject to subsection (a).
    (c) The prohibitions in this section do not apply with respect to a 
contractor's or subcontractor's agreements with employees or 
independent contractors that may not be enforced in a court of the 
United States.
    (d) The Secretary of Defense may waive the application of 
subsection (a) or (b) to a particular contractor or subcontractor for 
the purposes of a particular contract or subcontract if the Secretary 
or the Deputy Secretary personally determines that the waiver is 
necessary to avoid harm to national security interests of the United 
States, and that the term of the contract or subcontract is not longer 
than necessary to avoid such harm. The determination shall set forth 
with specificity the grounds for the waiver and for the contract or 
subcontract term selected, and shall state any alternatives considered 
in lieu of a waiver and the reasons each such alternative would not 
avoid harm to national security interests of the United States. The 
Secretary of Defense shall transmit to Congress, and simultaneously 
make public, any determination under this subsection not less than 15 
business days before the contract or subcontract addressed in the 
determination may be awarded.

                     (including transfer of funds)

    Sec. 1190.  From within the funds appropriated for operation and 
maintenance for the Defense Health Program in this Act, up to 
$115,519,000, shall be available for transfer to the Joint Department 
of Defense-Department of Veterans Affairs Medical Facility 
Demonstration Fund in accordance with the provisions of section 1704 of 
the National Defense Authorization Act for Fiscal Year 2010, Public Law 
111-84:  Provided, That for purposes of section 1704(b), the facility 
operations funded are operations of the integrated Captain James A. 
Lovell Federal Health Care Center, consisting of the North Chicago 
Veterans Affairs Medical Center, the Navy Ambulatory Care Center, and 
supporting facilities designated as a combined Federal medical facility 
as described by section 706 of Public Law 110-417:  Provided further, 
That additional funds may be transferred from funds appropriated for 
operation and maintenance for the Defense Health Program to the Joint 
Department of Defense-Department of Veterans Affairs Medical Facility 
Demonstration Fund upon written notification by the Secretary of 
Defense to the Committees on Appropriations of the House of 
Representatives and the Senate.
    Sec. 1191.  None of the funds appropriated or otherwise made 
available by this Act may be used by the Department of Defense or a 
component thereof in contravention of the provisions of section 130h of 
title 10, United States Code.
    Sec. 1192.  Appropriations available to the Department of Defense 
may be used for the purchase of heavy and light armored vehicles for 
the physical security of personnel or for force protection purposes up 
to a limit of $450,000 per vehicle, notwithstanding price or other 
limitations applicable to the purchase of passenger carrying vehicles.

                     (including transfer of funds)

    Sec. 1193.  Upon a determination by the Director of National 
Intelligence that such action is necessary and in the national 
interest, the Director may, with the approval of the Office of 
Management and Budget, transfer not to exceed $1,500,000,000 of the 
funds made available in this Act for the National Intelligence Program: 
 Provided, That such authority to transfer may not be used unless for 
higher priority items, based on unforeseen intelligence requirements, 
than those for which originally appropriated and in no case where the 
item for which funds are requested has been denied by the Congress:  
Provided further, That a request for multiple reprogrammings of funds 
using authority provided in this section shall be made prior to June 
30, 2017.
    Sec. 1194.  None of the funds appropriated or otherwise made 
available in this or any other Act may be used to transfer, release, or 
assist in the transfer or release to or within the United States, its 
territories, or possessions Khalid Sheikh Mohammed or any other 
detainee who--
            (1) is not a United States citizen or a member of the Armed 
        Forces of the United States; and
            (2) is or was held on or after June 24, 2009, at United 
        States Naval Station, Guantanamo Bay, Cuba, by the Department 
        of Defense.
    Sec. 1195. (a) None of the funds appropriated or otherwise made 
available in this or any other Act may be used to construct, acquire, 
or modify any facility in the United States, its territories, or 
possessions to house any individual described in subsection (c) for the 
purposes of detention or imprisonment in the custody or under the 
effective control of the Department of Defense.
    (b) The prohibition in subsection (a) shall not apply to any 
modification of facilities at United States Naval Station, Guantanamo 
Bay, Cuba.
    (c) An individual described in this subsection is any individual 
who, as of June 24, 2009, is located at United States Naval Station, 
Guantanamo Bay, Cuba, and who--
            (1) is not a citizen of the United States or a member of 
        the Armed Forces of the United States; and
            (2) is--
                    (A) in the custody or under the effective control 
                of the Department of Defense; or
                    (B) otherwise under detention at United States 
                Naval Station, Guantanamo Bay, Cuba.
    Sec. 1196.  None of the funds appropriated or otherwise made 
available in this Act may be used to transfer any individual detained 
at United States Naval Station Guantanamo Bay, Cuba, to the custody or 
control of the individual's country of origin, any other foreign 
country, or any other foreign entity except in accordance with section 
1034 of the National Defense Authorization Act for Fiscal Year 2016 
(Public Law 114-92) and section 1034 of the National Defense 
Authorization Act for Fiscal Year 2017 (Public Law 114-328).
    Sec. 1197.  None of the funds made available by this Act may be 
used in contravention of the War Powers Resolution (50 U.S.C. 1541 et 
seq.).
    Sec. 1198. (a) None of the funds appropriated or otherwise made 
available by this or any other Act may be used by the Secretary of 
Defense, or any other official or officer of the Department of Defense, 
to enter into a contract, memorandum of understanding, or cooperative 
agreement with, or make a grant to, or provide a loan or loan guarantee 
to Rosoboronexport or any subsidiary of Rosoboronexport.
    (b) The Secretary of Defense may waive the limitation in subsection 
(a) if the Secretary, in consultation with the Secretary of State and 
the Director of National Intelligence, determines that it is in the 
vital national security interest of the United States to do so, and 
certifies in writing to the congressional defense committees that, to 
the best of the Secretary's knowledge:
            (1) Rosoboronexport has ceased the transfer of lethal 
        military equipment to, and the maintenance of existing lethal 
        military equipment for, the Government of the Syrian Arab 
        Republic;
            (2) The armed forces of the Russian Federation have 
        withdrawn from Crimea, other than armed forces present on 
        military bases subject to agreements in force between the 
        Government of the Russian Federation and the Government of 
        Ukraine; and
            (3) Agents of the Russian Federation have ceased taking 
        active measures to destabilize the control of the Government of 
        Ukraine over eastern Ukraine.
    (c) The Inspector General of the Department of Defense shall 
conduct a review of any action involving Rosoboronexport with respect 
to a waiver issued by the Secretary of Defense pursuant to subsection 
(b), and not later than 90 days after the date on which such a waiver 
is issued by the Secretary of Defense, the Inspector General shall 
submit to the congressional defense committees a report containing the 
results of the review conducted with respect to such waiver.
    Sec. 1199.  None of the funds made available in this Act may be 
used for the purchase or manufacture of a flag of the United States 
unless such flags are treated as covered items under section 2533a(b) 
of title 10, United States Code.
    Sec. 1200. (a) Of the funds appropriated in this Act for the 
Department of Defense, amounts may be made available, under such 
regulations as the Secretary of Defense may prescribe, to local 
military commanders appointed by the Secretary, or by an officer or 
employee designated by the Secretary, to provide at their discretion ex 
gratia payments in amounts consistent with subsection (d) of this 
section for damage, personal injury, or death that is incident to 
combat operations of the Armed Forces in a foreign country.
    (b) An ex gratia payment under this section may be provided only 
if--
            (1) the prospective foreign civilian recipient is 
        determined by the local military commander to be friendly to 
        the United States;
            (2) a claim for damages would not be compensable under 
        chapter 163 of title 10, United States Code (commonly known as 
        the ``Foreign Claims Act''); and
            (3) the property damage, personal injury, or death was not 
        caused by action by an enemy.
    (c) Nature of Payments.--Any payments provided under a program 
under subsection (a) shall not be considered an admission or 
acknowledgement of any legal obligation to compensate for any damage, 
personal injury, or death.
    (d) Amount of Payments.--If the Secretary of Defense determines a 
program under subsection (a) to be appropriate in a particular setting, 
the amounts of payments, if any, to be provided to civilians determined 
to have suffered harm incident to combat operations of the Armed Forces 
under the program should be determined pursuant to regulations 
prescribed by the Secretary and based on an assessment, which should 
include such factors as cultural appropriateness and prevailing 
economic conditions.
    (e) Legal Advice.--Local military commanders shall receive legal 
advice before making ex gratia payments under this subsection. The 
legal advisor, under regulations of the Department of Defense, shall 
advise on whether an ex gratia payment is proper under this section and 
applicable Department of Defense regulations.
    (f) Written Record.--A written record of any ex gratia payment 
offered or denied shall be kept by the local commander and on a timely 
basis submitted to the appropriate office in the Department of Defense 
as determined by the Secretary of Defense.
    (g) Report.--The Secretary of Defense shall report to the 
congressional defense committees on an annual basis the efficacy of the 
ex gratia payment program including the number of types of cases 
considered, amounts offered, the response from ex gratia payment 
recipients, and any recommended modifications to the program.
    Sec. 1201.  None of the funds available in this Act to the 
Department of Defense, other than appropriations made for necessary or 
routine refurbishments, upgrades or maintenance activities, shall be 
used to reduce or to prepare to reduce the number of deployed and non-
deployed strategic delivery vehicles and launchers below the levels set 
forth in the report submitted to Congress in accordance with section 
1042 of the National Defense Authorization Act for Fiscal Year 2012.
    Sec. 1202.  The Secretary of Defense shall post grant awards on a 
public Website in a searchable format.
    Sec. 1203.  None of the funds made available by this Act may be 
used to fund the performance of a flight demonstration team at a 
location outside of the United States:  Provided, That this prohibition 
applies only if a performance of a flight demonstration team at a 
location within the United States was canceled during the current 
fiscal year due to insufficient funding.
    Sec. 1204.  None of the funds made available by this Act may be 
used by the National Security Agency to--
            (1) conduct an acquisition pursuant to section 702 of the 
        Foreign Intelligence Surveillance Act of 1978 for the purpose 
        of targeting a United States person; or
            (2) acquire, monitor, or store the contents (as such term 
        is defined in section 2510(8) of title 18, United States Code) 
        of any electronic communication of a United States person from 
        a provider of electronic communication services to the public 
        pursuant to section 501 of the Foreign Intelligence 
        Surveillance Act of 1978.
    Sec. 1205.  None of the funds made available by this Act may be 
obligated or expended to implement the Arms Trade Treaty until the 
Senate approves a resolution of ratification for the Treaty.
    Sec. 1206.  None of the funds made available in this or any other 
Act may be used to pay the salary of any officer or employee of any 
agency funded by this Act who approves or implements the transfer of 
administrative responsibilities or budgetary resources of any program, 
project, or activity financed by this Act to the jurisdiction of 
another Federal agency not financed by this Act unless explicity 
provided for in a Defense Appropriations Act:  Provided, That this 
limitation shall not apply to transfers of funds expressly provided for 
in Defense Appropriations Acts, or provisions of Acts providing 
supplemental appropriations for the Department of Defense.
    Sec. 1207.  None of the funds made available in this Act may be 
obligated for activities authorized under section 1208 of the Ronald W. 
Reagan National Defense Authorization Act for Fiscal Year 2005 (Public 
Law 112-81; 125 Stat. 1621) to initiate support for, or expand support 
to, foreign forces, irregular forces, groups, or individuals unless the 
congressional defense committees are notified in accordance with the 
direction contained in the classified annex accompanying this Act, not 
less than 15 days before initiating such support:  Provided, That none 
of the funds made available in this Act may be used under section 1208 
for any activity that is not in support of an ongoing military 
operation being conducted by United States Special Operations Forces to 
combat terrorism:  Provided further, That the Secretary of Defense may 
waive the prohibitions in this section if the Secretary determines that 
such waiver is required by extraordinary circumstances and, by not 
later than 72 hours after making such waiver, notifies the 
congressional defense committees of such waiver.
    Sec. 1208.  None of the funds made available by this Act may be 
used with respect to Iraq in contravention of the War Powers Resolution 
(50 U.S.C. 1541 et seq.), including for the introduction of United 
States armed forces into hostilities in Iraq, into situations in Iraq 
where imminent involvement in hostilities is clearly indicated by the 
circumstances, or into Iraqi territory, airspace, or waters while 
equipped for combat, in contravention of the congressional consultation 
and reporting requirements of sections 3 and 4 of such Resolution (50 
U.S.C. 1542 and 1543).
    Sec. 1209.  None of the funds provided in this Act for the T-AO 
Fleet Oiler or the Towing, Salvage, and Rescue Ship programs shall be 
used to award a new contract that provides for the acquisition of the 
following components unless those components are manufactured in the 
United States: Auxiliary equipment (including pumps) for shipboard 
services; propulsion equipment (including engines, reduction gears, and 
propellers); shipboard cranes; and spreaders for shipboard cranes.
    Sec. 1210.  The amount appropriated in title II of this Act for 
``Operation and Maintenance, Army'' is hereby reduced by $75,000,000 to 
reflect excess cash balances in Department of Defense Working Capital 
Funds.
    Sec. 1211.  Notwithstanding any other provision of this Act, to 
reflect savings due to lower than anticipated fuel costs, the total 
amount appropriated in title II of this Act is hereby reduced by 
$1,007,267,000.
    Sec. 1212.  None of the funds made available by this Act may be 
used for Government Travel Charge Card expenses by military or civilian 
personnel of the Department of Defense for gaming, or for entertainment 
that includes topless or nude entertainers or participants, as 
prohibited by Department of Defense FMR, Volume 9, Chapter 3 and 
Department of Defense Instruction 1015.10 (enclosure 3, 14a and 14b).
    Sec. 1213.  None of the funds made available by this Act may be 
used to propose, plan for, or execute a new or additional Base 
Realignment and Closure (BRAC) round.
    Sec. 1214.  Of the amounts appropriated in this Act for ``Operation 
and Maintenance, Navy'', $289,255,000, to remain available until 
expended, may be used for any purposes related to the National Defense 
Reserve Fleet established under section 11 of the Merchant Ship Sales 
Act of 1946 (50 U.S.C. 4405):  Provided, That such amounts are 
available for reimbursements to the Ready Reserve Force, Maritime 
Administration account of the United States Department of 
Transportation for programs, projects, activities, and expenses related 
to the National Defense Reserve Fleet.
    Sec. 1215.  None of the funds made available by this Act for the 
Joint Surveillance Target Attack Radar System recapitalization program 
may be obligated or expended for pre-milestone B activities after March 
31, 2018, except for source selection and other activities necessary to 
enter the engineering and manufacturing development phase.
    Sec. 1216.  None of the funds made available by this Act may be 
used to carry out the closure or realignment of the United States Naval 
Station, Guantanamo Bay, Cuba.

                     (including transfer of funds)

    Sec. 1217.  Additional readiness funds made available in title II 
of this Act for ``Operation and Maintenance, Army'', ``Operation and 
Maintenance, Navy'', ``Operation and Maintenance, Marine Corps'', and 
``Operation and Maintenance, Air Force'' may be transferred to and 
merged with any appropriation of the Department of Defense for 
activities related to the Zika virus in order to provide health support 
for the full range of military operations and sustain the health of the 
members of the Armed Forces, civilian employees of the Department of 
Defense, and their families, to include: research and development, 
disease surveillance, vaccine development, rapid detection, vector 
controls and surveillance, training, and outbreak response:  Provided, 
That the authority provided in this section is subject to the same 
terms and conditions as the authority provided in section 8005 of this 
Act.
    Sec. 1218. (a) None of the funds made available in this Act may be 
used to maintain or establish a computer network unless such network is 
designed to block access to pornography websites.
    (b) Nothing in subsection (a) shall limit the use of funds 
necessary for any Federal, State, tribal, or local law enforcement 
agency or any other entity carrying out criminal investigations, 
prosecution, or adjudication activities, or for any activity necessary 
for the national defense, including intelligence activities.
    Sec. 1219.  Notwithstanding any other provision of law, any 
transfer of funds appropriated or otherwise made available by this Act 
to the Global Engagement Center pursuant to section 1287 of the 
National Defense Authorization Act for Fiscal Year 2017 (Public Law 
114-328) shall be made in accordance with section 8005 or 9002 of this 
Act, as applicable.
    Sec. 1220.  No amounts credited or otherwise made available in this 
or any other Act to the Department of Defense Acquisition Workforce 
Development Fund may be transferred to:
            (1) the Rapid Prototyping Fund established under section 
        804(d) of the National Defense Authorization Act for Fiscal 
        Year 2016 (10 U.S.C. 2302 note); or
            (2) credited to a military-department specific fund 
        established under section 804(d)(2) of the National Defense 
        Authorization Act for Fiscal Year 2016 (as amended by section 
        897 of the National Defense Authorization Act for Fiscal Year 
        2017).

                       (including transfer fund)

    Sec. 1221.  In addition to amounts provided elsewhere in this Act 
for military personnel pay, including active duty, reserve and National 
Guard personnel, $206,400,000 is hereby appropriated to the Department 
of Defense and made available for transfer only to military personnel 
accounts: Provided, That the transfer authority provided under this 
heading is in addition to any other transfer authority provided 
elsewhere in this Act.
    Sec. 1222.  In addition to amounts provided elsewhere in this Act, 
there is appropriated $235,000,000, for an additional amount for 
``Operation and Maintenance, Defense-Wide'', to remain available until 
expended: Provided, That such funds shall only be available to the 
Secretary of Defense, acting through the Office of Economic Adjustment 
of the Department of Defense, or for transfer to the Secretary of 
Education, notwithstanding any other provision of law, to make grants, 
conclude cooperative agreements, or supplement other Federal funds to 
construct, renovate, repair, or expand elementary and secondary public 
schools on military installations in order to address capacity or 
facility condition deficiencies at such schools: Provided further, That 
in making such funds available, the Office of Economic Adjustment or 
the Secretary of Education shall give priority consideration to those 
military installations with schools having the most serious capacity or 
facility condition deficiencies as determined by the Secretary of 
Defense: Provided further, That as a condition of receiving funds under 
this section a local educational agency or State shall provide a 
matching share as described in the notice titled ``Department of 
Defense Program for Construction, Renovation, Repair or Expansion of 
Public Schools Located on Military Installations'' published by the 
Department of Defense in the Federal Register on September 9, 2011 (76 
Fed. Reg. 55883 et seq.): Provided further, That these provisions apply 
to funds provided under this section, and to funds previously provided 
by Congress to construct, renovate, repair, or expand elementary and 
secondary public schools on military installations in order to address 
capacity or facility condition deficiencies at such schools to the 
extent such funds remain unobligated on the date of enactment of this 
section.
    Sec. 1223.  None of the funds made available by this Act may be 
used to carry out the changes to the Joint Travel Regulations of the 
Department of Defense described in the memorandum of the Per Diem 
Travel and Transportation Allowance Committee titled ``UTD/CTD for MAP 
118-13/CAP 118-13 - Flat Rate Per Diem for Long Term TDY'' and dated 
October 1, 2014.
    Sec. 1224.  In carrying out the program described in the memorandum 
on the subject of ``Policy for Assisted Reproductive Services for the 
Benefit of Seriously or Severely Ill/Injured (Category II or III) 
Active Duty Service Members'' issued by the Assistant Secretary of 
Defense for Health Affairs on April 3, 2012, and the guidance issued to 
implement such memorandum, the Secretary of Defense shall apply such 
policy and guidance, except that--
            (1) the limitation on periods regarding embryo 
        cryopreservation and storage set forth in part III(G) and in 
        part IV(H) of such memorandum shall not apply; and
            (2) the term ``assisted reproductive technology'' shall 
        include embryo cryopreservation and storage without limitation 
        on the duration of such cryopreservation and storage.

                                TITLE IX

        OVERSEAS CONTINGENCY OPERATIONS/GLOBAL WAR ON TERRORISM

                           MILITARY PERSONNEL

                        Military Personnel, Army

    For an additional amount for ``Military Personnel, Army'', 
$2,635,317,000:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

                        Military Personnel, Navy

    For an additional amount for ``Military Personnel, Navy'', 
$377,857,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                    Military Personnel, Marine Corps

    For an additional amount for ``Military Personnel, Marine Corps'', 
$103,800,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                     Military Personnel, Air Force

    For an additional amount for ``Military Personnel, Air Force'', 
$912,779,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                        Reserve Personnel, Army

    For an additional amount for ``Reserve Personnel, Army'', 
$24,942,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                        Reserve Personnel, Navy

    For an additional amount for ``Reserve Personnel, Navy'', 
$9,091,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                    Reserve Personnel, Marine Corps

    For an additional amount for ``Reserve Personnel, Marine Corps'', 
$2,328,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                      Reserve Personnel, Air Force

    For an additional amount for ``Reserve Personnel, Air Force'', 
$20,569,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                     National Guard Personnel, Army

    For an additional amount for ``National Guard Personnel, Army'', 
$184,589,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                  National Guard Personnel, Air Force

    For an additional amount for ``National Guard Personnel, Air 
Force'', $5,004,000:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

         Military Personnel, National Defense Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $1,000,000,000, for the ``Military Personnel, National 
Defense Restoration Fund'': Provided, That such funds provided under 
this heading shall only be available for programs, projects and 
activities necessary to implement the 2018 National Defense Strategy: 
Provided further, That such funds shall not be available for transfer 
until 30 days after the Secretary has submitted, and the congressional 
defense committees have approved, the proposed allocation plan for the 
use of such funds to implement such strategy: Provided further, That 
such allocation plan shall include a detailed justification for the use 
of such funds and a description of how such investments are necessary 
to implement the strategy: Provided further, That the Secretary of 
Defense may transfer these funds only to military personnel accounts: 
Provided further, That the funds transferred shall be merged with and 
shall be available for the same purposes and for the same time period, 
as the appropriation to which transferred: Provided further, That none 
of the funds made available under this heading may be transferred to 
any program, project, or activity specifically limited or denied by 
this Act: Provided further, That the transfer authority provided under 
this heading is in addition to any other transfer authority available 
to the Department of Defense: Provided further, That such amount is 
designated by the Congress for Overseas Contingency Operations/Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

                       OPERATION AND MAINTENANCE

                    Operation and Maintenance, Army

    For an additional amount for ``Operation and Maintenance, Army'', 
$16,126,403,000:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

                    Operation and Maintenance, Navy

    For an additional amount for ``Operation and Maintenance, Navy'', 
$5,875,015,000, of which up to $161,885,000 may be transferred to the 
Coast Guard ``Operating Expenses'' account:  Provided, That such amount 
is designated by the Congress for Overseas Contingency Operations/
Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
Balanced Budget and Emergency Deficit Control Act of 1985.

                Operation and Maintenance, Marine Corps

    For an additional amount for ``Operation and Maintenance, Marine 
Corps'', $1,116,640,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                  Operation and Maintenance, Air Force

    For an additional amount for ``Operation and Maintenance, Air 
Force'', $10,266,295,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                Operation and Maintenance, Defense-Wide

    For an additional amount for ``Operation and Maintenance, Defense-
Wide'', $6,944,201,000:  Provided, That of the funds provided under 
this heading, not to exceed $900,000,000, to remain available until 
September 30, 2019, shall be for payments to reimburse key cooperating 
nations for logistical, military, and other support, including access, 
provided to United States military and stability operations in 
Afghanistan and to counter the Islamic State of Iraq and the Levant: 
Provided further, That such reimbursement payments may be made in such 
amounts as the Secretary of Defense, with the concurrence of the 
Secretary of State, and in consultation with the Director of the Office 
of Management and Budget, may determine, based on documentation 
determined by the Secretary of Defense to adequately account for the 
support provided, and such determination is final and conclusive upon 
the accounting officers of the United States, and 15 days following 
notification to the appropriate congressional committees: Provided 
further, That funds provided under this heading may be used for the 
purpose of providing specialized training and procuring supplies and 
specialized equipment and providing such supplies and loaning such 
equipment on a non-reimbursable basis to coalition forces supporting 
United States military and stability operations in Afghanistan and to 
counter the Islamic State of Iraq and the Levant, and 15 days following 
notification to the appropriate congressional committees:  Provided 
further, That funds provided under this heading may be used to support 
the Government of Jordan, in such amounts as the Secretary of Defense 
may determine, to enhance the ability of the armed forces of Jordan to 
increase or sustain security along its borders, upon 15 days prior 
written notification to the congressional defense committees outlining 
the amounts intended to be provided and the nature of the expenses 
incurred: Provided further, That of the funds provided under this 
heading, not to exceed $750,000,000, to remain available until 
September 30, 2019, shall be available to provide support and 
assistance to foreign security forces or other groups or individuals to 
conduct, support, or facilitate counterterrorism, crisis response, or 
other Department of Defense security cooperation programs: Provided 
further, That such amount is designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.

                Operation and Maintenance, Army Reserve

    For an additional amount for ``Operation and Maintenance, Army 
Reserve'', $24,699,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                Operation and Maintenance, Navy Reserve

    For an additional amount for ``Operation and Maintenance, Navy 
Reserve'', $23,980,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

            Operation and Maintenance, Marine Corps Reserve

    For an additional amount for ``Operation and Maintenance, Marine 
Corps Reserve'', $3,367,000:  Provided, That such amount is designated 
by the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

              Operation and Maintenance, Air Force Reserve

    For an additional amount for ``Operation and Maintenance, Air Force 
Reserve'', $58,523,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

             Operation and Maintenance, Army National Guard

    For an additional amount for ``Operation and Maintenance, Army 
National Guard'', $108,111,000:  Provided, That such amount is 
designated by the Congress for Overseas Contingency Operations/Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

             Operation and Maintenance, Air National Guard

    For an additional amount for ``Operation and Maintenance, Air 
National Guard'', $15,400,000:  Provided, That such amount is 
designated by the Congress for Overseas Contingency Operations/Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

      Operation and Maintenance, National Defense Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $2,000,000,000, for the ``Operation and Maintenance, 
National Defense Restoration Fund'': Provided, That such funds provided 
under this heading shall only be available for programs, projects and 
activities necessary to implement the 2018 National Defense Strategy: 
Provided further, That such funds shall not be available for transfer 
until 30 days after the Secretary has submitted, and the congressional 
defense committees have approved, the proposed allocation plan for the 
use of such funds to implement such strategy: Provided further, That 
such allocation plan shall include a detailed justification for the use 
of such funds and a description of how such investments are necessary 
to implement the strategy: Provided further, That the Secretary of 
Defense may transfer these funds only to operation and maintenance 
accounts: Provided further, That the funds transferred shall be merged 
with and shall be available for the same purposes and for the same time 
period, as the appropriation to which transferred: Provided further, 
That none of the funds made available under this heading may be 
transferred to any program, project, or activity specifically limited 
or denied by this Act: Provided further, That the transfer authority 
provided under this heading is in addition to any other transfer 
authority available to the Department of Defense: Provided further, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                    Afghanistan Security Forces Fund

    For the ``Afghanistan Security Forces Fund'', $4,937,515,000 
(reduced by $12,000,000), to remain available until September 30, 2019: 
 Provided, That such funds shall be available to the Secretary of 
Defense, notwithstanding any other provision of law, for the purpose of 
allowing the Commander, Combined Security Transition Command--
Afghanistan, or the Secretary's designee, to provide assistance, with 
the concurrence of the Secretary of State, to the security forces of 
Afghanistan, including the provision of equipment, supplies, services, 
training, facility and infrastructure repair, renovation, construction, 
and funding:  Provided further, That the Secretary of Defense may 
obligate and expend funds made available to the Department of Defense 
in this title for additional costs associated with existing projects 
previously funded with amounts provided under the heading ``Afghanistan 
Infrastructure Fund'' in prior Acts:  Provided further, That such costs 
shall be limited to contract changes resulting from inflation, market 
fluctuation, rate adjustments, and other necessary contract actions to 
complete existing projects, and associated supervision and 
administration costs and costs for design during construction:  
Provided further, That the Secretary may not use more than $50,000,000 
under the authority provided in this section:  Provided further, That 
the Secretary shall notify in advance such contract changes and 
adjustments in annual reports to the congressional defense committees:  
Provided further, That the authority to provide assistance under this 
heading is in addition to any other authority to provide assistance to 
foreign nations:  Provided further, That contributions of funds for the 
purposes provided herein from any person, foreign government, or 
international organization may be credited to this Fund, to remain 
available until expended, and used for such purposes:  Provided 
further, That the Secretary of Defense shall notify the congressional 
defense committees in writing upon the receipt and upon the obligation 
of any contribution, delineating the sources and amounts of the funds 
received and the specific use of such contributions:  Provided further, 
That the Secretary of Defense shall, not fewer than 15 days prior to 
obligating from this appropriation account, notify the congressional 
defense committees in writing of the details of any such obligation:  
Provided further, That the Secretary of Defense shall notify the 
congressional defense committees of any proposed new projects or 
transfer of funds between budget sub-activity groups in excess of 
$20,000,000:  Provided further, That the United States may accept 
equipment procured using funds provided under this heading in this or 
prior Acts that was transferred to the security forces of Afghanistan 
and returned by such forces to the United States:  Provided further, 
That equipment procured using funds provided under this heading in this 
or prior Acts, and not yet transferred to the security forces of 
Afghanistan or transferred to the security forces of Afghanistan and 
returned by such forces to the United States, may be treated as stocks 
of the Department of Defense upon written notification to the 
congressional defense committees:  Provided further, That of the funds 
provided under this heading, not less than $10,000,000 shall be for 
recruitment and retention of women in the Afghanistan National Security 
Forces, and the recruitment and training of female security personnel:  
Provided further, That such amount is designated by the Congress for 
Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                   Counter-ISIL Train and Equip Fund

    For the ``Counter-Islamic State of Iraq and the Levant Train and 
Equip Fund'', $1,769,000,000, to remain available until September 30, 
2019: Provided, That such funds shall be available to the Secretary of 
Defense in coordination with the Secretary of State, to provide 
assistance, including training; equipment; logistics support, supplies, 
and services; stipends; infrastructure repair and renovation; and 
sustainment, to foreign security forces, irregular forces, groups, or 
individuals participating, or preparing to participate in activities to 
counter the Islamic State of Iraq and the Levant, and their affiliated 
or associated groups: Provided further, That these funds may be used in 
such amounts as the Secretary of Defense may determine to enhance the 
border security of nations adjacent to conflict areas including Jordan, 
Lebanon, Egypt, and Tunisia resulting from actions of the Islamic State 
of Iraq and the Levant: Provided further, That amounts made available 
under this heading shall be available to provide assistance only for 
activities in a country designated by the Secretary of Defense, in 
coordination with the Secretary of State, as having a security mission 
to counter the Islamic State of Iraq and the Levant, and following 
written notification to the congressional defense committees of such 
designation:  Provided further, That the Secretary of Defense shall 
ensure that prior to providing assistance to elements of any forces or 
individuals, such elements or individuals are appropriately vetted, 
including at a minimum, assessing such elements for associations with 
terrorist groups or groups associated with the Government of Iran; and 
receiving commitments from such elements to promote respect for human 
rights and the rule of law: Provided further, That the Secretary of 
Defense shall, not fewer than 15 days prior to obligating from this 
appropriation account, notify the congressional defense committees in 
writing of the details of any such obligation: Provided further, That 
the Secretary of Defense may accept and retain contributions, including 
assistance in-kind, from foreign governments, including the Government 
of Iraq and other entities, to carry out assistance authorized under 
this heading: Provided further, That contributions of funds for the 
purposes provided herein from any foreign government or other entity 
may be credited to this Fund, to remain available until expended, and 
used for such purposes: Provided further, That the Secretary of Defense 
may waive a provision of law relating to the acquisition of items and 
support services or sections 40 and 40A of the Arms Export Control Act 
(22 U.S.C. 2780 and 2785) if the Secretary determines that such 
provision of law would prohibit, restrict, delay or otherwise limit the 
provision of such assistance and a notice of and justification for such 
waiver is submitted to the congressional defense committees, the 
Committees on Appropriations and Foreign Relations of the Senate and 
the Committees on Appropriations and Foreign Affairs of the House of 
Representatives: Provided further, That the United States may accept 
equipment procured using funds provided under this heading, or under 
the heading, ``Iraq Train and Equip Fund'' in prior Acts, that was 
transferred to security forces, irregular forces, or groups 
participating, or preparing to participate in activities to counter the 
Islamic State of Iraq and the Levant and returned by such forces or 
groups to the United States, may be treated as stocks of the Department 
of Defense upon written notification to the congressional defense 
committees: Provided further, That equipment procured using funds 
provided under this heading, or under the heading, ``Iraq Train and 
Equip Fund'' in prior Acts, and not yet transferred to security forces, 
irregular forces, or groups participating, or preparing to participate 
in activities to counter the Islamic State of Iraq and the Levant may 
be treated as stocks of the Department of Defense when determined by 
the Secretary to no longer be required for transfer to such forces or 
groups and upon written notification to the congressional defense 
committees: Provided further, That the Secretary of Defense shall 
provide quarterly reports to the congressional defense committees on 
the use of funds provided under this heading, including, but not 
limited to, the number of individuals trained, the nature and scope of 
support and sustainment provided to each group or individual, the area 
of operations for each group, and the contributions of other countries, 
groups, or individuals: Provided further, That such amount is 
designated by the Congress for Overseas Contingency Operations/ Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

                              PROCUREMENT

                       Aircraft Procurement, Army

    For an additional amount for ``Aircraft Procurement, Army'', 
$424,686,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                       Missile Procurement, Army

    For an additional amount for ``Missile Procurement, Army'', 
$557,583,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

        Procurement of Weapons and Tracked Combat Vehicles, Army

    For an additional amount for ``Procurement of Weapons and Tracked 
Combat Vehicles, Army'', $1,191,139,000, to remain available until 
September 30, 2020:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

                    Procurement of Ammunition, Army

    For an additional amount for ``Procurement of Ammunition, Army'', 
$193,436,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                        Other Procurement, Army

    For an additional amount for ``Other Procurement, Army'', 
$405,575,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                       Aircraft Procurement, Navy

    For an additional amount for ``Aircraft Procurement, Navy'', 
$157,300,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                       Weapons Procurement, Navy

    For an additional amount for ``Weapons Procurement, Navy'', 
$130,994,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

            Procurement of Ammunition, Navy and Marine Corps

    For an additional amount for ``Procurement of Ammunition, Navy and 
Marine Corps'', $223,843,000, to remain available until September 30, 
2020:  Provided, That such amount is designated by the Congress for 
Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                        Other Procurement, Navy

    For an additional amount for ``Other Procurement, Navy'', 
$207,984,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                       Procurement, Marine Corps

    For an additional amount for ``Procurement, Marine Corps'', 
$64,071,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                    Aircraft Procurement, Air Force

    For an additional amount for ``Aircraft Procurement, Air Force'', 
$510,836,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                     Missile Procurement, Air Force

    For an additional amount for ``Missile Procurement, Air Force'', 
$381,700,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                      Space Procurement, Air Force

    For an additional amount for ``Space Procurement, Air Force'', 
$2,256,000, to remain available until September 30, 2020: Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

                  Procurement of Ammunition, Air Force

    For an additional amount for ``Procurement of Ammunition, Air 
Force'', $501,509,000, to remain available until September 30, 2020:  
Provided, That such amount is designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.

                      Other Procurement, Air Force

    For an additional amount for ``Other Procurement, Air Force'', 
$3,998,887,000, to remain available until September 30, 2020:  
Provided, That such amount is designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.

                       Procurement, Defense-Wide

    For an additional amount for ``Procurement, Defense-Wide'', 
$510,741,000, to remain available until September 30, 2020:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

              National Guard and Reserve Equipment Account

    For procurement of rotary-wing aircraft; combat, tactical and 
support vehicles; other weapons; and other procurement items for the 
reserve components of the Armed Forces, $1,000,000,000, to remain 
available for obligation until September 30, 2020:  Provided, That the 
Chiefs of National Guard and Reserve components shall, not later than 
30 days after enactment of this Act, individually submit to the 
congressional defense committees the modernization priority assessment 
for their respective National Guard or Reserve component:  Provided 
further, That none of the funds made available by this paragraph may be 
used to procure manned fixed wing aircraft, or procure or modify 
missiles, munitions, or ammunition:  Provided further, That such amount 
is designated by the Congress for Overseas Contingency Operations/
Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the 
Balanced Budget and Emergency Deficit Control Act of 1985.

             Procurement, National Defense Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $6,000,000,000, for the ``Procurement, National Defense 
Restoration Fund'': Provided, That such funds provided under this 
heading shall only be available for programs, projects and activities 
necessary to implement the 2018 National Defense Strategy: Provided 
further, That such funds shall not be available for transfer until 30 
days after the Secretary has submitted, and the congressional defense 
committees have approved, the proposed allocation plan for the use of 
such funds to implement such strategy: Provided further, That such 
allocation plan shall include a detailed justification for the use of 
such funds and a description of how such investments are necessary to 
implement the strategy: Provided further, That the Secretary of Defense 
may transfer these funds only to procurement accounts: Provided 
further, That the funds transferred shall be merged with and shall be 
available for the same purposes and for the same time period, as the 
appropriation to which transferred: Provided further, That none of the 
funds made available under this heading may be transferred to any 
program, project, or activity specifically limited or denied by this 
Act: Provided further, That the transfer authority provided under this 
heading is in addition to any other transfer authority available to the 
Department of Defense: Provided further, That such amount is designated 
by the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

               RESEARCH, DEVELOPMENT, TEST AND EVALUATION

            Research, Development, Test and Evaluation, Army

    For an additional amount for ``Research, Development, Test and 
Evaluation, Army'', $119,368,000 (increased by $6,000,000), to remain 
available until September 30, 2019:  Provided, That such amount is 
designated by the Congress for Overseas Contingency Operations/Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

            Research, Development, Test and Evaluation, Navy

    For an additional amount for ``Research, Development, Test and 
Evaluation, Navy'', $124,865,000, to remain available until September 
30, 2019:  Provided, That such amount is designated by the Congress for 
Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

         Research, Development, Test and Evaluation, Air Force

    For an additional amount for ``Research, Development, Test and 
Evaluation, Air Force'', $144,508,000, to remain available until 
September 30, 2019:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

        Research, Development, Test and Evaluation, Defense-Wide

    For an additional amount for ``Research, Development, Test and 
Evaluation, Defense-Wide'', $226,096,000, to remain available until 
September 30, 2019:  Provided, That such amount is designated by the 
Congress for Overseas Contingency Operations/Global War on Terrorism 
pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget and 
Emergency Deficit Control Act of 1985.

     Research, Development, Test and Evaluation, National Defense 
                            Restoration Fund

                     (including transfer of funds)

    In addition to amounts provided elsewhere in this Act, there is 
appropriated $1,000,000,000, for the ``Research, Development, Test and 
Evaluation, National Defense Restoration Fund'': Provided, That such 
funds provided under this heading shall only be available for programs, 
projects and activities necessary to implement the 2018 National 
Defense Strategy: Provided further, That such funds shall not be 
available for transfer until 30 days after the Secretary has submitted, 
and the congressional defense committees have approved, the proposed 
allocation plan for the use of such funds to implement such strategy: 
Provided further, That such allocation plan shall include a detailed 
justification for the use of such funds and a description of how such 
investments are necessary to implement the strategy: Provided further, 
That the Secretary of Defense may transfer these funds only to 
research, development, test and evaluation accounts: Provided further, 
That the funds transferred shall be merged with and shall be available 
for the same purposes and for the same time period, as the 
appropriation to which transferred: Provided further, That none of the 
funds made available under this heading may be transferred to any 
program, project, or activity specifically limited or denied by this 
Act: Provided further, That the transfer authority provided under this 
heading is in addition to any other transfer authority available to the 
Department of Defense: Provided further, That such amount is designated 
by the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                     REVOLVING AND MANAGEMENT FUNDS

                     Defense Working Capital Funds

    For an additional amount for ``Defense Working Capital Funds'', 
$148,956,000:  Provided, That such amount is designated by the Congress 
for Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985.

                  OTHER DEPARTMENT OF DEFENSE PROGRAMS

                         Defense Health Program

    For an additional amount for ``Defense Health Program'', 
$395,805,000, which shall be for operation and maintenance:  Provided, 
That such amount is designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985.

         Drug Interdiction and Counter-Drug Activities, Defense

    For an additional amount for ``Drug Interdiction and Counter-Drug 
Activities, Defense'', $196,300,000:  Provided, That such amount is 
designated by the Congress for Overseas Contingency Operations/Global 
War on Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced 
Budget and Emergency Deficit Control Act of 1985.

                  Joint Improvised-Threat Defeat Fund

                     (including transfer of funds)

    For the ``Joint Improvised-Threat Defeat Fund'', $483,058,000, to 
remain available until September 30, 2020:  Provided, That such funds 
shall be available to the Secretary of Defense, notwithstanding any 
other provision of law, for the purpose of allowing the Director of the 
Joint Improvised-Threat Defeat Organization to investigate, develop and 
provide equipment, supplies, services, training, facilities, personnel 
and funds to assist United States forces in the defeat of improvised 
explosive devices:  Provided further, That the Secretary of Defense may 
transfer funds provided herein to appropriations for military 
personnel; operation and maintenance; procurement; research, 
development, test and evaluation; and defense working capital funds to 
accomplish the purpose provided herein:  Provided further, That this 
transfer authority is in addition to any other transfer authority 
available to the Department of Defense:  Provided further, That the 
Secretary of Defense shall, not fewer than 5 days prior to making 
transfers from this appropriation, notify the congressional defense 
committees in writing of the details of any such transfer:  Provided 
further, That such amount is designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.

                    Office of the Inspector General

    For an additional amount for the ``Office of the Inspector 
General'', $24,692,000:  Provided, That such amount is designated by 
the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                     GENERAL PROVISIONS--THIS TITLE

    Sec. 1301.  Notwithstanding any other provision of law, funds made 
available in this title are in addition to amounts appropriated or 
otherwise made available for the Department of Defense for fiscal year 
2018.

                     (including transfer of funds)

    Sec. 1302.  Upon the determination of the Secretary of Defense that 
such action is necessary in the national interest, the Secretary may, 
with the approval of the Office of Management and Budget, transfer up 
to $2,500,000,000 between the appropriations or funds made available to 
the Department of Defense in this title:  Provided, That the Secretary 
shall notify the Congress promptly of each transfer made pursuant to 
the authority in this section:  Provided further, That the authority 
provided in this section is in addition to any other transfer authority 
available to the Department of Defense and is subject to the same terms 
and conditions as the authority provided in section 8005 of this Act.
    Sec. 1303.  Supervision and administration costs and costs for 
design during construction associated with a construction project 
funded with appropriations available for operation and maintenance or 
the ``Afghanistan Security Forces Fund'' provided in this Act and 
executed in direct support of overseas contingency operations in 
Afghanistan, may be obligated at the time a construction contract is 
awarded:  Provided, That, for the purpose of this section, supervision 
and administration costs and costs for design during construction 
include all in-house Government costs.
    Sec. 1304.  From funds made available in this title, the Secretary 
of Defense may purchase for use by military and civilian employees of 
the Department of Defense in the United States Central Command area of 
responsibility:
            (1) passenger motor vehicles up to a limit of $75,000 per 
        vehicle; and
            (2) heavy and light armored vehicles for the physical 
        security of personnel or for force protection purposes up to a 
        limit of $450,000 per vehicle, notwithstanding price or other 
        limitations applicable to the purchase of passenger carrying 
        vehicles.
    Sec. 1305.  Not to exceed $5,000,000 of the amounts appropriated by 
this title under the heading ``Operation and Maintenance, Army'' may be 
used, notwithstanding any other provision of law, to fund the 
Commanders' Emergency Response Program (CERP), for the purpose of 
enabling military commanders in Afghanistan to respond to urgent, 
small-scale, humanitarian relief and reconstruction requirements within 
their areas of responsibility:  Provided, That each project (including 
any ancillary or related elements in connection with such project) 
executed under this authority shall not exceed $2,000,000:  Provided 
further, That not later than 45 days after the end of each 6 months of 
the fiscal year, the Secretary of Defense shall submit to the 
congressional defense committees a report regarding the source of funds 
and the allocation and use of funds during that 6-month period that 
were made available pursuant to the authority provided in this section 
or under any other provision of law for the purposes described herein:  
Provided further, That, not later than 30 days after the end of each 
fiscal year quarter, the Army shall submit to the congressional defense 
committees quarterly commitment, obligation, and expenditure data for 
the CERP in Afghanistan:  Provided further, That, not less than 15 days 
before making funds available pursuant to the authority provided in 
this section or under any other provision of law for the purposes 
described herein for a project with a total anticipated cost for 
completion of $500,000 or more, the Secretary shall submit to the 
congressional defense committees a written notice containing each of 
the following:
            (1) The location, nature and purpose of the proposed 
        project, including how the project is intended to advance the 
        military campaign plan for the country in which it is to be 
        carried out.
            (2) The budget, implementation timeline with milestones, 
        and completion date for the proposed project, including any 
        other CERP funding that has been or is anticipated to be 
        contributed to the completion of the project.
            (3) A plan for the sustainment of the proposed project, 
        including the agreement with either the host nation, a non-
        Department of Defense agency of the United States Government or 
        a third-party contributor to finance the sustainment of the 
        activities and maintenance of any equipment or facilities to be 
        provided through the proposed project.
    Sec. 1306.  Funds available to the Department of Defense for 
operation and maintenance may be used, notwithstanding any other 
provision of law, to provide supplies, services, transportation, 
including airlift and sealift, and other logistical support to allied 
forces participating in a combined operation with the armed forces of 
the United States and coalition forces supporting military and 
stability operations in Afghanistan and to counter the Islamic State of 
Iraq and the Levant:  Provided, That the Secretary of Defense shall 
provide quarterly reports to the congressional defense committees 
regarding support provided under this section.
    Sec. 1307.  None of the funds appropriated or otherwise made 
available by this or any other Act shall be obligated or expended by 
the United States Government for a purpose as follows:
            (1) To establish any military installation or base for the 
        purpose of providing for the permanent stationing of United 
        States Armed Forces in Iraq.
            (2) To exercise United States control over any oil resource 
        of Iraq.
            (3) To establish any military installation or base for the 
        purpose of providing for the permanent stationing of United 
        States Armed Forces in Afghanistan.
    Sec. 1308.  None of the funds made available in this Act may be 
used in contravention of the following laws enacted or regulations 
promulgated to implement the United Nations Convention Against Torture 
and Other Cruel, Inhuman or Degrading Treatment or Punishment (done at 
New York on December 10, 1984):
            (1) Section 2340A of title 18, United States Code.
            (2) Section 2242 of the Foreign Affairs Reform and 
        Restructuring Act of 1998 (division G of Public Law 105-277; 
        112 Stat. 2681-822; 8 U.S.C. 1231 note) and regulations 
        prescribed thereto, including regulations under part 208 of 
        title 8, Code of Federal Regulations, and part 95 of title 22, 
        Code of Federal Regulations.
            (3) Sections 1002 and 1003 of the Department of Defense, 
        Emergency Supplemental Appropriations to Address Hurricanes in 
        the Gulf of Mexico, and Pandemic Influenza Act, 2006 (Public 
        Law 109-148).
    Sec. 1309.  None of the funds provided for the ``Afghanistan 
Security Forces Fund'' (ASFF) may be obligated prior to the approval of 
a financial and activity plan by the Afghanistan Resources Oversight 
Council (AROC) of the Department of Defense:  Provided, That the AROC 
must approve the requirement and acquisition plan for any service 
requirements in excess of $50,000,000 annually and any non-standard 
equipment requirements in excess of $100,000,000 using ASFF:  Provided 
further, That the Department of Defense must certify to the 
congressional defense committees that the AROC has convened and 
approved a process for ensuring compliance with the requirements in the 
preceding proviso and accompanying report language for the ASFF.
    Sec. 1310.  Funds made available in this title to the Department of 
Defense for operation and maintenance may be used to purchase items 
having an investment unit cost of not more than $250,000:  Provided, 
That, upon determination by the Secretary of Defense that such action 
is necessary to meet the operational requirements of a Commander of a 
Combatant Command engaged in contingency operations overseas, such 
funds may be used to purchase items having an investment item unit cost 
of not more than $500,000.
    Sec. 1311.  Up to $500,000,000 of funds appropriated by this Act 
for the Defense Security Cooperation Agency in ``Operation and 
Maintenance, Defense-Wide'' may be used to provide assistance to the 
Government of Jordan to support the armed forces of Jordan and to 
enhance security along its borders.
    Sec. 1312.  None of the funds made available by this Act under the 
heading ``Counter-ISIL Train and Equip Fund'' may be used to procure or 
transfer man-portable air defense systems.
    Sec. 1313.  For the ``Ukraine Security Assistance Initiative'', 
$150,000,000 is hereby appropriated, to remain available until 
September 30, 2018:  Provided, That such funds shall be available to 
the Secretary of Defense, in coordination with the Secretary of State, 
to provide assistance, including training; equipment; lethal weapons of 
a defensive nature; logistics support, supplies and services; 
sustainment; and intelligence support to the military and national 
security forces of Ukraine, and for replacement of any weapons or 
defensive articles provided to the Government of Ukraine from the 
inventory of the United States:  Provided further, That the Secretary 
of Defense shall, not less than 15 days prior to obligating funds 
provided under this heading, notify the congressional defense 
committees in writing of the details of any such obligation:  Provided 
further, That the United States may accept equipment procured using 
funds provided under this heading in this or prior Acts that was 
transferred to the security forces of Ukraine and returned by such 
forces to the United States:  Provided further, That equipment procured 
using funds provided under this heading in this or prior Acts, and not 
yet transferred to the military or National Security Forces of Ukraine 
or returned by such forces to the United States, may be treated as 
stocks of the Department of Defense upon written notification to the 
congressional defense committees:  Provided further, That amounts made 
available by this section are designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985.
    Sec. 1314.  Funds appropriated in this title shall be available for 
replacement of funds for items provided to the Government of Ukraine 
from the inventory of the United States to the extent specifically 
provided for in section 9013 of this Act.
    Sec. 1315.  None of the funds made available by this Act under 
section 9013 for ``Assistance and Sustainment to the Military and 
National Security Forces of Ukraine'' may be used to procure or 
transfer man-portable air defense systems.
    Sec. 1316. (a) None of the funds appropriated or otherwise made 
available by this Act under the heading ``Operation and Maintenance, 
Defense-Wide'' for payments under section 1233 of Public Law 110-181 
for reimbursement to the Government of Pakistan may be made available 
unless the Secretary of Defense, in coordination with the Secretary of 
State, certifies to the congressional defense committees that the 
Government of Pakistan is--
            (1) cooperating with the United States in counterterrorism 
        efforts against the Haqqani Network, the Quetta Shura Taliban, 
        Lashkar e-Tayyiba, Jaish-e-Mohammed, Al Qaeda, and other 
        domestic and foreign terrorist organizations, including taking 
        steps to end support for such groups and prevent them from 
        basing and operating in Pakistan and carrying out cross border 
        attacks into neighboring countries;
            (2) not supporting terrorist activities against United 
        States or coalition forces in Afghanistan, and Pakistan's 
        military and intelligence agencies are not intervening extra-
        judicially into political and judicial processes in Pakistan;
            (3) dismantling improvised explosive device (IED) networks 
        and interdicting precursor chemicals used in the manufacture of 
        IEDs;
            (4) preventing the proliferation of nuclear-related 
        material and expertise;
            (5) implementing policies to protect judicial independence 
        and due process of law;
            (6) issuing visas in a timely manner for United States 
        visitors engaged in counterterrorism efforts and assistance 
        programs in Pakistan; and
            (7) providing humanitarian organizations access to 
        detainees, internally displaced persons, and other Pakistani 
        civilians affected by the conflict.
    (b) The Secretary of Defense, in coordination with the Secretary of 
State, may waive the restriction in subsection (a) on a case-by-case 
basis by certifying in writing to the congressional defense committees 
that it is in the national security interest to do so:  Provided, That 
if the Secretary of Defense, in coordination with the Secretary of 
State, exercises such waiver authority, the Secretaries shall report to 
the congressional defense committees on both the justification for the 
waiver and on the requirements of this section that the Government of 
Pakistan was not able to meet:  Provided further, That such report may 
be submitted in classified form if necessary.

                     (including transfer of funds)

    Sec. 1317.  In addition to amounts otherwise made available in this 
Act, $500,000,000 is hereby appropriated to the Department of Defense 
and made available for transfer only to the operation and maintenance, 
military personnel, and procurement accounts, to improve the 
intelligence, surveillance, and reconnaissance capabilities of the 
Department of Defense:  Provided, That the transfer authority provided 
in this section is in addition to any other transfer authority provided 
elsewhere in this Act:  Provided further, That not later than 30 days 
prior to exercising the transfer authority provided in this section, 
the Secretary of Defense shall submit a report to the congressional 
defense committees on the proposed uses of these funds:  Provided 
further, That the funds provided in this section may not be transferred 
to any program, project, or activity specifically limited or denied by 
this Act:  Provided further, That amounts made available by this 
section are designated by the Congress for Overseas Contingency 
Operations/Global War on Terrorism pursuant to section 251(b)(2)(A)(ii) 
of the Balanced Budget and Emergency Deficit Control Act of 1985:  
Provided further, That the authority to provide funding under this 
section shall terminate on September 30, 2018.
    Sec. 1318.  None of the funds made available by this Act may be 
used with respect to Syria in contravention of the War Powers 
Resolution (50 U.S.C. 1541 et seq.), including for the introduction of 
United States armed or military forces into hostilities in Syria, into 
situations in Syria where imminent involvement in hostilities is 
clearly indicated by the circumstances, or into Syrian territory, 
airspace, or waters while equipped for combat, in contravention of the 
congressional consultation and reporting requirements of sections 3 and 
4 of that law (50 U.S.C. 1542 and 1543).

                             (rescissions)

    Sec. 1319.  Of the funds appropriated in Department of Defense 
Appropriations Acts, the following funds are hereby rescinded from the 
following accounts and programs in the specified amounts:  Provided, 
That such amounts are designated by the Congress for Overseas 
Contingency Operations/Global War on Terrorism pursuant to section 
251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit Control 
Act of 1985:
            ``Other Procurement, Air Force'', 2017/2019, $25,100,000;
            ``Afghanistan Security Forces Fund'', 2017/2018, 
        $100,000,000; and
            ``Counter-ISIL Train and Equip Fund'', 2017/2018, 
        $112,513,000.
            ``Operation and Maintenance, Defense-Wide, DSCA Coalition 
        Support Fund'', 2017/2018, $350,000,000.
    Sec. 1320.  Each amount designated in this Act by the Congress for 
Overseas Contingency Operations/Global War on Terrorism pursuant to 
section 251(b)(2)(A)(ii) of the Balanced Budget and Emergency Deficit 
Control Act of 1985 shall be available only if the President 
subsequently so designates all such amounts and transmits such 
designations to the Congress.
    Sec. 1321. (a) Not later than 30 days after the date of the 
enactment of this Act, the President shall submit to Congress a report 
on the United States strategy to defeat Al-Qaeda, the Taliban, the 
Islamic State of Iraq and Syria (ISIS), and their associated forces and 
co-belligerents.
    (b) The report required under subsection (a) shall include the 
following:
            (1) An analysis of the adequacy of the existing legal 
        framework to accomplish the strategy described in subsection 
        (a), particularly with respect to the Authorization for Use of 
        Military Force (Public Law 107-40; 50 U.S.C. 1541 note) and the 
        Authorization for Use of Military Force Against Iraq Resolution 
        of 2002 (Public Law 107-243; 50 U.S.C. 1541 note).
            (2) An analysis of the budgetary resources necessary to 
        accomplish the strategy described in subsection (a).
    (c) Not later than 30 days after the date on which the President 
submits to the appropriate congressional committees the report required 
by subsection (a), the Secretary of State and the Secretary of Defense 
shall testify at any hearing held by any of the appropriate 
congressional committees on the report and to which the Secretary is 
invited.
    (d) In this section, the term ``appropriate congressional 
committees'' means--
            (1) the Committee on Foreign Relations and the Committee on 
        Armed Services of the Senate; and
            (2) the Committee on Foreign Affairs and the Committee on 
        Armed Services of the House of Representatives.
    Sec. 1322. (a) In addition to amounts provided elsewhere in this 
Act, there is hereby appropriated $1,184,112,000, for the following 
accounts and programs in the specified amounts for costs associated 
with Operation Freedom's Sentinel:
            (1) ``Military Personnel, Army'', $48,377,000;
            (2) ``Military Personnel, Marine Corps'', $179,000;
            (3) ``Military Personnel, Air Force'', $1,340,000;
            (4) ``Operation and Maintenance, Army'', $872,491,000;
            (5) ``Operation and Maintenance, Navy'', $76,274,000;
            (6) ``Operation and Maintenance, Marine Corps'', 
        $24,734,000;
            (7) ``Operation and Maintenance, Defense-Wide'', 
        $81,164,000;
            (8) ``Procurement of Ammunition, Navy and Marine Corps'', 
        $10,853,000, to remain available until September 30, 2020;
            (9) ``Other Procurement, Navy'', $31,500,000, to remain 
        available until September 30, 2020; and
            (10) ``Research, Development, Test and Evaluation, Navy'', 
        $37,200,000, to remain available until September 30, 2019.
    (b) Amounts provided pursuant to this section are hereby designated 
by the Congress for Overseas Contingency Operations/Global War on 
Terrorism pursuant to section 251(b)(2)(A)(ii) of the Balanced Budget 
and Emergency Deficit Control Act of 1985.

                 TITLE X--ADDITIONAL GENERAL PROVISIONS

                          references to report

    Sec. 1401.  Any reference to a ``report accompanying this Act'' 
contained in this Act shall be treated as a reference to House Report 
115-219. Such report shall apply for purposes of determining the 
allocation of funds provided by, and the implementation of, this Act.

                       spending reduction account

    Sec. 1402.  $0.
    Sec. 1403.  None of the funds appropriated or otherwise made 
available under the heading ``Afghanistan Security Forces Fund'' may be 
used to procure uniforms for the Afghan National Army.
    Sec. 1404.  None of the funds made available in this Act may be 
used for the closure of a biosafety level 4 laboratory.
    Sec. 1405.  None of the funds made available by this Act may be 
used to provide arms, training, or other assistance to the Azov 
Battalion.
    Sec. 1406.  None of the finds made available by this Act may be 
used to purchase heavy water from Iran.
    Sec. 1407.  None of the funds appropriated by this Act may be used 
to plan for, begin, continue, complete, process, or approve a public-
private competition under the Office of Management and Budget Circular 
A-76.
    Sec. 1408.  Notwithstanding any other provision of law, with 
respect to the revised security category (as that term is defined in 
section 250(c)(4)(D) of the Balanced Budget and Emergency Deficit 
Control Act of 1985), any sequestration order issued under such Act for 
fiscal year 2018 shall have no force or effect.
    This division may be cited as the ``Department of Defense 
Appropriations Act, 2018''.

                       DIVISION D--MISCELLANEOUS

    Sec. 1501. (a) Section 1240B of the Food Security Act of 1985 (16 
U.S.C. 3839aa-2) is amended by striking subsection (a) and inserting 
the following:
    ``(a) Establishment.--During each of the 2002 through 2019 fiscal 
years, the Secretary shall provide payments to producers that enter 
into contracts with the Secretary under the program.''.
    (b) Section 1241 of the Food Security Act of 1985 (16 U.S.C. 3841) 
is amended--
            (1) in subsection (a)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``2018'' and inserting ``2018 (and fiscal year 
                2019 in the case of the program specified in paragraph 
                (5))''; and
                    (B) in paragraph (5)(E), by striking ``fiscal year 
                2018'' and inserting ``each of fiscal years 2018 
                through 2019''; and
            (2) in subsection (b), by striking ``2018'' and inserting 
        ``2018 (and fiscal year 2019 in the case of the program 
        specified in subsection (a)(5))''.

                        DIVISION E--TAX MATTERS

SEC. 1601. REPEAL OF SHIFT IN TIME OF PAYMENT OF CORPORATE ESTIMATED 
              TAXES.

    The Trade Preferences Extension Act of 2015 is amended by striking 
section 803 (relating to time for payment of corporate estimated 
taxes).

                     DIVISION F--HEALTH PROVISIONS

SEC. 2100. SHORT TITLE.

    This division may be cited as the ``Strengthening and Underpinning 
the Safety-net to Aid Individuals Needing Care Act of 2018'' or the 
``SUSTAIN Care Act of 2018''.

            TITLE I--MEDICARE EXTENDERS AND RELATED POLICIES

                      Subtitle A--Medicare Part A

SEC. 2101. EXTENSION OF THE MEDICARE-DEPENDENT HOSPITAL (MDH) PROGRAM.

    (a) In General.--Section 1886(d)(5)(G) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(G)) is amended--
            (1) in clause (i), by striking ``October 1, 2017'' and 
        inserting ``October 1, 2019'';
            (2) in clause (ii)(II), by striking ``October 1, 2017'' and 
        inserting ``October 1, 2019''; and
            (3) in clause (iv)--
                    (A) by amending subclause (I) to read as follows:
                                    ``(I) that--
                                            ``(aa) is located in a 
                                        rural area; or
                                            ``(bb) for discharges 
                                        occurring on or after October 
                                        1, 2017, is located in a State 
                                        with no rural area (as defined 
                                        in paragraph (2)(D)) and 
                                        satisfies any of the criteria 
                                        in subclause (I), (II), (III), 
                                        or (IV) of paragraph 
                                        (8)(E)(ii),''; and
                    (B) by adding at the end, after and below subclause 
                (IV), the following flush sentence:
``For purposes of applying subclause (II) of paragraph (8)(E)(ii) under 
subclause (I)(bb), such subclause (II) shall be applied by inserting 
`as of January 1, 2018,' after `such State' each place it appears.''.
    (b) Conforming Amendments.--
            (1) Extension of target amount.--Section 1886(b)(3)(D) of 
        the Social Security Act (42 U.S.C. 1395ww(b)(3)(D)) is 
        amended--
                    (A) in the matter preceding clause (i), by striking 
                ``October 1, 2017'' and inserting ``October 1, 2019''; 
                and
                    (B) in clause (iv), by striking ``through fiscal 
                year 2017'' and inserting ``through fiscal year 2019''.
            (2) Permitting hospitals to decline reclassification.--
        Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 
        1993 (42 U.S.C. 1395ww note) is amended by striking ``through 
        fiscal year 2017'' and inserting ``through fiscal year 2019''.

SEC. 2102. EXTENSION OF INCREASED INPATIENT HOSPITAL PAYMENT ADJUSTMENT 
              FOR CERTAIN LOW-VOLUME HOSPITALS.

    Section 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(12)) is amended--
            (1) in subparagraph (B), in the matter preceding clause 
        (i), by striking ``fiscal year 2018'' and inserting ``fiscal 
        year 2020'';
            (2) in subparagraph (C)(i), by striking ``fiscal years 2011 
        through 2017'' and inserting ``fiscal years 2011 through 2019'' 
        each place it appears; and
            (3) in subparagraph (D), by striking ``fiscal years 2011 
        through 2017'' and inserting ``fiscal years 2011 through 
        2019''.

SEC. 2103. STUDIES RELATING TO HOSPITAL PROGRAMS PAID OUTSIDE OF 
              PROSPECTIVE PAYMENT SYSTEMS.

    (a) MedPAC Report.--Using data from hospital programs with respect 
to which hospitals receive payment outside of the prospective payment 
systems under sections 1833 and 1886 of the Social Security Act (42 
U.S.C. 1395l; 42 U.S.C. 1395ww) (such programs referred to in this 
subsection as ``PPS carve-out programs'') or other data, as available, 
not later than June 30, 2019, the Medicare Payment Advisory Commission 
shall submit to Congress a report that evaluates and recommends changes 
to PPS carve-out programs, including with respect to amendments made by 
sections 2101 and 2102 of this Act, sections 1814, 1820, 
1886(d)(5)(D)(iii), and 1115(A) of the Social Security Act, and such 
other sections of title XVIII of the Social Security Act deemed 
appropriate. To the extent feasible, such report shall make 
recommendations on a payment methodology under the Medicare program for 
hospital payments, including with respect to PPS carve-out programs, 
that differs from the payment methodology applicable to such programs 
as of September 30, 2017.
    (b) MedPAC Recommendations for Possible Alternative Payments.--Not 
later than 2 years after the date by which the Secretary of Health and 
Human Services has collected 2 years of data under sections 
1886(d)(5)(G) and 1886(d)(12) of the Social Security Act (42 U.S.C. 
1395ww(d)(5)(G); 42 U.S.C. 1395ww(d)(12)), as extended pursuant to 
sections 2101 and 2102 of this Act, the Medicare Payment Advisory 
Commission shall submit to Congress a report, including--
            (1) recommendations on payments, including a technical 
        prototype for payments for PPS carve-out programs, if 
        warranted;
            (2) recommendations, if any, on which Medicare fee-for-
        service regulations for hospital payments under title XVIII of 
        the Social Security Act should be altered (such as the critical 
        access hospital 96-hour rule);
            (3) an analysis of the impact of the recommended payments 
        described in paragraph (1) on Medicare beneficiary cost-
        sharing, access to care, and choice of setting;
            (4) a projection of any potential reduction in expenditures 
        under title XVIII of the Social Security Act that may be 
        attributable to the application of the recommended payments 
        described in paragraph (1);
            (5) a review of the value of hospitals participating in PPS 
        carve-out programs collecting and reporting to the Secretary 
        standardized patient assessment data with respect to inpatient 
        hospital services;
            (6) the types of rural hospital classifications and payment 
        methodologies under the Medicare program, including information 
        on each special payment structure such as eligibility criteria, 
        and any areas of overlap between such special payment programs;
            (7) Medicare spending on each PPS carve-out program;
            (8) the financial aspects of hospitals participating in 
        such PPS carve-out programs, such as the share of discharges 
        under the Medicare and Medicaid programs; and
            (9) whether such payment programs are empirically justified 
        to support Medicare beneficiary access to care.

SEC. 2104. EXTENSION OF HOME HEALTH RURAL ADD-ON.

    (a) Extension.--
            (1) In general.--Section 421 of the Medicare Prescription 
        Drug, Improvement, and Modernization Act of 2003 (Public Law 
        108-173; 117 Stat. 2283; 42 U.S.C. 1395fff note), as amended by 
        section 5201(b) of the Deficit Reduction Act of 2005 (Public 
        Law 109-171; 120 Stat. 46), section 3131(c) of the Patient 
        Protection and Affordable Care Act (Public Law 111-148; 124 
        Stat. 428), and section 210 of the Medicare Access and CHIP 
        Reauthorization Act of 2015 (Public Law 114-10; 129 Stat. 151) 
        is amended--
                    (A) in subsection (a), by striking ``January 1, 
                2018'' and inserting ``January 1, 2019'' each place it 
                appears;
                    (B) by redesignating subsections (b) and (c) as 
                subsections (c) and (d), respectively;
                    (C) in each of subsections (c) and (d), as so 
                redesignated, by striking ``subsection (a)'' and 
                inserting ``subsection (a) or (b)''; and
                    (D) by inserting after subsection (a) the following 
                new subsection:
    ``(b) Subsequent Temporary Increase.--
            ``(1) In general.--The Secretary shall increase the payment 
        amount otherwise made under such section 1895 for home health 
        services furnished in a county (or equivalent area) in a rural 
        area (as defined in such section 1886(d)(2)(D)) that, as 
        determined by the Secretary--
                    ``(A) is in the highest quartile of all counties 
                (or equivalent areas) based on the number of Medicare 
                home health episodes furnished per 100 individuals who 
                are entitled to, or enrolled for, benefits under part A 
                of title XVIII of the Social Security Act or enrolled 
                for benefits under part B of such title (but not 
                enrolled in a plan under part C of such title)--
                            ``(i) in the case of episodes and visits 
                        ending during 2019, by 1.5 percent; and
                            ``(ii) in the case of episodes and visits 
                        ending during 2020, by 0.5 percent;
                    ``(B) has a population density of 6 individuals or 
                fewer per square mile of land area and is not described 
                in subparagraph (A)--
                            ``(i) in the case of episodes and visits 
                        ending during 2019, by 4 percent;
                            ``(ii) in the case of episodes and visits 
                        ending during 2020, by 3 percent;
                            ``(iii) in the case of episodes and visits 
                        ending during 2021, by 2 percent; and
                            ``(iv) in the case of episodes and visits 
                        ending during 2022, by 1 percent; and
                    ``(C) is not described in either subparagraph (A) 
                or (B)--
                            ``(i) in the case of episodes and visits 
                        ending during 2019, by 3 percent;
                            ``(ii) in the case of episodes and visits 
                        ending during 2020, by 2 percent; and
                            ``(iii) in the case of episodes and visits 
                        ending during 2021, by 1 percent.
            ``(2) Rules for determinations.--
                    ``(A) No switching.--For purposes of this 
                subsection, the determination by the Secretary as to 
                which subparagraph of paragraph (1) applies to a county 
                (or equivalent area) shall be made a single time and 
                shall apply for the duration of the period to which 
                this subsection applies.
                    ``(B) Utilization.--In determining which counties 
                (or equivalent areas) are in the highest quartile under 
                paragraph (1)(A), the following rules shall apply:
                            ``(i) The Secretary shall use data from 
                        2015.
                            ``(ii) The Secretary shall exclude data 
                        from the territories (and the territories shall 
                        not be described in such paragraph).
                            ``(iii) The Secretary may exclude data from 
                        counties (or equivalent areas) in rural areas 
                        with a low volume of home health episodes (and 
                        if data is so excluded with respect to a county 
                        (or equivalent area), such county (or 
                        equivalent area) shall not be described in such 
                        paragraph).
                    ``(C) Population density.--In determining 
                population density under paragraph (1)(B), the 
                Secretary shall use data from the 2010 decennial 
                Census.
            ``(3) Limitations on review.--There shall be no 
        administrative or judicial review under section 1869, section 
        1878, or otherwise of determinations under paragraph (1).''.
            (2) Requirement to submit county data on claim form.--
        Section 1895(c) of the Social Security Act (42 U.S.C. 
        1395fff(c)) is amended--
                    (A) in paragraph (1), by striking ``and'' at the 
                end;
                    (B) in paragraph (2), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(3) in the case of home health services furnished on or 
        after January 1, 2019, the claim contains the code for the 
        county (or equivalent area) in which the home health service 
        was furnished.''.
    (b) OIG Review.--The Office of the Inspector General shall submit 
to Congress, not later than January 1, 2020, and annually thereafter 
through January 1, 2024, a report containing--
            (1) an analysis of payments made under section 1895 of the 
        Social Security Act (42 U.S.C. 1395fff) increased under section 
        421 of the Medicare Prescription Drug, Improvement, and 
        Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2283; 
        42 U.S.C. 1395fff note), as amended by section 5201(b) of the 
        Deficit Reduction Act of 2005 (Public Law 109-171; 120 Stat. 
        46), section 3131(c) of the Patient Protection and Affordable 
        Care Act (Public Law 111-148; 124 Stat. 428), section 210 of 
        the Medicare Access and CHIP Reauthorization Act of 2015 
        (Public Law 114-10; 129 Stat. 151), and subsection (a); and
            (2) a recommendation on whether such payments should 
        continue to be made based on county data.

                      Subtitle B--Medicare Part B

SEC. 2111. GROUND AMBULANCE SERVICES COST REPORTING REQUIREMENT.

    (a) In General.--Section 1121 of the Social Security Act (42 U.S.C. 
1320a) is amended--
            (1) in subsection (a)--
                    (A) by striking ``For the purposes of'' and 
                inserting ``Subject to subsection (d), for the purposes 
                of'';
                    (B) by inserting ``suppliers of ground ambulance 
                services,'' after ``health maintenance 
                organizations,''; and
                    (C) in the matter following paragraph (5), by 
                adding the following new sentence: ``Not later than 
                December 31, 2019, the Secretary shall modify the 
                uniform reporting systems for providers of services 
                with respect to ground ambulance services to ensure 
                that such systems contain information similar (as 
                determined by the Secretary) to information required 
                under the uniform reporting system for suppliers of 
                ground ambulance services.''; and
            (2) by adding at the end the following new subsection:
    ``(d) In the case of a provider or supplier of ground ambulance 
services, the Secretary may modify the requirements for the inclusion 
of any data element specified in subsection (a) in reports made in 
accordance with the uniform reporting system established under this 
section with respect to such services for such provider or supplier.''.
    (b) Suspension of Payment for Ground Ambulance Services; Deeming 
Certain Payments Overpayments.--Section 1834(l) of the Social Security 
Act (42 U.S.C. 1395m(l)) is amended by adding at the end the following 
new paragraph:
            ``(17) Requirement to submit cost report and authority to 
        suspend payments and deem certain payments overpayments for 
        ground ambulance services.--
                    ``(A) In general.--With respect to ground ambulance 
                services furnished by a supplier of such services 
                during cost reporting periods (as defined in 
                subparagraph (I)) beginning on or after January 1, 
                2020, such supplier shall make reports to the Secretary 
                of information described in section 1121(a) in 
                accordance with the uniform reporting system 
                established under such section for such suppliers and, 
                as may be required by the Secretary, of any of the 
                information described in subparagraph (B).
                    ``(B) Additional information.--The Secretary may, 
                with respect to a supplier of ground ambulance 
                services, require the following information (to be 
                reported to the extent practicable under the uniform 
                reporting system established under section 1121(a) for 
                such suppliers):
                            ``(i) Whether the supplier is part of an 
                        emergency services department, a governmental 
                        organization, or another type of entity (as 
                        described by the Secretary).
                            ``(ii) The number of hours in a week during 
                        which the supplier is available for furnishing 
                        ground ambulance services.
                            ``(iii) The average number of volunteer 
                        hours a week used by the supplier.
                    ``(C) Suspension of payment.--Subject to 
                subparagraph (E), in the case that the Secretary 
                determines that a supplier of ground ambulance services 
                has not made to the Secretary a timely report described 
                in subparagraph (A) with respect to a cost reporting 
                period beginning on or after January 1, 2020, and 
                before January 1, 2022, the Secretary may suspend 
                payments made under this subsection, in whole or in 
                part, to such supplier until the Secretary determines 
                that such supplier has made such a report.
                    ``(D) Deeming certain payments overpayments.--
                Subject to subparagraphs (E) and (F), in the case that 
                the Secretary determines that a supplier of ground 
                ambulance services has not made to the Secretary a 
                complete, accurate, and timely report described in 
                subparagraph (A) with respect to a cost reporting 
                period beginning on or after January 1, 2022, the 
                Secretary may either--
                            ``(i) deem payments made under this 
                        subsection to such supplier for such period to 
                        be overpayments and recoup such overpayments; 
                        or
                            ``(ii) suspend payments made under this 
                        subsection to such supplier for such period.
                    ``(E) Hardship delay.--The Secretary shall 
                establish a process whereby a supplier of ground 
                ambulance services may request a delay in making a 
                report described in subparagraph (A) with respect to a 
                cost reporting period for reason of significant 
                hardship (as determined by the Secretary).
                    ``(F) Authority to modify cost reporting elements 
                and enforcement.--Not earlier than January 1, 2024, the 
                Secretary may provide that subparagraph (D) no longer 
                applies to suppliers of ground ambulance services or a 
                category of such suppliers after--
                            ``(i) taking into account the 
                        recommendation of the Medicare Payment Advisory 
                        Commission in the most recent report available 
                        to the Secretary submitted under section 
                        2111(g) of the SUSTAIN Care Act of 2018 whether 
                        cost reports made by suppliers or a category of 
                        suppliers (as specified for purposes of the 
                        report submitted under such section) of ground 
                        ambulance services should be required or 
                        modified; and
                            ``(ii) undertaking notice and comment 
                        rulemaking.
                    ``(G) Audit of cost reports.--The Secretary shall 
                audit reports described in subparagraph (A) made with 
                respect to cost reporting periods beginning on or after 
                January 1, 2021.
                    ``(H) Appeals.--The Secretary shall establish a 
                process whereby a supplier of ground ambulance services 
                may appeal a determination described in subparagraph 
                (C) or (D) made with respect to a cost report required 
                to be made by such supplier under subparagraph (A).
                    ``(I) Definition.--In this paragraph, the term 
                `cost reporting period' means, with respect to a year, 
                the 12-month period beginning on January 1 of such 
                year.''.
    (c) Stakeholder Feedback.--
            (1) In general.--The Secretary of Health and Human Services 
        shall implement the provisions of this section, including the 
        amendments made by this section, through notice and comment 
        rulemaking and seek input from stakeholders.
            (2) Nonapplication of paperwork reduction act.--Chapter 35 
        of title 44, United States Code, shall not apply with respect 
        to--
                    (A) the development and implementation of the 
                uniform reporting system required under section 1121(a) 
                of the Social Security Act (42 U.S.C. 1320a(a)) for 
                suppliers of ground ambulance services and reports 
                required to be made under section 1834(l)(17) of such 
                Act (42 U.S.C. 1395m(l)(17)); and
                    (B) the modification of the uniform reporting 
                systems under such section 1121(a) of such Act for 
                providers of such services and reports required to be 
                made under section 1861(v)(1)(F) of such Act (42 U.S.C. 
                1395x(v)(1)(F)).
    (d) Implementation Resources.--In addition to funds otherwise 
available, there are appropriated to the Centers for Medicare & 
Medicaid Services Program Management Account from the Federal Hospital 
Insurance Trust Fund under section 1817 of the Social Security Act (42 
U.S.C. 1395i) $8,000,000 and from the Federal Supplementary Medical 
Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t) 
$137,000,000 (of which not less than $15,000,000 shall be used to 
fulfill the auditing requirement under section 1834(l)(17)(G) of such 
Act, as added by subsection (b) of this section) to carry out the 
provisions of this section, including the amendments made by this 
section, to remain available through December 31, 2022. Of the amounts 
appropriated under the previous sentence, the Secretary shall use such 
sums as may be necessary to hire not less than 2 full-time employees 
for purposes of carrying out such provisions, including such 
amendments.
    (e) Extension of Rural Add-on Payments.--Section 1834(l) of the 
Social Security Act (42. U.S.C. 1395m(l)) is amended--
            (1) in paragraph (12)(A), by striking ``2018'' and 
        inserting ``2023''; and
            (2) in paragraph (13)(A), by striking ``2018'' each place 
        it appears and inserting ``2023''.
    (f) Sense of Congress.--It is the sense of Congress that--
            (1) a cost report made by a supplier of ground ambulance 
        services with respect to a cost reporting period beginning 
        before January 1, 2022, may not contain complete and accurate 
        information on ground ambulance services furnished during such 
        a period by the supplier; and
            (2) the Secretary should take into account only the 
        timeliness of such a report made with respect to such a period 
        when determining whether to suspend payments to a supplier 
        under section 1834(l) of the Social Security Act (42 U.S.C. 
        1395m(l)).
    (g) Ground Ambulance Services Cost Reporting Study.--
            (1) In general.--Not later than March 15, 2023, and as 
        determined necessary by the Medicare Payment Advisory 
        Commission thereafter, such Commission shall assess and submit 
        to Congress a report on cost reports of suppliers and providers 
        of ground ambulance services carried out in accordance with 
        sections 1121(a) and 1834(l) of the Social Security Act (42 
        U.S.C. 1320a(a), 1395m(l)), the adequacy of payments for such 
        services made under section 1834(l) of such Act, and geographic 
        variations in the cost of providing such services.
            (2) Contents.--The report described in paragraph (1) shall 
        contain the following:
                    (A) An analysis of cost report data submitted in 
                accordance with such sections.
                    (B) An analysis of any burden on providers and 
                suppliers of such services associated with reporting 
                such data.
                    (C) A recommendation on whether or not cost reports 
                of ground ambulance services made by suppliers or a 
                category of suppliers (as specified by the Secretary) 
                of such services, or the ground ambulance portion of 
                cost reports made by providers of such services, should 
                be required or modified, taking into account the 
                analyses described in subparagraphs (A) and (B).

SEC. 2112. EXTENSION OF WORK GPCI FLOOR.

    Section 1848(e)(1)(E) of the Social Security Act (42 U.S.C. 1395w-
4(e)(1)(E)) is amended by striking ``January 1, 2018'' and inserting 
``January 1, 2020''.

SEC. 2113. REPEAL OF MEDICARE PAYMENT CAP FOR THERAPY SERVICES; 
              REPLACEMENT WITH LIMITATION TO ENSURE APPROPRIATE 
              THERAPY.

    Section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)) is 
amended--
            (1) in paragraph (1)--
                    (A) by striking ``Subject to paragraphs (4) and 
                (5)'' and inserting ``(A) Subject to paragraphs (4) and 
                (5)'';
                    (B) in the subparagraph (A), as inserted and 
                designated by subparagraph (A) of this paragraph, by 
                adding at the end the following new sentence: ``The 
                preceding sentence shall not apply to expenses incurred 
                with respect to services furnished after December 31, 
                2017.''; and
                    (C) by adding at the end the following new 
                subparagraph:
    ``(B) With respect to services furnished during 2018 or a 
subsequent year, in the case of physical therapy services of the type 
described in section 1861(p), speech-language pathology services of the 
type described in such section through the application of section 
1861(ll)(2), and physical therapy services and speech-language 
pathology services of such type which are furnished by a physician or 
as incident to physicians' services, with respect to expenses incurred 
in any calendar year, any amount that is more than the amount specified 
in paragraph (2) for the year shall not be considered as incurred 
expenses for purposes of subsections (a) and (b) unless the applicable 
requirements of paragraph (7) are met.'';
            (2) in paragraph (3)--
                    (A) by striking ``Subject to paragraphs (4) and 
                (5)'' and inserting ``(A) Subject to paragraphs (4) and 
                (5)'';
                    (B) in the subparagraph (A), as inserted and 
                designated by subparagraph (A) of this paragraph, by 
                adding at the end the following new sentence: ``The 
                preceding sentence shall not apply to expenses incurred 
                with respect to services furnished after December 31, 
                2017.''; and
                    (C) by adding at the end the following new 
                subparagraph:.
    ``(B) With respect to services furnished during 2018 or a 
subsequent year, in the case of occupational therapy services (of the 
type that are described in section 1861(p) through the operation of 
section 1861(g) and of such type which are furnished by a physician or 
as incident to physicians' services), with respect to expenses incurred 
in any calendar year, any amount that is more than the amount specified 
in paragraph (2) for the year shall not be considered as incurred 
expenses for purposes of subsections (a) and (b) unless the applicable 
requirements of paragraph (7) are met.'';
            (3) in paragraph (5)--
                    (A) by redesignating subparagraph (D) as paragraph 
                (8) and moving such paragraph to immediately follow 
                paragraph (7), as added by paragraph (4) of this 
                section; and
                    (B) in subparagraph (E)(iv), by inserting ``, 
                except as such process is applied under paragraph 
                (7)(B)'' before the period at the end; and
            (4) by adding at the end the following new paragraph:
    ``(7) For purposes of paragraphs (1)(B) and (3)(B), with respect to 
services described in such paragraphs, the requirements described in 
this paragraph are as follows:
            ``(A) Inclusion of appropriate modifier.--The claim for 
        such services contains an appropriate modifier (such as the KX 
        modifier described in paragraph (5)(B)) indicating that such 
        services are medically necessary as justified by appropriate 
        documentation in the medical record involved.
            ``(B) Targeted medical review for certain services above 
        threshold.--
                    ``(i) In general.--In the case where expenses that 
                would be incurred for such services would exceed the 
                threshold described in clause (ii) for the year, such 
                services shall be subject to the process for medical 
                review implemented under paragraph (5)(E).
                    ``(ii) Threshold.--The threshold under this clause 
                for--
                            ``(I) a year before 2028, is $3,000;
                            ``(II) 2028, is the amount specified in 
                        subclause (I) increased by the percentage 
                        increase in the MEI (as defined in section 
                        1842(i)(3)) for 2028; and
                            ``(III) a subsequent year, is the amount 
                        specified in this clause for the preceding year 
                        increased by the percentage increase in the MEI 
                        (as defined in section 1842(i)(3)) for such 
                        subsequent year;
                except that if an increase under subclause (II) or 
                (III) for a year is not a multiple of $10, it shall be 
                rounded to the nearest multiple of $10.
                    ``(iii) Application.--The threshold under clause 
                (ii) shall be applied separately--
                            ``(I) for physical therapy services and 
                        speech-language pathology services; and
                            ``(II) for occupational therapy services.
                    ``(iv) Funding.--For purposes of carrying out this 
                subparagraph, the Secretary shall provide for the 
                transfer, from the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 to the Centers 
                for Medicare & Medicaid Services Program Management 
                Account, of $5,000,000 for each fiscal year beginning 
                with fiscal year 2018, to remain available until 
                expended. Such funds may not be used by a contractor 
                under section 1893(h) for medical reviews under this 
                subparagraph.''.

                       Subtitle C--Miscellaneous

SEC. 2121. PROVIDING CONTINUED ACCESS TO MEDICARE ADVANTAGE SPECIAL 
              NEEDS PLANS FOR VULNERABLE POPULATIONS.

    (a) Extension.--Section 1859(f)(1) of the Social Security Act (42 
U.S.C. 1395w-28(f)(1)) is amended by striking ``and for periods before 
January 1, 2019''.
    (b) Increased Integration of Dual SNPs.--
            (1) In general.--Section 1859(f) of the Social Security Act 
        (42 U.S.C. 1395w-28(f)) is amended--
                    (A) in paragraph (3), by adding at the end the 
                following new subparagraph:
                    ``(F) The plan meets the requirements applicable 
                under paragraph (8).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(8) Increased integration of dual snps.--
                    ``(A) Designated contact.--The Secretary, acting 
                through the Federal Coordinated Health Care Office 
                established under section 2602 of Public Law 111-148, 
                shall serve as a dedicated point of contact for States 
                to address misalignments that arise with the 
                integration of specialized MA plans for special needs 
                individuals described in subsection (b)(6)(B)(ii) under 
                this paragraph and, consistent with such role, shall 
                establish--
                            ``(i) a uniform process for disseminating 
                        to State Medicaid agencies information under 
                        this title impacting contracts between such 
                        agencies and such plans under this subsection; 
                        and
                            ``(ii) basic resources for States 
                        interested in exploring such plans as a 
                        platform for integration, such as a model 
                        contract or other tools to achieve those goals.
                    ``(B) Unified grievances and appeals process.--
                            ``(i) In general.--Not later than April 1, 
                        2020, the Secretary shall establish procedures, 
                        to the extent feasible as determined by the 
                        Secretary, unifying grievances and appeals 
                        procedures under sections 1852(f), 1852(g), 
                        1902(a)(3), 1902(a)(5), and 1932(b)(4) for 
                        items and services provided by specialized MA 
                        plans for special needs individuals described 
                        in subsection (b)(6)(B)(ii) under this title 
                        and title XIX. With respect to items and 
                        services described in the preceding sentence, 
                        procedures established under this clause shall 
                        apply in place of otherwise applicable 
                        grievances and appeals procedures. The 
                        Secretary shall solicit comment in developing 
                        such procedures from States, plans, 
                        beneficiaries and their representatives, and 
                        other relevant stakeholders.
                            ``(ii) Procedures.--The procedures 
                        established under clause (i) shall be included 
                        in the plan contract under paragraph (3)(D) and 
                        shall--
                                    ``(I) adopt the provisions for the 
                                enrollee that are most protective for 
                                the enrollee and, to the extent 
                                feasible as determined by the 
                                Secretary, are compatible with unified 
                                timeframes and consolidated access to 
                                external review under an integrated 
                                process;
                                    ``(II) take into account 
                                differences in State plans under title 
                                XIX to the extent necessary;
                                    ``(III) be easily navigable by an 
                                enrollee; and
                                    ``(IV) include the elements 
                                described in clause (iii), as 
                                applicable.
                            ``(iii) Elements described.--Both unified 
                        appeals and unified grievance procedures shall 
                        include, as applicable, the following elements 
                        described in this clause:
                                    ``(I) Single written notification 
                                of all applicable grievances and appeal 
                                rights under this title and title XIX. 
                                For purposes of this subparagraph, the 
                                Secretary may waive the requirements 
                                under section 1852(g)(1)(B) when the 
                                specialized MA plan covers items or 
                                services under this part or under title 
                                XIX.
                                    ``(II) Single pathways for 
                                resolution of any grievance or appeal 
                                related to a particular item or service 
                                provided by specialized MA plans for 
                                special needs individuals described in 
                                subsection (b)(6)(B)(ii) under this 
                                title and title XIX.
                                    ``(III) Notices written in plain 
                                language and available in a language 
                                and format that is accessible to the 
                                enrollee, including in non-English 
                                languages that are prevalent in the 
                                service area of the specialized MA 
                                plan.
                                    ``(IV) Unified timeframes for 
                                grievances and appeals processes, such 
                                as an individual's filing of a 
                                grievance or appeal, a plan's 
                                acknowledgment and resolution of a 
                                grievance or appeal, and notification 
                                of decisions with respect to a 
                                grievance or appeal.
                                    ``(V) Requirements for how the plan 
                                must process, track, and resolve 
                                grievances and appeals, to ensure 
                                beneficiaries are notified on a timely 
                                basis of decisions that are made 
                                throughout the grievance or appeals 
                                process and are able to easily 
                                determine the status of a grievance or 
                                appeal.
                            ``(iv) Continuation of benefits pending 
                        appeal.--The unified procedures under clause 
                        (i) shall, with respect to all benefits under 
                        parts A and B and title XIX subject to appeal 
                        under such procedures, incorporate provisions 
                        under current law and implementing regulations 
                        that provide continuation of benefits pending 
                        appeal under this title and title XIX.
                    ``(C) Requirement for unified grievances and 
                appeals.--For 2021 and subsequent years, the contract 
                of a specialized MA plan for special needs individuals 
                described in subsection (b)(6)(B)(ii) with a State 
                Medicaid agency under paragraph (3)(D) shall require 
                the use of unified grievances and appeals procedures as 
                described in subparagraph (B).
                    ``(D) Requirements for integration.--
                            ``(i) In general.--For 2021 and subsequent 
                        years, a specialized MA plan for special needs 
                        individuals described in subsection 
                        (b)(6)(B)(ii) shall meet one or more of the 
                        following requirements, to the extent permitted 
                        under State law, for integration of benefits 
                        under this title and title XIX:
                                    ``(I) The specialized MA plan must 
                                meet the requirements of contracting 
                                with the State Medicaid agency 
                                described in paragraph (3)(D) in 
                                addition to coordinating long-term 
                                services and supports or behavioral 
                                health services, or both, by meeting an 
                                additional minimum set of requirements 
                                determined by the Secretary through the 
                                Federal Coordinated Health Care Office 
                                established under section 2602 of the 
                                Patient Protection and Affordable Care 
                                Act based on input from stakeholders, 
                                such as notifying the State in a timely 
                                manner of hospitalizations, emergency 
                                room visits, and hospital or nursing 
                                home discharges of enrollees, assigning 
                                one primary care provider for each 
                                enrollee, or sharing data that would 
                                benefit the coordination of items and 
                                services under this title and the State 
                                plan under title XIX. Such minimum set 
                                of requirements must be included in the 
                                contract of the specialized MA plan 
                                with the State Medicaid agency under 
                                such paragraph.
                                    ``(II) The specialized MA plan must 
                                meet the requirements of a fully 
                                integrated plan described in section 
                                1853(a)(1)(B)(iv)(II) (other than the 
                                requirement that the plan have similar 
                                average levels of frailty, as 
                                determined by the Secretary, as the 
                                PACE program), or enter into a 
                                capitated contract with the State 
                                Medicaid agency to provide long-term 
                                services and supports or behavioral 
                                health services, or both.
                                    ``(III) In the case of a 
                                specialized MA plan that is offered by 
                                a parent organization that is also the 
                                parent organization of a Medicaid 
                                managed care organization providing 
                                long term services and supports or 
                                behavioral services under a contract 
                                under section 1903(m), the parent 
                                organization must assume clinical and 
                                financial responsibility for benefits 
                                provided under this title and title XIX 
                                with respect to any individual who is 
                                enrolled in both the specialized MA 
                                plan and the Medicaid managed care 
                                organization.
                            ``(ii) Suspension of enrollment for failure 
                        to meet requirements during initial period.--
                        During the period of plan years 2021 through 
                        2025, if the Secretary determines that a 
                        specialized MA plan for special needs 
                        individuals described in subsection 
                        (b)(6)(B)(ii) has failed to comply with clause 
                        (i), the Secretary may provide for the 
                        application against the Medicare Advantage 
                        organization offering the plan of the remedy 
                        described in section 1857(g)(2)(B) in the same 
                        manner as the Secretary may apply such remedy, 
                        and in accordance with the same procedures as 
                        would apply, in the case of an MA organization 
                        determined by the Secretary to have engaged in 
                        conduct described in section 1857(g)(1). If the 
                        Secretary applies such remedy to a Medicare 
                        Advantage organization under the preceding 
                        sentence, the organization shall submit to the 
                        Secretary (at a time, and in a form and manner, 
                        specified by the Secretary) information 
                        describing how the plan will come into 
                        compliance with clause (i).
                    ``(E) Study and report to congress.--
                            ``(i) In general.--Not later than January 
                        1, 2022, and, subject to clause (iii), 
                        biennially thereafter through 2032, the 
                        Medicare Payment Advisory Commission 
                        established under section 1805, in consultation 
                        with the Medicaid and CHIP Payment and Access 
                        Commission established under section 1900, 
                        shall conduct (and submit to the Secretary and 
                        the Committees on Ways and Means and Energy and 
                        Commerce of the House of Representatives and 
                        the Committee on Finance of the Senate a report 
                        on) a study to determine how specialized MA 
                        plans for special needs individuals described 
                        in subsection (b)(6)(B)(ii) perform among each 
                        other based on data from Healthcare 
                        Effectiveness Data and Information Set (HEDIS) 
                        quality measures, reported on the plan level, 
                        as required under section 1852(e)(3) (or such 
                        other measures or data sources that are 
                        available and appropriate, such as encounter 
                        data and Consumer Assessment of Healthcare 
                        Providers and Systems data, as specified by 
                        such Commissions as enabling an accurate 
                        evaluation under this subparagraph). Such study 
                        shall include, as feasible, the following 
                        comparison groups of specialized MA plans for 
                        special needs individuals described in 
                        subsection (b)(6)(B)(ii):
                                    ``(I) A comparison group of such 
                                plans that are described in 
                                subparagraph (D)(i)(I).
                                    ``(II) A comparison group of such 
                                plans that are described in 
                                subparagraph (D)(i)(II).
                                    ``(III) A comparison group of such 
                                plans operating within the Financial 
                                Alignment Initiative demonstration for 
                                the period for which such plan is so 
                                operating and the demonstration is in 
                                effect, and, in the case that an 
                                integration option that is not with 
                                respect to specialized MA plans for 
                                special needs individuals is 
                                established after the conclusion of the 
                                demonstration involved.
                                    ``(IV) A comparison group of such 
                                plans that are described in 
                                subparagraph (D)(i)(III).
                                    ``(V) A comparison group of MA 
                                plans, as feasible, not described in a 
                                previous subclause of this clause, with 
                                respect to the performance of such 
                                plans for enrollees who are special 
                                needs individuals described in 
                                subsection (b)(6)(B)(ii).
                            ``(ii) Discretionary additional reports.--
                        Beginning with 2033 and every five years 
                        thereafter, the Medicare Payment Advisory 
                        Commission, in consultation with the Medicaid 
                        and CHIP Payment and Access Commission shall, 
                        at the discretion of the Secretary, conduct a 
                        study described in clause (i).''.
            (2) Conforming amendment to responsibilities of federal 
        coordinated health care office.--Section 2602(d) of Public Law 
        111-148 (42 U.S.C. 1315b(d)) is amended by adding at the end 
        the following new paragraphs:
            ``(6) To act as a designated contact for States under 
        subsection (f)(8)(A) of section 1859 of the Social Security Act 
        (42 U.S.C. 1395w-28) with respect to the integration of 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section.
            ``(7) To be responsible, subject to the final approval of 
        the Secretary, for developing regulations and guidance related 
        to the implementation of a unified grievance and appeals 
        process as described in subparagraphs (B) and (C) of section 
        1859(f)(8) of the Social Security Act (42 U.S.C. 1395w-
        28(f)(8)).
            ``(8) To be responsible, subject to the final approval of 
        the Secretary, for developing regulations and guidance related 
        to the integration or alignment of policy and oversight under 
        the Medicare program under title XVIII of such Act and the 
        Medicaid program under title XIX of such Act regarding 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6)(B)(ii) of such section 1859.''.
    (c) Improvements to Severe or Disabling Chronic Condition SNPs.--
            (1) Care management requirements.--Section 1859(f)(5) of 
        the Social Security Act (42 U.S.C. 1395w-28(f)(5)) is amended--
                    (A) by striking ``all snps.--The requirements'' and 
                inserting ``all snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                requirements'';
                    (B) by redesignating subparagraphs (A) and (B) as 
                clauses (i) and (ii), respectively, and indenting 
                appropriately; and
                    (C) in clause (ii), as redesignated by subparagraph 
                (B), by redesignating clauses (i) through (iii) as 
                subclauses (I) through (III), respectively, and 
                indenting appropriately; and
                    (D) by adding at the end the following new 
                subparagraph:
                    ``(B) Improvements to care management requirements 
                for severe or disabling chronic condition snps.--For 
                2020 and subsequent years, in the case of a specialized 
                MA plan for special needs individuals described in 
                subsection (b)(6)(B)(iii), the requirements described 
                in this paragraph include the following:
                            ``(i) The interdisciplinary team under 
                        subparagraph (A)(ii)(III) includes a team of 
                        providers with demonstrated expertise, 
                        including training in an applicable specialty, 
                        in treating individuals similar to the targeted 
                        population of the plan.
                            ``(ii) Requirements developed by the 
                        Secretary to provide face-to-face encounters 
                        with individuals enrolled in the plan not less 
                        frequently than on an annual basis.
                            ``(iii) As part of the model of care under 
                        clause (i) of subparagraph (A), the results of 
                        the initial assessment and annual reassessment 
                        under clause (ii)(I) of such subparagraph of 
                        each individual enrolled in the plan are 
                        addressed in the individual's individualized 
                        care plan under clause (ii)(II) of such 
                        subparagraph.
                            ``(iv) As part of the annual evaluation and 
                        approval of such model of care, the Secretary 
                        shall take into account whether the plan 
                        fulfilled the previous year's goals (as 
                        required under the model of care).
                            ``(v) The Secretary shall establish a 
                        minimum benchmark for each element of the model 
                        of care of a plan. The Secretary shall only 
                        approve a plan's model of care under this 
                        paragraph if each element of the model of care 
                        meets the minimum benchmark applicable under 
                        the preceding sentence.''.
            (2) Revisions to the definition of a severe or disabling 
        chronic conditions specialized needs individual.--
                    (A) In general.--Section 1859(b)(6)(B)(iii) of the 
                Social Security Act (42 U.S.C. 1395w-28(b)(6)(B)(iii)) 
                is amended--
                            (i) by striking ``who have'' and inserting 
                        ``who--
                                    ``(I) before January 1, 2022, 
                                have'';
                            (ii) in subclause (I), as added by clause 
                        (i), by striking the period at the end and 
                        inserting ``; and''; and
                            (iii) by adding at the end the following 
                        new subclause:
                                    ``(II) on or after January 1, 2022, 
                                have one or more comorbid and medically 
                                complex chronic conditions that is life 
                                threatening or significantly limits 
                                overall health or function, have a high 
                                risk of hospitalization or other 
                                adverse health outcomes, and require 
                                intensive care coordination and that is 
                                listed under subsection (f)(9)(A).''.
                    (B) Panel of clinical advisors.--Section 1859(f) of 
                the Social Security Act (42 U.S.C. 1395w-28(f)), as 
                amended by subsection (b), is amended by adding at the 
                end the following new paragraph:
            ``(9) List of conditions for clarification of the 
        definition of a severe or disabling chronic conditions 
        specialized needs individual.--
                    ``(A) In general.--Not later than December 31, 
                2020, and every 5 years thereafter, subject to 
                subparagraphs (B) and (C), the Secretary shall convene 
                a panel of clinical advisors to establish and update a 
                list of conditions that meet each of the following 
                criteria:
                            ``(i) Conditions that meet the definition 
                        of a severe or disabling chronic condition 
                        under subsection (b)(6)(B)(iii) on or after 
                        January 1, 2022.
                            ``(ii) Conditions that require prescription 
                        drugs, providers, and models of care that are 
                        unique to the specific population of enrollees 
                        in a specialized MA plan for special needs 
                        individuals described in such subsection on or 
                        after such date and--
                                    ``(I) as a result of access to, and 
                                enrollment in, such a specialized MA 
                                plan for special needs individuals, 
                                individuals with such condition would 
                                have a reasonable expectation of 
                                slowing or halting the progression of 
                                the disease, improving health outcomes 
                                and decreasing overall costs for 
                                individuals diagnosed with such 
                                condition compared to available options 
                                of care other than through such a 
                                specialized MA plan for special needs 
                                individuals; or
                                    ``(II) have a low prevalence in the 
                                general population of beneficiaries 
                                under this title or a disproportionally 
                                high per-beneficiary cost under this 
                                title.
                    ``(B) Inclusion of certain conditions.--The 
                conditions listed under subparagraph (A) shall include 
                HIV/AIDS, end stage renal disease, and chronic and 
                disabling mental illness.
                    ``(C) Requirement.--In establishing and updating 
                the list under subparagraph (A), the panel shall take 
                into account the availability of varied benefits, cost-
                sharing, and supplemental benefits under the model 
                described in paragraph (2) of section 1859(h), 
                including the expansion under paragraph (1) of such 
                section.''.
    (d) Quality Measurement at the Plan Level for SNPs and 
Determination of Feasability of Quality Measurement at the Plan Level 
for All MA Plans.--Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w-23(o)) is amended by adding at the end the following new 
paragraphs:
            ``(6) Quality measurement at the plan level for snps.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretary may require reporting of data under section 
                1852(e) for, and apply under this subsection, quality 
                measures at the plan level for specialized MA plans for 
                special needs individuals instead of at the contract 
                level.
                    ``(B) Considerations.--Prior to applying quality 
                measurement at the plan level under this paragraph, the 
                Secretary shall--
                            ``(i) take into consideration the minimum 
                        number of enrollees in a specialized MA plan 
                        for special needs individuals in order to 
                        determine if a statistically significant or 
                        valid measurement of quality at the plan level 
                        is possible under this paragraph;
                            ``(ii) take into consideration the impact 
                        of such application on plans that serve a 
                        disproportionate number of individuals dually 
                        eligible for benefits under this title and 
                        under title XIX;
                            ``(iii) if quality measures are reported at 
                        the plan level, ensure that MA plans are not 
                        required to provide duplicative information; 
                        and
                            ``(iv) ensure that such reporting does not 
                        interfere with the collection of encounter data 
                        submitted by MA organizations or the 
                        administration of any changes to the program 
                        under this part as a result of the collection 
                        of such data.
                    ``(C) Application.--If the Secretary applies 
                quality measurement at the plan level under this 
                paragraph--
                            ``(i) such quality measurement may include 
                        Medicare Health Outcomes Survey (HOS), 
                        Healthcare Effectiveness Data and Information 
                        Set (HEDIS), Consumer Assessment of Healthcare 
                        Providers and Systems (CAHPS) measures and 
                        quality measures under part D; and
                            ``(ii) the Secretary shall consider 
                        applying administrative actions, such as 
                        remedies described in section 1857(g)(2), at 
                        the plan level.
            ``(7) Determination of feasibility of quality measurement 
        at the plan level for all ma plans.--
                    ``(A) Determination of feasibility.--The Secretary 
                shall determine the feasibility of requiring reporting 
                of data under section 1852(e) for, and applying under 
                this subsection, quality measures at the plan level for 
                all MA plans under this part.
                    ``(B) Consideration of change.--After making a 
                determination under subparagraph (A), the Secretary 
                shall consider requiring such reporting and applying 
                such quality measures at the plan level as described in 
                such subparagraph''.
    (e) GAO Study and Report on State-Level Integration Between Dual 
SNPs and Medicaid.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on State-level integration between 
        specialized MA plans for special needs individuals described in 
        subsection (b)(6) (B)(ii) of section 1859 of the Social 
        Security Act (42 U.S.C. 1395w-28) and the Medicaid program 
        under title XIX of such Act (42 U.S.C. 1396 et seq.). Such 
        study shall include an analysis of the following:
                    (A) The characteristics of States in which the 
                State agency responsible for administering the State 
                plan under such title XIX has a contract with such a 
                specialized MA plan and that delivers long-term 
                services and supports under the State plan under such 
                title XIX through a managed care program, including the 
                requirements under such State plan with respect to 
                long-term services and supports.
                    (B) The types of such specialized MA plans, which 
                may include the following:
                            (i) A plan described in section 
                        1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
                        1395w-23(a)(1)(B)(iv)(II)).
                            (ii) A plan that meets the requirements 
                        described in subsection (f)(3)(D) of such 
                        section 1859.
                            (iii) A plan described in clause (ii) that 
                        also meets additional requirements established 
                        by the State.
                    (C) The characteristics of individuals enrolled in 
                such specialized MA plans.
                    (D) As practicable, the following with respect to 
                State programs for the delivery of long-term services 
                and supports under such title XIX through a managed 
                care program:
                            (i) Which populations of individuals are 
                        eligible to receive such services and supports.
                            (ii) Whether all such services and supports 
                        are provided on a capitated basis or if any of 
                        such services and supports are carved out and 
                        provided through fee-forservice.
                    (E) As practicable, how the availability and 
                variation of integration arrangements of such 
                specialized MA plans offered in States affects 
                spending, service delivery options, access to 
                community-based care, and utilization of care.
                    (F) The efforts of State Medicaid programs to 
                transition dually-eligible beneficiaries receiving 
                long-term services and supports (LTSS) from 
                institutional settings to home and community-based 
                settings and related financial impacts of such 
                transitions.
                    (G) Barriers and opportunities for making further 
                progress on dual integration, as well as 
                recommendations for legislation or administrative 
                action to expedite or refine pathways toward fully 
                integrated care.
            (2) Report.--Not later than 2 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 2122. EXTENSION OF CERTAIN MIPPA FUNDING PROVISIONS; STATE HEALTH 
              INSURANCE ASSISTANCE PROGRAM REPORTING REQUIREMENTS.

    (a) Funding Extensions.--Section 119 of the Medicare Improvements 
for Patients and Providers Act of 2008 (42 U.S.C. 1395b-3 note) is 
amended--
            (1) in subsection (a)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 and 
                        2019, of $13,000,000.'';
            (2) in subsection (b)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 and 
                        2019, of $7,500,000.'';
            (3) in subsection (c)(1)(B)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 and 
                        2019, of $5,000,000.''; and
            (4) in subsection (d)(2)--
                    (A) in clause (vi), by striking ``and'' at the end;
                    (B) in clause (vii), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by inserting after clause (vii) the following 
                new clause:
                            ``(viii) for each of fiscal years 2018 and 
                        2019, of $12,000,000.''.
    (b) State Health Insurance Assistance Program Reporting 
Requirements.--Beginning not later than April 1, 2019, and biennially 
thereafter, the Agency for Community Living shall electronically post 
on its website the following information, with respect to grants to 
States for State health insurance assistance programs, (such 
information to be presented by State and by entity receiving funds from 
the State to carry out such a program funded by such grant):
            (1) The amount of Federal funding provided to each such 
        State for such program for the period involved and the amount 
        of Federal funding provided by each such State for such program 
        to each such entity for the period involved.
            (2) Information as the Secretary may specify, with respect 
        to such programs carried out through such grants, consistent 
        with the terms and conditions for receipt of such grants.

SEC. 2123. EXTENSION OF FUNDING FOR QUALITY MEASURE ENDORSEMENT, INPUT, 
              AND SELECTION; REPORTING REQUIREMENTS.

    (a) In General.--Section 1890(d) of the Social Security Act (42 
U.S.C. 1395aaa(d)) is amended--
            (1) in paragraph (2), by adding at the end the following 
        new sentence: ``Any of such amounts remaining available as of 
        the date of the enactment of the SUSTAIN Care Act of 2018 shall 
        be used only for purposes under this section that are purposes 
        other than funding a contract entered into under subsection 
        (a).''; and
            (2) by adding at the end the following new paragraph:
            ``(3) For purposes of carrying out this section, the 
        Secretary shall provide for the transfer, from the Federal 
        Hospital Insurance Trust Fund under section 1817 and the 
        Federal Supplemental Medical Insurance Trust Fund under 1841, 
        in such proportion as Secretary deems appropriate, to the 
        Centers for Medicare & Medicaid Services Program Management 
        Account of $7,500,000 for each of fiscal years 2018 and 2019. 
        Of the amount transferred under the previous sentence for a 
        fiscal year, there shall be used for the purpose of funding a 
        contract entered into under subsection (a) with respect to 
        carrying out section 1890A (other than subsections (e) and (f)) 
        for such fiscal year an amount that is not less than the amount 
        used for such purpose for fiscal year 2017.''.
    (b) Annual Report by Secretary to Congress.--Section 1890 of the 
Social Security Act (42 U.S.C. 1395aaa) is amended by adding at the end 
the following new subsection:
    ``(e) Annual Report by Secretary to Congress.--By not later than 
March 1 of each year (beginning with 2018), the Secretary shall submit 
to Congress a report containing the following:
            ``(1) A comprehensive plan that identifies the quality 
        measurement needs of programs and initiatives of the Secretary 
        and provides a strategy for using the work performed by the 
        entity with a contract under subsection (a) and the work of any 
        other entity the Secretary has contracted with to perform work 
        associated with this section or section 1890A to help meet 
        those needs, specifically with respect to the programs under 
        this title and title XIX.
            ``(2) The amount of mandatory funding provided under 
        subsection (d) for purposes of carrying out this section and 
        section 1890A that has been obligated by the Secretary, the 
        amount of funding provided that has been expended, and the 
        amount of funding provided that remains unobligated.
            ``(3) A description of how the funds provided that are 
        obligated have been allocated, including how much of that 
        funding has been allocated for work performed by the Secretary, 
        the entity with a contract under subsection (a), and any other 
        entity the Secretary has contracted with to perform work 
        related to this section or section 1890A, respectively.
            ``(4) A description of the activities for which the 
        obligated funds have been or will be used, including any 
        activities performed by the Secretary, task orders, specific 
        projects, and activities assigned to the entity with a contract 
        under subsection (a), and task orders, specific projects, and 
        activities assigned to any other entity the Secretary has 
        contracted with to perform work related to carrying out this 
        section or section 1890A.
            ``(5) The amount of funding allocated to each of the 
        activities described in paragraph (4).
            ``(6) Estimates for, and descriptions of, obligations and 
        expenditures that the Secretary anticipates will be needed in 
        the succeeding two year period to carry out each of the quality 
        measurement activities required under this section and section 
        1890A, including any obligations that will require funds to be 
        expended in a future year.''.
    (c) Revisions to Annual Report From Consensus-based Entity to 
Congress and the Secretary.--
            (1) In general.--Section 1890(b)(5)(A) of the Social 
        Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is amended--
                    (A) by redesignating clauses (i) through (vi) as 
                subclauses (I) through (VI), respectively, and moving 
                the margins accordingly;
                    (B) in the matter preceding subclause (I), as 
                redesignated by clause (i), by striking ``containing a 
                description of--'' and inserting ``containing the 
                following:
                            ``(i) A description of--''; and
                    (C) by adding at the end the following new clauses:
                            ``(ii) An itemization of financial 
                        information for the fiscal year ending 
                        September 30 of the preceding year, including--
                                    ``(I) annual revenues of the entity 
                                (including any government funding, 
                                private sector contributions, grants, 
                                membership revenues, and investment 
                                revenue);
                                    ``(II) annual expenses of the 
                                entity (including grants paid, benefits 
                                paid, salaries or other compensation, 
                                fundraising expenses, and overhead 
                                costs); and
                                    ``(III) a breakdown of the amount 
                                awarded per contracted task order and 
                                the specific projects funded in each 
                                task order assigned to the entity.
                            ``(iii) Any updates or modifications of 
                        internal policies and procedures of the entity 
                        as they relate to the duties of the entity 
                        under this section, including--
                                    ``(I) specifically identifying any 
                                modifications to the disclosure of 
                                interests and conflicts of interests 
                                for committees, work groups, task 
                                forces, and advisory panels of the 
                                entity; and
                                    ``(II) information on external 
                                stakeholder participation in the duties 
                                of the entity under this section 
                                (including complete rosters for all 
                                committees, work groups, task forces, 
                                and advisory panels funded through 
                                government contracts, descriptions of 
                                relevant interests and any conflicts of 
                                interest for members of all committees, 
                                work groups, task forces, and advisory 
                                panels, and the total percentage by 
                                health care sector of all convened 
                                committees, work groups, task forces, 
                                and advisory panels.''.
            (2) Effective date.--The amendments made by this subsection 
        shall apply to reports submitted for years beginning with 2018.
    (d) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        shall conduct a study on health care quality measurement 
        efforts funded under sections 1890 and 1890A of the Social 
        Security Act (42 U.S.C. 1395aaa; 1395aaa-1). Such study shall 
        include an examination of the following:
                    (A) The extent to which the Secretary of Health and 
                Human Services (in this subsection referred to as the 
                ``Secretary'') has set and prioritized objectives to be 
                achieved for each of the quality measurement activities 
                required under such sections 1890 and 1890A.
                    (B) The efforts that the Secretary has undertaken 
                to meet quality measurement objectives associated with 
                such sections 1890 and 1890A, including division of 
                responsibilities for those efforts within the 
                Department of Health and Human Services and through 
                contracts with a consensus-based entity under 
                subsection (a) of such section 1890 (in this subsection 
                referred to as the ``consensus-based entity'') and 
                other entities, and the extent of any overlap among the 
                work performed by the Secretary, the consensus-based 
                entity, the Measure Application Partnership (MAP) 
                convened by such entity to provide input to the 
                Secretary on the selection of quality and efficiency 
                measures, and any other entities the Secretary has 
                contracted with to perform work related to carrying out 
                such sections 1890 and 1890A.
                    (C) The total amount of mandatory funding provided 
                to the Secretary for purposes of carrying out such 
                sections 1890 and 1890A, the amount of such funding 
                that has been obligated by the Secretary, and the 
                amount of such funding that remains unobligated.
                    (D) How the obligated funds have been allocated, 
                including how much of the obligated funding has been 
                allocated for work performed by the Secretary, the 
                consensus-based entity, and any other entity the 
                Secretary has contracted with to perform work related 
                to carrying out such sections 1890 and 1890A, 
                respectively, and descriptions of such work.
                    (E) The extent to which the Secretary has developed 
                a comprehensive and long-term plan to ensure that it 
                can achieve quality measurement objectives related to 
                carrying out such sections 1890 and 1890A in a timely 
                manner and with efficient use of available resources, 
                including the roles of the consensus-based entity, the 
                Measure Application Partnership (MAP), and any other 
                entity the Secretary has contracted with to perform 
                work related to such sections 1890 and 1890A in helping 
                the Secretary achieve those objectives.
            (2) Report.--Not later than 18 months after the date of 
        enactment of this Act, the Comptroller General of the United 
        States shall submit to Congress a report containing the results 
        of the study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Comptroller General determines appropriate.

      TITLE II--ADDITIONAL MEDICARE POLICIES RELATING TO EXTENDERS

SEC. 2201. HOME HEALTH PAYMENT REFORM.

    (a) Budget Neutral Transition to a 30-day Unit of Payment for Home 
Health Services.--Section 1895(b) of the Social Security Act (42 U.S.C. 
1395fff(b)) is amended--
            (1) in paragraph (2)--
                    (A) by striking ``payment.--In defining'' and 
                inserting ``payment.--
                    ``(A) In general.--In defining''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(B) 30-day unit of service.--For purposes of 
                implementing the prospective payment system with 
                respect to home health units of service furnished 
                during a year beginning with 2020, the Secretary shall 
                apply a 30-day unit of service as the unit of service 
                applied under this paragraph.'';
            (2) in paragraph (3)--
                    (A) in subparagraph (A), by adding at the end the 
                following new clause:
                            ``(iv) Budget neutrality for 2020.--With 
                        respect to payments for home health units of 
                        service furnished that end during the 12-month 
                        period beginning January 1, 2020, the Secretary 
                        shall calculate a standard prospective payment 
                        amount (or amounts) for 30-day units of service 
                        (as described in paragraph (2)(B)) for the 
                        prospective payment system under this 
                        subsection. Such standard prospective payment 
                        amount (or amounts) shall be calculated in a 
                        manner such that the estimated aggregate amount 
                        of expenditures under the system during such 
                        period with application of paragraph (2)(B) is 
                        equal to the estimated aggregate amount of 
                        expenditures that otherwise would have been 
                        made under the system during such period if 
                        paragraph (2)(B) had not been enacted. The 
                        previous sentence shall be applied before (and 
                        not affect the application of) paragraph 
                        (3)(B). In calculating such amount (or 
                        amounts), the Secretary shall make assumptions 
                        about behavior changes that could occur as a 
                        result of the implementation of paragraph 
                        (2)(B) and the case-mix adjustment factors 
                        established under paragraph (4)(B) and shall 
                        provide a description of such assumptions in 
                        the notice and comment rulemaking used to 
                        implement this clause.''; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(D) Behavior assumptions and adjustments.--
                            ``(i) In general.--The Secretary shall 
                        annually determine the impact of differences 
                        between assumed behavior changes (as described 
                        in paragraph (3)(A)(iv)) and actual behavior 
                        changes on estimated aggregate expenditures 
                        under this subsection with respect to years 
                        beginning with 2020 and ending with 2026.
                            ``(ii) Permanent adjustments.--The 
                        Secretary shall, at a time and in a manner 
                        determined appropriate, through notice and 
                        comment rulemaking, provide for one or more 
                        permanent increases or decreases to the 
                        standard prospective payment amount (or 
                        amounts) for applicable years, on a prospective 
                        basis, to offset for such increases or 
                        decreases in estimated aggregate expenditures 
                        (as determined under clause (i)).
                            ``(iii) Temporary adjustments for 
                        retrospective behavior.--The Secretary shall, 
                        at a time and in a manner determined 
                        appropriate, through notice and comment 
                        rulemaking, provide for one or more temporary 
                        increases or decreases to the payment amount 
                        for a unit of home health services (as 
                        determined under paragraph (4)) for applicable 
                        years, on a prospective basis, to offset for 
                        such increases or decreases in estimated 
                        aggregate expenditures (as determined under 
                        clause (i)). Such a temporary increase or 
                        decrease shall apply only with respect to the 
                        year for which such temporary increase or 
                        decrease is made, and the Secretary shall not 
                        take into account such a temporary increase or 
                        decrease in computing such amount under this 
                        subsection for a subsequent year.''; and
            (3) in paragraph (4)(B)--
                    (A) by striking ``Factors.--The Secretary'' and 
                inserting ``Factors.--
                            ``(i) In general.--The Secretary''; and
                    (B) by adding at the end the following new clause:
                            ``(ii) Treatment of therapy thresholds.--
                        For 2020 and subsequent years, the Secretary 
                        shall eliminate the use of therapy thresholds 
                        (established by the Secretary) in case mix 
                        adjustment factors established under clause (i) 
                        for calculating payments under the prospective 
                        payment system under this subsection.''.
    (b) Technical Expert Panel.--
            (1) In general.--During the period beginning on January 1, 
        2018, and ending on December 31, 2018, the Secretary of Health 
        and Human Services shall hold at least one session of a 
        technical expert panel, the participants of which shall include 
        home health providers, patient representatives, and other 
        relevant stakeholders. The technical expert panel shall 
        identify and prioritize recommendations with respect to the 
        prospective payment system for home health services under 
        section 1895(b) of the Social Security Act (42 U.S.C. 
        1395fff(b)), on the following:
                    (A) The Home Health Groupings Model, as described 
                in the proposed rule ``Medicare and Medicaid Programs; 
                CY 2018 Home Health Prospective Payment System Rate 
                Update and Proposed CY 2019 Case-Mix Adjustment 
                Methodology Refinements; Home Health Value-Based 
                Purchasing Model; and Home Health Quality Reporting 
                Requirements'' (82 Fed. Reg. 35294 through 35332 (July 
                28, 2017)).
                    (B) Alternative case-mix models to the Home Health 
                Groupings Model that were submitted during 2017 as 
                comments in response to proposed rule making, including 
                patient-focused factors that consider the risks of 
                hospitalization and readmission to a hospital, 
                improvement or maintenance of functionality of 
                individuals to increase the capacity for self-care, 
                quality of care, and resource utilization.
            (2) Inapplicability of faca.--The provisions of the Federal 
        Advisory Committee Act (5 U.S.C. App.) shall not apply to the 
        technical expert panel under paragraph (1).
            (3) Report.--Not later than April 1, 2019, the Secretary of 
        Health and Human Services shall submit to the Committee on Ways 
        and Means and the Committee on Energy and Commerce of the House 
        of Representatives and the Committee on Finance of the Senate a 
        report on the recommendations of such panel described in such 
        paragraph.
            (4) Notice and comment rulemaking.--Not later than December 
        31, 2019, the Secretary of Health and Human Services shall 
        pursue notice and comment rulemaking on a case-mix system with 
        respect to the prospective payment system for home health 
        services under section 1895(b) of the Social Security Act (42 
        U.S.C. 1395fff(b)).
    (c) Reports.--
            (1) Interim report.--Not later than March 15, 2022, the 
        Medicare Payment Advisory Commission shall submit to Congress 
        an interim report on the application of a 30-day unit of 
        service as the unit of service applied under section 1895(b)(2) 
        of the Social Security Act (42 U.S.C. 1395fff(b)(2)), as 
        amended by subsection (a), including an analysis of the level 
        of payments provided to home health agencies as compared to the 
        cost of delivering home health services, and any unintended 
        consequences, including with respect to behavioral changes and 
        quality.
            (2) Final report.--Not later than March 15, 2026, such 
        Commission shall submit to Congress a final report on such 
        application and any such consequences.

SEC. 2202. INFORMATION TO SATISFY DOCUMENTATION OF MEDICARE ELIGIBILITY 
              FOR HOME HEALTH SERVICES.

    (a) Part A.--Section 1814(a) of the Social Security Act (42 U.S.C. 
1395f(a)) is amended by inserting before ``For purposes of paragraph 
(2)(C),'' the following new sentence: ``For purposes of documentation 
for physician certification and recertification made under paragraph 
(2) on or after January 1, 2019, and made with respect to home health 
services furnished by a home health agency, in addition to using 
documentation in the medical record of the physician who so certifies 
or the medical record of the acute or post-acute care facility (in the 
case that home health services were furnished to an individual who was 
directly admitted to the home health agency from such a facility), the 
Secretary may use documentation in the medical record of the home 
health agency as supporting material, as appropriate to the case 
involved.''.
    (b) Part B.--Section 1835(a) of the Social Security Act (42 U.S.C. 
1395n(a)) is amended by inserting before ``For purposes of paragraph 
(2)(A),'' the following new sentence: ``For purposes of documentation 
for physician certification and recertification made under paragraph 
(2) on or after January 1, 2019, and made with respect to home health 
services furnished by a home health agency, in addition to using 
documentation in the medical record of the physician who so certifies 
or the medical record of the acute or post-acute care facility (in the 
case that home health services were furnished to an individual who was 
directly admitted to the home health agency from such a facility), the 
Secretary may use documentation in the medical record of the home 
health agency as supporting material, as appropriate to the case 
involved.''.

SEC. 2203. VOLUNTARY SETTLEMENT OF HOME HEALTH CLAIMS.

    (a) Settlement Process for Home Health Claims.--
            (1) In general.--Not later than one year after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall establish a settlement process under which a 
        home health agency entitled to an eligible administrative 
        appeal has the option to enter into a settlement with the 
        Secretary that is reached in a manner consistent with the 
        succeeding paragraphs of this subsection.
            (2) Process and consideration of home health claims.--A 
        settlement under paragraph (1) with a home health agency that 
        is with respect to an eligible administrative appeal may only 
        be reached in accordance with the following process:
                    (A) A settlement under such paragraph with the home 
                health agency shall be with respect to all claims by 
                such agency, subject to paragraph (4), that, as of the 
                date of such settlement, are under an eligible 
                administrative appeal.
                    (B) For the duration of the settlement process with 
                such agency, an eligible administrative appeal that is 
                with respect to any such claim by such agency shall be 
                suspended.
                    (C) Under the settlement process, the Secretary 
                shall determine an aggregate amount to be paid to the 
                home health agency with respect to all claims by such 
                agency that are under an eligible administrative appeal 
                in the following manner:
                            (i) The Secretary shall, for purposes of 
                        applying clause (ii) with respect to all 
                        settlements under paragraph (1), select a 
                        percentage. In selecting such percentage, the 
                        Secretary shall consider the percentage used 
                        under the Centers for Medicare & Medicaid 
                        Services hospital appeals settlement that began 
                        on August 29, 2014.
                            (ii) The Secretary shall, with respect to 
                        each denied claim for such agency that is under 
                        an eligible administrative appeal, calculate an 
                        amount (referred to in this subparagraph as an 
                        ``individual claim amount'') by multiplying the 
                        net payable amount for such claim by the 
                        percentage selected under clause (i).
                            (iii) Such aggregate amount with respect to 
                        such agency shall be determined by calculating 
                        the total sum of all the individual claim 
                        amounts calculated under clause (ii) with 
                        respect to such agency.
            (3) Effect of process.--
                    (A) Effect of settlement.--
                            (i) Further appeal.--As part of any 
                        settlement under paragraph (1) between a home 
                        health agency and the Secretary, such home 
                        health agency shall be required to forego the 
                        right to an administrative appeal under section 
                        1869 of the Social Security Act (42 U.S.C. 
                        1395ff) or section 1878 of such Act (42 U.S.C. 
                        1395oo) (including any redetermination, 
                        reconsideration, hearing, or review) with 
                        respect to any claims for home health services 
                        that are subject to the settlement.
                            (ii) Judicial review.--There shall be no 
                        administrative or judicial review under such 
                        section 1869 or otherwise of a settlement under 
                        paragraph (1) and the claims covered by the 
                        settlement.
                    (B) Effect of no settlement.--In the event that the 
                process described in paragraph (2) does not, with 
                respect to a home health agency, result in a settlement 
                under paragraph (1) with such agency, any appeal under 
                such section 1869 that is with respect to a claim by 
                such agency that was suspended pursuant to paragraph 
                (2)(B) shall resume under such section.
            (4) Coordination with law enforcement.--The Secretary of 
        Health and Human Services shall establish a process to 
        coordinate with appropriate law enforcement agencies in order 
        to avoid the inadvertent settlement of cases that involve fraud 
        or other criminal activity.
    (b) No Entitlement to Settlement Process.--Nothing in this section 
shall be construed as creating an entitlement to enter into a 
settlement process established pursuant to subsection (a).
    (c) Eligible Administrative Appeal Defined.--For purposes of this 
section, the term ``eligible administrative appeal'' means an appeal 
under section 1869 of the Social Security Act (42 U.S.C. 1395ff) 
(including any redetermination, reconsideration, hearing, or review)--
            (1) that is with respect to one or more claims that--
                    (A) are for home health services that were 
                furnished on or after January 1, 2011, and before 
                January 1, 2015; and
                    (B) were timely filed consistent with section 
                1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) or 
                sections 1835(a)(1) and 1842(b)(3) of such Act (42 
                U.S.C. 1395n(a)(1), 1395u(b)(3)); and
            (2) either--
                    (A) was timely filed consistent with section 1869 
                of such Act (42 U.S.C. 1395ff) and is pending; or
                    (B) for which the applicable time frame to file an 
                appeal has not expired.
    (d) Conforming Amendment.--Section 1869 of the Social Security Act 
(42 U.S.C. 1395ff) is amended by adding at the end the following new 
subsection:
    ``(j) Application With Respect to Certain Home Health Claims.--For 
the application of the provisions of this section with respect to 
certain claims for home health services that were furnished on or after 
January 1, 2011, and before January 1, 2015, see section 106 of the 
Healthcare Extension, Reauthorization, and Opportunities Act of 
2017.''.

SEC. 2204. EXTENSION OF ENFORCEMENT INSTRUCTION ON MEDICARE SUPERVISION 
              REQUIREMENTS FOR OUTPATIENT THERAPEUTIC SERVICES IN 
              CRITICAL ACCESS AND SMALL RURAL HOSPITALS.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m) is 
amended by adding at the end the following new subsection:
    ``(v) Extension of Enforcement Instruction on Supervision 
Requirements for Outpatient Therapeutic Services in Critical Access and 
Small Rural Hospitals.--For calendar year 2017, the Secretary shall 
continue to apply the enforcement instruction described in the notice 
of the Centers for Medicare & Medicaid Services entitled `Enforcement 
Instruction on Supervision Requirements for Outpatient Therapeutic 
Services in Critical Access and Small Rural Hospitals for CY 2013', 
dated November 1, 2012 (providing for an exception to the restatement 
and clarification under the final rulemaking changes to the Medicare 
hospital outpatient prospective payment system and calendar year 2009 
payment rates (published in the Federal Register on November 18, 2008, 
73 Fed. Reg. 68702 through 68704) with respect to requirements for 
direct supervision by physicians for therapeutic hospital outpatient 
services), as previously extended under section 1 of Public Law 113-
198, as amended by section 1 of Public Law 114-112 and section 16004(a) 
of the 21st Century Cures Act (Public Law 114-255).''.

SEC. 2205. TECHNICAL AMENDMENTS TO PUBLIC LAW 114-10.

    (a) MIPS Transition.--Section 1848 of the Social Security Act (42 
U.S.C. 1395w-4) is amended--
            (1) in subsection (q)--
                    (A) in paragraph (1)--
                            (i) in subparagraph (B), by striking 
                        ``items and services'' and inserting ``covered 
                        professional services (as defined in subsection 
                        (k)(3)(A))''; and
                            (ii) in subparagraph (C)(iv)--
                                    (I) by amending subclause (I) to 
                                read as follows:
                                    ``(I) The minimum number (as 
                                determined by the Secretary) of--
                                            ``(aa) for performance 
                                        periods beginning before 
                                        January 1, 2018, individuals 
                                        enrolled under this part who 
                                        are treated by the eligible 
                                        professional for the 
                                        performance period involved; 
                                        and
                                            ``(bb) for performance 
                                        periods beginning on or after 
                                        January 1, 2018, individuals 
                                        enrolled under this part who 
                                        are furnished covered 
                                        professional services (as 
                                        defined in subsection 
                                        (k)(3)(A)) by the eligible 
                                        professional for the 
                                        performance period involved.'';
                                    (II) in subclause (II), by striking 
                                ``items and services'' and inserting 
                                ``covered professional services (as 
                                defined in subsection (k)(3)(A))''; and
                                    (III) by amending subclause (III) 
                                to read as follows:
                                    ``(III) The minimum amount (as 
                                determined by the Secretary) of--
                                            ``(aa) for performance 
                                        periods beginning before 
                                        January 1, 2018, allowed 
                                        charges billed by such 
                                        professional under this part 
                                        for such performance period; 
                                        and
                                            ``(bb) for performance 
                                        periods beginning on or after 
                                        January 1, 2018, allowed 
                                        charges for covered 
                                        professional services (as 
                                        defined in subsection 
                                        (k)(3)(A)) billed by such 
                                        professional for such 
                                        performance period.'';
                    (B) in paragraph (5)(D)--
                            (i) in clause (i)(I), by inserting 
                        ``subject to clause (iii),'' after ``clauses 
                        (i) and (ii) of paragraph (2)(A),''; and
                            (ii) by adding at the end the following new 
                        clause:
                            ``(iii) Transition years.--For each of the 
                        second, third, fourth, and fifth years for 
                        which the MIPS applies to payments, the 
                        performance score for the performance category 
                        described in paragraph (2)(A)(ii) shall not 
                        take into account the improvement of the 
                        professional involved.'';
                    (C) in paragraph (5)(E)--
                            (i) in clause (i)(I)(bb)--
                                    (I) in the heading by striking 
                                ``First 2 years'' and inserting ``First 
                                5 years''; and
                                    (II) by striking ``the first and 
                                second years'' and inserting ``each of 
                                the first through fifth years'';
                            (ii) in clause (i)(II)(bb)--
                                    (I) in the heading, by striking ``2 
                                years'' and inserting ``5 years''; and
                                    (II) by striking the second 
                                sentence and inserting the following 
                                new sentences: ``For each of the 
                                second, third, fourth, and fifth years 
                                for which the MIPS applies to payments, 
                                not less than 10 percent and not more 
                                than 30 percent of such score shall be 
                                based on performance with respect to 
                                the category described in clause (ii) 
                                of paragraph (2)(A). Nothing in the 
                                previous sentence shall be construed, 
                                with respect to a performance period 
                                for a year described in the previous 
                                sentence, as preventing the Secretary 
                                from basing 30 percent of such score 
                                for such year with respect to the 
                                category described in such clause (ii), 
                                if the Secretary determines, based on 
                                information posted under subsection 
                                (r)(2)(I) that sufficient resource use 
                                measures are ready for adoption for use 
                                under the performance category under 
                                paragraph (2)(A)(ii) for such 
                                performance period.'';
                    (D) in paragraph (6)(D)--
                            (i) in clause (i), in the second sentence, 
                        by striking ``Such performance threshold'' and 
                        inserting ``Subject to clauses (iii) and (iv), 
                        such performance threshold'';
                            (ii) in clause (ii)--
                                    (I) in the first sentence, by 
                                inserting ``(beginning with 2019 and 
                                ending with 2024)'' after ``for each 
                                year of the MIPS''; and
                                    (II) in the second sentence, by 
                                inserting ``subject to clause (iii),'' 
                                after ``For each such year,'';
                            (iii) in clause (iii)--
                                    (I) in the heading, by striking 
                                ``2'' and inserting ``5''; and
                                    (II) in the first sentence, by 
                                striking ``two years'' and inserting 
                                ``five years''; and
                            (iv) by adding at the end the following new 
                        clause:
                            ``(iv) Additional special rule for third, 
                        fourth and fifth years of mips.--For purposes 
                        of determining MIPS adjustment factors under 
                        subparagraph (A), in addition to the 
                        requirements specified in clause (iii), the 
                        Secretary shall increase the performance 
                        threshold with respect to each of the third, 
                        fourth, and fifth years to which the MIPS 
                        applies to ensure a gradual and incremental 
                        transition to the performance threshold 
                        described in clause (i) (as estimated by the 
                        Secretary) with respect to the sixth year to 
                        which the MIPS applies.'';
                    (E) in paragraph (6)(E)--
                            (i) by striking ``In the case of items and 
                        services'' and inserting ``In the case of 
                        covered professional services (as defined in 
                        subsection (k)(3)(A))''; and
                            (ii) by striking ``under this part with 
                        respect to such items and services'' and 
                        inserting ``under this part with respect to 
                        such covered professional services''; and
                    (F) in paragraph (7), in the first sentence, by 
                striking ``items and services'' and inserting ``covered 
                professional services (as defined in subsection 
                (k)(3)(A))'';
            (2) in subsection (r)(2), by adding at the end the 
        following new subparagraph:
                    ``(I) Information.--The Secretary shall, not later 
                than December 31st of each year (beginning with 2018), 
                post on the Internet website of the Centers for 
                Medicare & Medicaid Services information on resource 
                use measures in use under subsection (q), resource use 
                measures under development and the time-frame for such 
                development, potential future resource use measure 
                topics, a description of stakeholder engagement, and 
                the percent of expenditures under part A and this part 
                that are covered by resource use measures.''; and
            (3) in subsection (s)(5)(B), by striking ``section 
        1833(z)(2)(C)'' and inserting ``section 1833(z)(3)(D)''.
    (b) Physician-focused Payment Model Technical Advisory Committee 
Provision of Initial Proposal Feedback.--Section 1868(c)(2)(C) of the 
Social Security Act (42 U.S.C. 1395ee(c)(2)(C)) is amended to read as 
follows:
                    ``(C) Committee review of models submitted.--The 
                Committee, on a periodic basis--
                            ``(i) shall review models submitted under 
                        subparagraph (B);
                            ``(ii) may provide individuals and 
                        stakeholder entities who submitted such models 
                        with--
                                    ``(I) initial feedback on such 
                                models regarding the extent to which 
                                such models meet the criteria described 
                                in subparagraph (A); and
                                    ``(II) an explanation of the basis 
                                for the feedback provided under 
                                subclause (I); and
                            ``(iii) shall prepare comments and 
                        recommendations regarding whether such models 
                        meet the criteria described in subparagraph (A) 
                        and submit such comments and recommendations to 
                        the Secretary.''.

SEC. 2206. REVISED REQUIREMENTS FOR MEDICARE INTENSIVE CARDIAC 
              REHABILITATION PROGRAMS.

    (a) In General.--Section 1861(eee)(4)(B) of the Social Security Act 
(42 U.S.C. 1395x(eee)(4)(B)) is amended--
            (1) in clause (v), by striking ``or'' at the end;
            (2) in clause (vi), by striking the period at the end and 
        inserting a semicolon; and
            (3) by adding at the end the following new clauses:
                    ``(vii) stable, chronic heart failure (defined as 
                patients with left ventricular ejection fraction of 35 
                percent or less and New York Heart Association (NYHA) 
                class II to IV symptoms despite being on optimal heart 
                failure therapy for at least 6 weeks); or
                    ``(viii) any additional condition for which the 
                Secretary has determined that a cardiac rehabilitation 
                program shall be covered, unless the Secretary 
                determines, using the same process used to determine 
                that the condition is covered for a cardiac 
                rehabilitation program, that such coverage is not 
                supported by the clinical evidence.''.
    (b) Ensuring Future Supervision Level Parity With Cardiac 
Rehabilitation Programs.--Section 1861(eee)(4)(A) of the Social 
Security Act (42 U.S.C. 1395x(eee)(4)(A)) is amended, in the matter 
preceding clause (i), by striking ``physician-supervised program (as 
described in paragraph (2))'' and inserting ``program (supervised as 
described in paragraph (2))''.

  TITLE III--CREATING HIGH-QUALITY RESULTS AND OUTCOMES NECESSARY TO 
                     IMPROVE CHRONIC (CHRONIC) CARE

          Subtitle A--Receiving High Quality Care in the Home

SEC. 2301. EXTENDING THE INDEPENDENCE AT HOME DEMONSTRATION PROGRAM.

    (a) In General.--Section 1866E of the Social Security Act (42 
U.S.C. 1395cc-5) is amended--
            (1) in subsection (e)--
                    (A) in paragraph (1)--
                            (i) by striking ``An agreement'' and 
                        inserting ``Agreements''; and
                            (ii) by striking ``5-year'' and inserting 
                        ``7-year''; and
                    (B) in paragraph (5)--
                            (i) by striking ``10,000'' and inserting 
                        ``15,000''; and
                            (ii) by adding at the end the following new 
                        sentence: ``An applicable beneficiary that 
                        participates in the demonstration program by 
                        reason of the increase from 10,000 to 15,000 in 
                        the preceding sentence pursuant to the 
                        amendment made by section 2301(a)(1)(B) of the 
                        SUSTAIN Care Act of 2018 shall be considered in 
                        the spending target estimates under paragraph 
                        (1) of subsection (c) and the incentive payment 
                        calculations under paragraph (2) of such 
                        subsection for the sixth and seventh years of 
                        such program.'';
            (2) in subsection (g), in the first sentence, by inserting 
        ``, including, to the extent practicable, with respect to the 
        use of electronic health information systems, as described in 
        subsection (b)(1)(A)(vi)'' after ``under the demonstration 
        program''; and
            (3) in subsection (i)(1)(A), by striking ``will not receive 
        an incentive payment for the second of 2'' and inserting ``did 
        not achieve savings for the third of 3''.
    (b) Effective Date.--The amendment made by subsection (a)(3) shall 
take effect as if included in the enactment of Public Law 111-148.

SEC. 2302. EXPANDING ACCESS TO HOME DIALYSIS THERAPY.

    (a) In General.--Section 1881(b)(3) of the Social Security Act (42 
U.S.C. 1395rr(b)(3)) is amended--
            (1) by redesignating subparagraphs (A) and (B) as clauses 
        (i) and (ii), respectively;
            (2) in clause (ii), as redesignated by paragraph (1), by 
        striking ``on a comprehensive'' and insert ``subject to 
        subparagraph (B), on a comprehensive'';
            (3) by striking ``With respect to'' and inserting ``(A) 
        With respect to''; and
            (4) by adding at the end the following new subparagraph:
    ``(B)(i) For purposes of subparagraph (A)(ii), subject to clause 
(ii), an individual determined to have end stage renal disease 
receiving home dialysis may choose to receive monthly end stage renal 
disease-related clinical assessments furnished on or after January 1, 
2019, via telehealth.
    ``(ii) Clause (i) shall apply to an individual only if the 
individual receives a face-to-face clinical assessment, without the use 
of telehealth--
            ``(I) in the case of the initial 3 months of home dialysis 
        of such individual, at least monthly; and
            ``(II) after such initial 3 months, at least once every 3 
        consecutive months.''.
    (b) Originating Site Requirements.--
            (1) In general.--Section 1834(m) of the Social Security Act 
        (42 U.S.C. 1395m(m)) is amended--
                    (A) in paragraph (4)(C)(ii), by adding at the end 
                the following new subclauses:
                                    ``(IX) A renal dialysis facility, 
                                but only for purposes of section 
                                1881(b)(3)(B).
                                    ``(X) The home of an individual, 
                                but only for purposes of section 
                                1881(b)(3)(B).''; and
                    (B) by adding at the end the following new 
                paragraph:
            ``(5) Treatment of home dialysis monthly esrd-related 
        visit.--The geographic requirements described in paragraph 
        (4)(C)(i) shall not apply with respect to telehealth services 
        furnished on or after January 1, 2019, for purposes of section 
        1881(b)(3)(B), at an originating site described in subclause 
        (VI), (IX), or (X) of paragraph (4)(C)(ii).''.
            (2) No facility fee if originating site for home dialysis 
        therapy is the home.--Section 1834(m)(2)(B) of the Social 
        Security (42 U.S.C. 1395m(m)(2)(B)) is amended--
                    (A) by redesignating clauses (i) and (ii) as 
                subclauses (I) and (II), and indenting appropriately;
                    (B) in subclause (II), as redesignated by 
                subparagraph (A), by striking ``clause (i) or this 
                clause'' and inserting ``subclause (I) or this 
                subclause'';
                    (C) by striking ``site.--With respect to'' and 
                inserting ``site.--
                            ``(i) In general.--Subject to clause (ii), 
                        with respect to''; and
                    (D) by adding at the end the following new clause:
                            ``(ii) No facility fee if originating site 
                        for home dialysis therapy is the home.--No 
                        facility fee shall be paid under this 
                        subparagraph to an originating site described 
                        in paragraph (4)(C)(ii)(X).''.
    (c) Clarification Regarding Telehealth Provided to Beneficiaries.--
Section 1128A(i)(6) of the Social Security Act (42 U.S.C. 1320a-
7a(i)(6)) is amended--
            (1) in subparagraph (H), by striking ``or'' at the end;
            (2) in subparagraph (I), by striking the period at the end 
        and inserting ``; or''; and
            (3) by adding at the end the following new subparagraph:
                    ``(J) the provision of telehealth technologies (as 
                defined by the Secretary) on or after January 1, 2019, 
                by a provider of services or a renal dialysis facility 
                (as such terms are defined for purposes of title XVIII) 
                to an individual with end stage renal disease who is 
                receiving home dialysis for which payment is being made 
                under part B of such title, if--
                            ``(i) the telehealth technologies are not 
                        offered as part of any advertisement or 
                        solicitation;
                            ``(ii) the telehealth technologies are 
                        provided for the purpose of furnishing 
                        telehealth services related to the individual's 
                        end stage renal disease; and
                            ``(iii) the provision of the telehealth 
                        technologies meets any other requirements set 
                        forth in regulations promulgated by the 
                        Secretary.''.
    (d) Conforming Amendment.--Section 1881(b)(1) of the Social 
Security Act (42 U.S.C. 1395rr(b)(1)) is amended by striking 
``paragraph (3)(A)'' and inserting ``paragraph (3)(A)(i)''.

            Subtitle B--Expanding Innovation and Technology

SEC. 2311. ADAPTING BENEFITS TO MEET THE NEEDS OF CHRONICALLY ILL 
              MEDICARE ADVANTAGE ENROLLEES.

    Section 1859 of the Social Security Act (42 U.S.C. 1395w-28) is 
amended by adding at the end the following new subsection:
    ``(h) National Testing of Medicare Advantage Value-Based Insurance 
Design Model.--
            ``(1) In general.--In implementing the Medicare Advantage 
        Value-Based Insurance Design model that is being tested under 
        section 1115A(b), the Secretary shall revise the testing of the 
        model under such section to cover, effective not later than 
        January 1, 2020, all States.
            ``(2) Termination and modification provision not applicable 
        until january 1, 2022.--The provisions of section 
        1115A(b)(3)(B) shall apply to the Medicare Advantage Value-
        Based Insurance Design model, including such model as revised 
        under paragraph (1), beginning January 1, 2022, but shall not 
        apply to such model, as so revised, prior to such date.
            ``(3) Funding.--The Secretary shall allocate funds made 
        available under section 1115A(f)(1) to design, implement, and 
        evaluate the Medicare Advantage Value-Based Insurance Design 
        model, as revised under paragraph (1).''.

SEC. 2312. EXPANDING SUPPLEMENTAL BENEFITS TO MEET THE NEEDS OF 
              CHRONICALLY ILL MEDICARE ADVANTAGE ENROLLEES.

    (a) In General.--Section 1852(a)(3) of the Social Security Act (42 
U.S.C. 1395w-22(a)(3)) is amended--
            (1) in subparagraph (A), by striking ``Each'' and inserting 
        ``Subject to subparagraph (D), each''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Expanding supplemental benefits to meet the 
                needs of chronically ill enrollees.--
                            ``(i) In general.--For plan year 2020 and 
                        subsequent plan years, in addition to any 
                        supplemental health care benefits otherwise 
                        provided under this paragraph, an MA plan, 
                        including a specialized MA plan for special 
                        needs individuals (as defined in section 
                        1859(b)(6)), may provide supplemental benefits 
                        described in clause (ii) to a chronically ill 
                        enrollee (as defined in clause (iii)).
                            ``(ii) Supplemental benefits described.--
                                    ``(I) In general.--Supplemental 
                                benefits described in this clause are 
                                supplemental benefits that, with 
                                respect to a chronically ill enrollee, 
                                have a reasonable expectation of 
                                improving or maintaining the health or 
                                overall function of the chronically ill 
                                enrollee and may not be limited to 
                                being primarily health related 
                                benefits.
                                    ``(II) Authority to waive 
                                uniformity requirements.--The Secretary 
                                may, only with respect to supplemental 
                                benefits provided to a chronically ill 
                                enrollee under this subparagraph, waive 
                                the uniformity requirements under this 
                                part, as determined appropriate by the 
                                Secretary.
                            ``(iii) Chronically ill enrollee defined.--
                        In this subparagraph, the term `chronically ill 
                        enrollee' means an enrollee in an MA plan that 
                        the Secretary determines--
                                    ``(I) has one or more comorbid and 
                                medically complex chronic conditions 
                                that is life threatening or 
                                significantly limits the overall health 
                                or function of the enrollee;
                                    ``(II) has a high risk of 
                                hospitalization or other adverse health 
                                outcomes; and
                                    ``(III) requires intensive care 
                                coordination.''.
    (b) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on supplemental benefits provided to 
        enrollees in Medicare Advantage plans under part C of title 
        XVIII of the Social Security Act, including specialized MA 
        plans for special needs individuals (as defined in section 
        1859(b)(6) of such Act (42 U.S.C. 1395w-28(b)(6))). To the 
        extend data are available, such study shall include an analysis 
        of the following:
                    (A) The type of supplemental benefits provided to 
                such enrollees, the total number of enrollees receiving 
                each supplemental benefit, and whether the supplemental 
                benefit is covered by the standard benchmark cost of 
                the benefit or with an additional premium.
                    (B) The frequency in which supplemental benefits 
                are utilized by such enrollees.
                    (C) The impact supplemental benefits have on--
                            (i) indicators of the quality of care 
                        received by such enrollees, including overall 
                        health and function of the enrollees;
                            (ii) the utilization of items and services 
                        for which benefits are available under the 
                        original Medicare fee-for-service program 
                        option under parts A and B of such title XVIII 
                        by such enrollees; and
                            (iii) the amount of the bids submitted by 
                        Medicare Advantage Organizations for Medicare 
                        Advantage plans under such part C.
            (2) Consultation.--In conducting the study under paragraph 
        (1), the Comptroller General shall, as necessary, consult with 
        the Centers for Medicare & Medicaid Services and Medicare 
        Advantage organizations offering Medicare Advantage plans.
            (3) Report.--Not later than 5 years after the date of the 
        enactment of this Act, the Comptroller General shall submit to 
        Congress a report containing the results of the study conducted 
        under paragraph (1), together with recommendations for such 
        legislation and administrative action as the Comptroller 
        General determines appropriate.

SEC. 2313. INCREASING CONVENIENCE FOR MEDICARE ADVANTAGE ENROLLEES 
              THROUGH TELEHEALTH.

    (a) In General.--Section 1852 of the Social Security Act (42 U.S.C. 
1395w-22) is amended--
            (1) in subsection (a)(1)(B)(i), by inserting ``, subject to 
        subsection (m),'' after ``means''; and
            (2) by adding at the end the following new subsection:
    ``(m) Provision of Additional Telehealth Benefits.--
            ``(1) MA plan option.--For plan year 2020 and subsequent 
        plan years, subject to the requirements of paragraph (3), an MA 
        plan may provide additional telehealth benefits (as defined in 
        paragraph (2)) to individuals enrolled under this part.
            ``(2) Additional telehealth benefits defined.--
                    ``(A) In general.--For purposes of this subsection 
                and section 1854:
                            ``(i) Definition.--The term `additional 
                        telehealth benefits' means services--
                                    ``(I) for which benefits are 
                                available under part B, including 
                                services for which payment is not made 
                                under section 1834(m) due to the 
                                conditions for payment under such 
                                section; and
                                    ``(II) that are identified for the 
                                year involved by the Secretary as 
                                clinically appropriate to furnish using 
                                electronic information and 
                                telecommunications technology when a 
                                physician (as defined in section 
                                1861(r)) or practitioner (described in 
                                section 1842(b)(18)(C)) providing the 
                                service is not at the same location as 
                                the plan enrollee.
                            ``(ii) Exclusion of capital and 
                        infrastructure costs and investments.--The term 
                        `additional telehealth benefits' does not 
                        include capital and infrastructure costs and 
                        investments relating to such benefits.
                    ``(B) Public comment.--Not later than November 30, 
                2018, the Secretary shall solicit comments on--
                            ``(i) what types of items and services 
                        (including those provided through supplemental 
                        health care benefits, such as remote patient 
                        monitoring, secure messaging, store and forward 
                        technologies, and other non-face-to-face 
                        communication) should be considered to be 
                        additional telehealth benefits; and
                            ``(ii) the requirements for the provision 
                        or furnishing of such benefits (such as 
                        licensure, training, and coordination 
                        requirements).
            ``(3) Requirements for additional telehealth benefits.--The 
        Secretary shall specify requirements for the provision or 
        furnishing of additional telehealth benefits, including with 
        respect to the following:
                    ``(A) Physician or practitioner qualifications 
                (other than licensure) and other requirements such as 
                specific training.
                    ``(B) Factors necessary for the coordination of 
                such benefits with other items and services, including 
                those furnished in-person.
                    ``(C) Such other areas as determined by the 
                Secretary.
            ``(4) Enrollee choice.--If an MA plan provides a service as 
        an additional telehealth benefit (as defined in paragraph 
        (2))--
                    ``(A) the MA plan shall also provide access to such 
                benefit through an in-person visit (and not only as an 
                additional telehealth benefit); and
                    ``(B) an individual enrollee shall have discretion 
                as to whether to receive such service through the in-
                person visit or as an additional telehealth benefit.
            ``(5) Treatment under ma.--For purposes of this subsection 
        and section 1854, if a plan provides additional telehealth 
        benefits, such additional telehealth benefits shall be treated 
        as if they were benefits under the original Medicare fee-for-
        service program option.
            ``(6) Construction.--Nothing in this subsection shall be 
        construed as affecting the requirement under subsection (a)(1) 
        that MA plans provide enrollees with items and services (other 
        than hospice care) for which benefits are available under parts 
        A and B, including benefits available under section 1834(m).''.
    (b) Clarification Regarding Inclusion in Bid Amount.--Section 
1854(a)(6)(A)(ii)(I) of the Social Security Act (42 U.S.C. 1395w-
24(a)(6)(A)(ii)(I)) is amended by inserting ``, including, for plan 
year 2020 and subsequent plan years, the provision of additional 
telehealth benefits as described in section 1852(m)'' before the 
semicolon at the end.

SEC. 2314. PROVIDING ACCOUNTABLE CARE ORGANIZATIONS THE ABILITY TO 
              EXPAND THE USE OF TELEHEALTH.

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj) is amended by adding at the end the following new subsection:
    ``(l) Providing ACOs the Ability To Expand the Use of Telehealth 
Services.--
            ``(1) In general.--In the case of telehealth services for 
        which payment would otherwise be made under this title 
        furnished on or after January 1, 2020, for purposes of this 
        subsection only, the following shall apply with respect to such 
        services furnished by a physician or practitioner participating 
        in an applicable ACO (as defined in paragraph (2)) to a 
        Medicare fee-for-service beneficiary assigned to the applicable 
        ACO:
                    ``(A) Inclusion of home as originating site.--
                Subject to paragraph (3), the home of a beneficiary 
                shall be treated as an originating site described in 
                section 1834(m)(4)(C)(ii).
                    ``(B) No application of geographic limitation.--The 
                geographic limitation under section 1834(m)(4)(C)(i) 
                shall not apply with respect to an originating site 
                described in section 1834(m)(4)(C)(ii) (including the 
                home of a beneficiary under subparagraph (A)), subject 
                to State licensing requirements.
            ``(2) Definitions.--In this subsection:
                    ``(A) Applicable aco.--The term `applicable ACO' 
                means an ACO participating in a model tested or 
                expanded under section 1115A or under this section--
                            ``(i) that operates under a two-sided 
                        model--
                                    ``(I) described in section 
                                425.600(a) of title 42, Code of Federal 
                                Regulations; or
                                    ``(II) tested or expanded under 
                                section 1115A; and
                            ``(ii) for which Medicare fee-for-service 
                        beneficiaries are assigned to the ACO using a 
                        prospective assignment method, as determined 
                        appropriate by the Secretary.
                    ``(B) Home.--The term `home' means, with respect to 
                a Medicare fee-for-service beneficiary, the place of 
                residence used as the home of the beneficiary.
            ``(3) Telehealth services received in the home.--In the 
        case of telehealth services described in paragraph (1) where 
        the home of a Medicare fee-for-service beneficiary is the 
        originating site, the following shall apply:
                    ``(A) No facility fee.--There shall be no facility 
                fee paid to the originating site under section 
                1834(m)(2)(B).
                    ``(B) Exclusion of certain services.--No payment 
                may be made for such services that are inappropriate to 
                furnish in the home setting such as services that are 
                typically furnished in inpatient settings such as a 
                hospital.''.
    (b) Study and Report.--
            (1) Study.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this subsection referred to as the 
                ``Secretary'') shall conduct a study on the 
                implementation of section 1899(l) of the Social 
                Security Act, as added by subsection (a). Such study 
                shall include an analysis of the utilization of, and 
                expenditures for, telehealth services under such 
                section.
                    (B) Collection of data.--The Secretary may collect 
                such data as the Secretary determines necessary to 
                carry out the study under this paragraph.
            (2) Report.--Not later than January 1, 2026, the Secretary 
        shall submit to Congress a report containing the results of the 
        study conducted under paragraph (1), together with 
        recommendations for such legislation and administrative action 
        as the Secretary determines appropriate.

SEC. 2315. EXPANDING THE USE OF TELEHEALTH FOR INDIVIDUALS WITH STROKE.

    Section 1834(m) of the Social Security Act (42 U.S.C. 1395m(m)), as 
amended by section 2302(b), is amended--
            (1) in paragraph (4)(C)(i), in the matter preceding 
        subclause (I), by striking ``The term'' and inserting ``Except 
        as provided in paragraph (6), the term''; and
            (2) by adding at the end the following new paragraph:
            ``(6) Treatment of stroke telehealth services.--
                    ``(A) Non-application of originating site 
                requirements.--The requirements described in paragraph 
                (4)(C) shall not apply with respect to telehealth 
                services furnished on or after January 1, 2021, for 
                purposes of diagnosis, evaluation, or treatment of 
                symptoms of an acute stroke, as determined by the 
                Secretary.
                    ``(B) Inclusion of certain sites.--With respect to 
                telehealth services described in subparagraph (A), the 
                term `originating site' shall include any hospital (as 
                defined in section 1861(e)) or critical access hospital 
                (as defined in section 1861(mm)(1)), any mobile stroke 
                unit (as defined by the Secretary), or any other site 
                determined appropriate by the Secretary, at which the 
                eligible telehealth individual is located at the time 
                the service is furnished via a telecommunications 
                system.
                    ``(C) No originating site facility fee for new 
                sites.--No facility fee shall be paid under paragraph 
                (2)(B) to an originating site with respect to a 
                telehealth service described in subparagraph (A) if the 
                originating site does not otherwise meet the 
                requirements for an originating site under paragraph 
                (4)(C).''.

         Subtitle C--Identifying the Chronically Ill Population

SEC. 2321. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO BE PART OF AN 
              ACCOUNTABLE CARE ORGANIZATION.

    Section 1899(c) of the Social Security Act (42 U.S.C. 1395jjj(c)) 
is amended--
            (1) by redesignating paragraphs (1) and (2) as 
        subparagraphs (A) and (B), respectively, and indenting 
        appropriately;
            (2) by striking ``ACOs.--The Secretary'' and inserting 
        ``ACOs.--
            ``(1) In general.--Subject to paragraph (2), the 
        Secretary''; and
            (3) by adding at the end the following new paragraph:
            ``(2) Providing flexibility.--
                    ``(A) Choice of prospective assignment.--For each 
                agreement period (effective for agreements entered into 
                or renewed on or after January 1, 2020), in the case 
                where an ACO established under the program is in a 
                Track that provides for the retrospective assignment of 
                Medicare fee-for-service beneficiaries to the ACO, the 
                Secretary shall permit the ACO to choose to have 
                Medicare fee-for-service beneficiaries assigned 
                prospectively, rather than retrospectively, to the ACO 
                for an agreement period.
                    ``(B) Assignment based on voluntary identification 
                by medicare fee-for-service beneficiaries.--
                            ``(i) In general.--For performance year 
                        2018 and each subsequent performance year, if a 
                        system is available for electronic designation, 
                        the Secretary shall permit a Medicare fee-for-
                        service beneficiary to voluntarily identify an 
                        ACO professional as the primary care provider 
                        of the beneficiary for purposes of assigning 
                        such beneficiary to an ACO, as determined by 
                        the Secretary.
                            ``(ii) Notification process.--The Secretary 
                        shall establish a process under which a 
                        Medicare fee-for-service beneficiary is--
                                    ``(I) notified of their ability to 
                                make an identification described in 
                                clause (i); and
                                    ``(II) informed of the process by 
                                which they may make and change such 
                                identification.
                            ``(iii) Superseding claims-based 
                        assignment.--A voluntary identification by a 
                        Medicare fee-for-service beneficiary under this 
                        subparagraph shall supersede any claims-based 
                        assignment otherwise determined by the 
                        Secretary.''.

   Subtitle D--Empowering Individuals and Caregivers in Care Delivery

SEC. 2331. ELIMINATING BARRIERS TO CARE COORDINATION UNDER ACCOUNTABLE 
              CARE ORGANIZATIONS.

    (a) In General.--Section 1899 of the Social Security Act (42 U.S.C. 
1395jjj), as amended by section 2314(a), is amended--
            (1) in subsection (b)(2), by adding at the end the 
        following new subparagraph:
                    ``(I) An ACO that seeks to operate an ACO 
                Beneficiary Incentive Program pursuant to subsection 
                (m) shall apply to the Secretary at such time, in such 
                manner, and with such information as the Secretary may 
                require.'';
            (2) by adding at the end the following new subsection:
    ``(m) Authority To Provide Incentive Payments to Beneficiaries With 
Respect to Qualifying Primary Care Services.--
            ``(1) Program.--
                    ``(A) In general.--In order to encourage Medicare 
                fee-for-service beneficiaries to obtain medically 
                necessary primary care services, an ACO participating 
                under this section under a payment model described in 
                clause (i) or (ii) of paragraph (2)(B) may apply to 
                establish an ACO Beneficiary Incentive Program to 
                provide incentive payments to such beneficiaries who 
                are furnished qualifying services in accordance with 
                this subsection. The Secretary shall permit such an ACO 
                to establish such a program at the Secretary's 
                discretion and subject to such requirements, including 
                program integrity requirements, as the Secretary 
                determines necessary.
                    ``(B) Implementation.--The Secretary shall 
                implement this subsection on a date determined 
                appropriate by the Secretary. Such date shall be no 
                earlier than January 1, 2019, and no later than January 
                1, 2020.
            ``(2) Conduct of program.--
                    ``(A) Duration.--Subject to subparagraph (H), an 
                ACO Beneficiary Incentive Program established under 
                this subsection shall be conducted for such period (of 
                not less than 1 year) as the Secretary may approve.
                    ``(B) Scope.--An ACO Beneficiary Incentive Program 
                established under this subsection shall provide 
                incentive payments to all of the following Medicare 
                fee-for-service beneficiaries who are furnished 
                qualifying services by the ACO:
                            ``(i) With respect to the Track 2 and Track 
                        3 payment models described in section 
                        425.600(a) of title 42, Code of Federal 
                        Regulations (or in any successor regulation), 
                        Medicare fee-for-service beneficiaries who are 
                        preliminarily prospectively or prospectively 
                        assigned (or otherwise assigned, as determined 
                        by the Secretary) to the ACO.
                            ``(ii) With respect to any future payment 
                        models involving two-sided risk, Medicare fee-
                        for-service beneficiaries who are assigned to 
                        the ACO, as determined by the Secretary.
                    ``(C) Qualifying service.--For purposes of this 
                subsection, a qualifying service is a primary care 
                service, as defined in section 425.20 of title 42, Code 
                of Federal Regulations (or in any successor 
                regulation), with respect to which coinsurance applies 
                under part B, furnished through an ACO by--
                            ``(i) an ACO professional described in 
                        subsection (h)(1)(A) who has a primary care 
                        specialty designation included in the 
                        definition of primary care physician under 
                        section 425.20 of title 42, Code of Federal 
                        Regulations (or any successor regulation);
                            ``(ii) an ACO professional described in 
                        subsection (h)(1)(B); or
                            ``(iii) a Federally qualified health center 
                        or rural health clinic (as such terms are 
                        defined in section 1861(aa)).
                    ``(D) Incentive payments.--An incentive payment 
                made by an ACO pursuant to an ACO Beneficiary Incentive 
                Program established under this subsection shall be--
                            ``(i) in an amount up to $20, with such 
                        maximum amount updated annually by the 
                        percentage increase in the consumer price index 
                        for all urban consumers (United States city 
                        average) for the 12-month period ending with 
                        June of the previous year;
                            ``(ii) in the same amount for each Medicare 
                        fee-for-service beneficiary described in clause 
                        (i) or (ii) of subparagraph (B) without regard 
                        to enrollment of such a beneficiary in a 
                        medicare supplemental policy (described in 
                        section 1882(g)(1)), in a State Medicaid plan 
                        under title XIX or a waiver of such a plan, or 
                        in any other health insurance policy or health 
                        benefit plan;
                            ``(iii) made for each qualifying service 
                        furnished to such a beneficiary described in 
                        clause (i) or (ii) of subparagraph (B) during a 
                        period specified by the Secretary; and
                            ``(iv) made no later than 30 days after a 
                        qualifying service is furnished to such a 
                        beneficiary described in clause (i) or (ii) of 
                        subparagraph (B).
                    ``(E) No separate payments from the secretary.--The 
                Secretary shall not make any separate payment to an ACO 
                for the costs, including incentive payments, of 
                carrying out an ACO Beneficiary Incentive Program 
                established under this subsection. Nothing in this 
                subparagraph shall be construed as prohibiting an ACO 
                from using shared savings received under this section 
                to carry out an ACO Beneficiary Incentive Program.
                    ``(F) No application to shared savings 
                calculation.--Incentive payments made by an ACO under 
                this subsection shall be disregarded for purposes of 
                calculating benchmarks, estimated average per capita 
                Medicare expenditures, and shared savings under this 
                section.
                    ``(G) Reporting requirements.--An ACO conducting an 
                ACO Beneficiary Incentive Program under this subsection 
                shall, at such times and in such format as the 
                Secretary may require, report to the Secretary such 
                information and retain such documentation as the 
                Secretary may require, including the amount and 
                frequency of incentive payments made and the number of 
                Medicare fee-for-service beneficiaries receiving such 
                payments.
                    ``(H) Termination.--The Secretary may terminate an 
                ACO Beneficiary Incentive Program established under 
                this subsection at any time for reasons determined 
                appropriate by the Secretary.
            ``(3) Exclusion of incentive payments.--Any payment made 
        under an ACO Beneficiary Incentive Program established under 
        this subsection shall not be considered income or resources or 
        otherwise taken into account for purposes of--
                    ``(A) determining eligibility for benefits or 
                assistance (or the amount or extent of benefits or 
                assistance) under any Federal program or under any 
                State or local program financed in whole or in part 
                with Federal funds; or
                    ``(B) any Federal or State laws relating to 
                taxation.'';
            (3) in subsection (e), by inserting ``, including an ACO 
        Beneficiary Incentive Program under subsections (b)(2)(I) and 
        (m)'' after ``the program''; and
            (4) in subsection (g)(6), by inserting ``or of an ACO 
        Beneficiary Incentive Program under subsections (b)(2)(I) and 
        (m)'' after ``under subsection (d)(4)''.
    (b) Amendment to Section 1128B.--Section 1128B(b)(3) of the Social 
Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
            (1) by striking ``and'' at the end of subparagraph (I);
            (2) by striking the period at the end of subparagraph (J) 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) an incentive payment made to a Medicare fee-
                for-service beneficiary by an ACO under an ACO 
                Beneficiary Incentive Program established under 
                subsection (m) of section 1899, if the payment is made 
                in accordance with the requirements of such subsection 
                and meets such other conditions as the Secretary may 
                establish.''.
    (c) Evaluation and Report.--
            (1) Evaluation.--The Secretary of Health and Human Services 
        (in this subsection referred to as the ``Secretary'') shall 
        conduct an evaluation of the ACO Beneficiary Incentive Program 
        established under subsections (b)(2)(I) and (m) of section 1899 
        of the Social Security Act (42 U.S.C. 1395jjj), as added by 
        subsection (a). The evaluation shall include an analysis of the 
        impact of the implementation of the Program on expenditures and 
        beneficiary health outcomes under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (2) Report.--Not later than October 1, 2023, the Secretary 
        shall submit to Congress a report containing the results of the 
        evaluation under paragraph (1), together with recommendations 
        for such legislation and administrative action as the Secretary 
        determines appropriate.

SEC. 2332. GAO STUDY AND REPORT ON LONGITUDINAL COMPREHENSIVE CARE 
              PLANNING SERVICES UNDER MEDICARE PART B.

    (a) Study.--The Comptroller General shall conduct a study on the 
establishment under part B of the Medicare program under title XVIII of 
the Social Security Act of a payment code for a visit for longitudinal 
comprehensive care planning services. Such study shall include an 
analysis of the following to the extent such information is available:
            (1) The frequency with which services similar to 
        longitudinal comprehensive care planning services are furnished 
        to Medicare beneficiaries, which providers of services and 
        suppliers are furnishing those services, whether Medicare 
        reimbursement is being received for those services, and, if so, 
        through which codes those services are being reimbursed.
            (2) Whether, and the extent to which, longitudinal 
        comprehensive care planning services would overlap, and could 
        therefore result in duplicative payment, with services covered 
        under the hospice benefit as well as the chronic care 
        management code, evaluation and management codes, or other 
        codes that already exist under part B of the Medicare program.
            (3) Any barriers to hospitals, skilled nursing facilities, 
        hospice programs, home health agencies, and other applicable 
        providers working with a Medicare beneficiary to engage in the 
        care planning process and complete the necessary documentation 
        to support the treatment and care plan of the beneficiary and 
        provide such documentation to other providers and the 
        beneficiary or the beneficiary's representative.
            (4) Any barriers to providers, other than the provider 
        furnishing longitudinal comprehensive care planning services, 
        accessing the care plan and associated documentation for use 
        related to the care of the Medicare beneficiary.
            (5) Potential options for ensuring that applicable 
        providers are notified of a patient's existing longitudinal 
        care plan and that applicable providers consider that plan in 
        making their treatment decisions, and what the challenges might 
        be in implementing such options.
            (6) Stakeholder's views on the need for the development of 
        quality metrics with respect to longitudinal comprehensive care 
        planning services, such as measures related to--
                    (A) the process of eliciting input from the 
                Medicare beneficiary or from a legally authorized 
                representative and documenting in the medical record 
                the patient-directed care plan;
                    (B) the effectiveness and patient-centeredness of 
                the care plan in organizing delivery of services 
                consistent with the plan;
                    (C) the availability of the care plan and 
                associated documentation to other providers that care 
                for the beneficiary; and
                    (D) the extent to which the beneficiary received 
                services and support that is free from discrimination 
                based on advanced age, disability status, or advanced 
                illness.
            (7) Stakeholder's views on how such quality metrics would 
        provide information on--
                    (A) the goals, values, and preferences of the 
                beneficiary;
                    (B) the documentation of the care plan;
                    (C) services furnished to the beneficiary; and
                    (D) outcomes of treatment.
            (8) Stakeholder's views on--
                    (A) the type of training and education needed for 
                applicable providers, individuals, and caregivers in 
                order to facilitate longitudinal comprehensive care 
                planning services;
                    (B) the types of providers of services and 
                suppliers that should be included in the 
                interdisciplinary team of an applicable provider; and
                    (C) the characteristics of Medicare beneficiaries 
                that would be most appropriate to receive longitudinal 
                comprehensive care planning services, such as 
                individuals with advanced disease and individuals who 
                need assistance with multiple activities of daily 
                living.
            (9) Stakeholder's views on the frequency with which 
        longitudinal comprehensive care planning services should be 
        furnished.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study conducted under subsection 
(a), together with recommendations for such legislation and 
administrative action as the Comptroller General determines 
appropriate.
    (c) Definitions.--In this section:
            (1) Applicable provider.--The term ``applicable provider'' 
        means a hospice program (as defined in subsection (dd)(2) of 
        section 1861 of the Social Security Act (42 U.S.C. 1395ww)) or 
        other provider of services (as defined in subsection (u) of 
        such section) or supplier (as defined in subsection (d) of such 
        section) that--
                    (A) furnishes longitudinal comprehensive care 
                planning services through an interdisciplinary team; 
                and
                    (B) meets such other requirements as the Secretary 
                may determine to be appropriate.
            (2) Comptroller general.--The term ``Comptroller General'' 
        means the Comptroller General of the United States.
            (3) Interdisciplinary team.--The term ``interdisciplinary 
        team'' means a group that--
                    (A) includes the personnel described in subsection 
                (dd)(2)(B)(i) of such section 1861;
                    (B) may include a chaplain, minister, or other 
                clergy; and
                    (C) may include other direct care personnel.
            (4) Longitudinal comprehensive care planning services.--The 
        term ``longitudinal comprehensive care planning services'' 
        means a voluntary shared decisionmaking process that is 
        furnished by an applicable provider through an 
        interdisciplinary team and includes a conversation with 
        Medicare beneficiaries who have received a diagnosis of a 
        serious or life-threatening illness. The purpose of such 
        services is to discuss a longitudinal care plan that addresses 
        the progression of the disease, treatment options, the goals, 
        values, and preferences of the beneficiary, and the 
        availability of other resources and social supports that may 
        reduce the beneficiary's health risks and promote self-
        management and shared decisionmaking.
            (5) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

   Subtitle E--Other Policies to Improve Care for the Chronically Ill

SEC. 2341. GAO STUDY AND REPORT ON IMPROVING MEDICATION 
              SYNCHRONIZATION.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall conduct a 
study on the extent to which Medicare prescription drug plans (MA-PD 
plans and stand alone prescription drug plans) under part D of title 
XVIII of the Social Security Act and private payors use programs that 
synchronize pharmacy dispensing so that individuals may receive 
multiple prescriptions on the same day to facilitate comprehensive 
counseling and promote medication adherence. The study shall include a 
analysis of the following:
            (1) The extent to which pharmacies have adopted such 
        programs.
            (2) The common characteristics of such programs, including 
        how pharmacies structure counseling sessions under such 
        programs and the types of payment and other arrangements that 
        Medicare prescription drug plans and private payors employ 
        under such programs to support the efforts of pharmacies.
            (3) How such programs compare for Medicare prescription 
        drug plans and private payors.
            (4) What is known about how such programs affect patient 
        medication adherence and overall patient health outcomes, 
        including if adherence and outcomes vary by patient 
        subpopulations, such as disease state and socioeconomic status.
            (5) What is known about overall patient satisfaction with 
        such programs and satisfaction with such programs, including 
        within patient subpopulations, such as disease state and 
        socioeconomic status.
            (6) The extent to which laws and regulations of the 
        Medicare program support such programs.
            (7) Barriers to the use of medication synchronization 
        programs by Medicare prescription drug plans.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.

SEC. 2342. GAO STUDY AND REPORT ON IMPACT OF OBESITY DRUGS ON PATIENT 
              HEALTH AND SPENDING.

    (a) Study.--The Comptroller General of the United States (in this 
section referred to as the ``Comptroller General'') shall, to the 
extent data are available, conduct a study on the use of prescription 
drugs to manage the weight of obese patients and the impact of coverage 
of such drugs on patient health and on health care spending. Such study 
shall examine the use and impact of these obesity drugs in the non-
Medicare population and for Medicare beneficiaries who have such drugs 
covered through an MA-PD plan (as defined in section 1860D-1(a)(3)(C) 
of the Social Security Act (42 U.S.C. 1395w-101(a)(3)(C))) as a 
supplemental health care benefit. The study shall include an analysis 
of the following:
            (1) The prevalence of obesity in the Medicare and non-
        Medicare population.
            (2) The utilization of obesity drugs.
            (3) The distribution of Body Mass Index by individuals 
        taking obesity drugs, to the extent practicable.
            (4) What is known about the use of obesity drugs in 
        conjunction with the receipt of other items or services, such 
        as behavioral counseling, and how these compare to items and 
        services received by obese individuals who do not take obesity 
        drugs.
            (5) Physician considerations and attitudes related to 
        prescribing obesity drugs.
            (6) The extent to which coverage policies cease or limit 
        coverage for individuals who fail to receive clinical benefit.
            (7) What is known about the extent to which individuals who 
        take obesity drugs adhere to the prescribed regimen.
            (8) What is known about the extent to which individuals who 
        take obesity drugs maintain weight loss over time.
            (9) What is known about the subsequent impact such drugs 
        have on medical services that are directly related to obesity, 
        including with respect to subpopulations determined based on 
        the extent of obesity.
            (10) What is known about the spending associated with the 
        care of individuals who take obesity drugs, compared to the 
        spending associated with the care of individuals who do not 
        take such drugs.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Comptroller General shall submit to Congress 
a report containing the results of the study under subsection (a), 
together with recommendations for such legislation and administrative 
action as the Comptroller General determines appropriate.

SEC. 2343. HHS STUDY AND REPORT ON LONG-TERM RISK FACTORS FOR CHRONIC 
              CONDITIONS AMONG MEDICARE BENEFICIARIES.

    (a) Study.--The Secretary of Health and Human Services (in this 
section referred to as the ``Secretary'') shall conduct a study on 
long-term cost drivers to the Medicare program, including obesity, 
tobacco use, mental health conditions, and other factors that may 
contribute to the deterioration of health conditions among individuals 
with chronic conditions in the Medicare population. The study shall 
include an analysis of any barriers to collecting and analyzing such 
information and how to remove any such barriers (including through 
legislation and administrative actions).
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary shall submit to Congress a report 
containing the results of the study under subsection (a), together with 
recommendations for such legislation and administrative action as the 
Secretary determines appropriate. The Secretary shall also post such 
report on the Internet website of the Department of Health and Human 
Services.

            TITLE IV--MEDICARE PART B MISCELLANEOUS POLICIES

              Subtitle A--Medicare Part B Improvement Act

SEC. 2401. HOME INFUSION THERAPY SERVICES TEMPORARY TRANSITIONAL 
              PAYMENT.

    (a) In General.--Section 1834(u) of the Social Security Act (42 
U.S.C. 1395m(u)) is amended by adding at the end the following new 
paragraph:
            ``(7) Home infusion therapy services temporary transitional 
        payment.--
                    ``(A) Temporary transitional payment.--
                            ``(i) In general.--The Secretary shall, in 
                        accordance with the payment methodology 
                        described in subparagraph (B) and subject to 
                        the provisions of this paragraph, provide a 
                        home infusion therapy services temporary 
                        transitional payment under this part to an 
                        eligible home infusion supplier (as defined in 
                        subparagraph (F)) for items and services 
                        described in subparagraphs (A) and (B) of 
                        section 1861(iii)(2)) furnished during the 
                        period specified in clause (ii) by such 
                        supplier in coordination with the furnishing of 
                        transitional home infusion drugs (as defined in 
                        clause (iii)).
                            ``(ii) Period specified.--For purposes of 
                        clause (i), the period specified in this clause 
                        is the period beginning on January 1, 2019, and 
                        ending on the day before the date of the 
                        implementation of the payment system under 
                        paragraph (1)(A).
                            ``(iii) Transitional home infusion drug 
                        defined.--For purposes of this paragraph, the 
                        term `transitional home infusion drug' has the 
                        meaning given to the term `home infusion drug' 
                        under section 1861(iii)(3)(C)), except that 
                        clause (ii) of such section shall not apply if 
                        a drug described in such clause is identified 
                        in clauses (i), (ii), (iii) or (iv) of 
                        subparagraph (C) as of the date of the 
                        enactment of this paragraph.
                    ``(B) Payment methodology.--For purposes of this 
                paragraph, the Secretary shall establish a payment 
                methodology, with respect to items and services 
                described in subparagraph (A)(i). Under such payment 
                methodology the Secretary shall--
                            ``(i) create the three payment categories 
                        described in clauses (i), (ii), and (iii) of 
                        subparagraph (C);
                            ``(ii) assign drugs to such categories, in 
                        accordance with such clauses;
                            ``(iii) assign appropriate Healthcare 
                        Common Procedure Coding System (HCPCS) codes to 
                        each payment category; and
                            ``(iv) establish a single payment amount 
                        for each such payment category, in accordance 
                        with subparagraph (D), for each infusion drug 
                        administration calendar day in the individual's 
                        home for drugs assigned to such category.
                    ``(C) Payment categories.--
                            ``(i) Payment category 1.--The Secretary 
                        shall create a payment category 1 and assign to 
                        such category drugs which are covered under the 
                        Local Coverage Determination on External 
                        Infusion Pumps (LCD number L33794) and billed 
                        with the following HCPCS codes (as identified 
                        as of January 1, 2018, and as subsequently 
                        modified by the Secretary): J0133, J0285, 
                        J0287, J0288, J0289, J0895, J1170, J1250, 
                        J1265, J1325, J1455, J1457, J1570, J2175, 
                        J2260, J2270, J2274, J2278, J3010, or J3285.
                            ``(ii) Payment category 2.--The Secretary 
                        shall create a payment category 2 and assign to 
                        such category drugs which are covered under 
                        such local coverage determination and billed 
                        with the following HCPCS codes (as identified 
                        as of January 1, 2018, and as subsequently 
                        modified by the Secretary): J1555 JB, J1559 JB, 
                        J1561 JB, J1562 JB, J1569 JB, or J1575 JB.
                            ``(iii) Payment category 3.--The Secretary 
                        shall create a payment category 3 and assign to 
                        such category drugs which are covered under 
                        such local coverage determination and billed 
                        with the following HCPCS codes (as identified 
                        as of January 1, 2018, and as subsequently 
                        modified by the Secretary): J9000, J9039, 
                        J9040, J9065, J9100, J9190, J9200, J9360, or 
                        J9370.
                            ``(iv) Infusion drugs not otherwise 
                        included.--With respect to drugs that are not 
                        included in payment category 1, 2, or 3 under 
                        clause (i), (ii), or (iii), respectively, the 
                        Secretary shall assign to the most appropriate 
                        of such categories, as determined by the 
                        Secretary, drugs which are--
                                    ``(I) covered under such local 
                                coverage determination and billed under 
                                HCPCS codes J7799 or J7999 (as 
                                identified as of July 1, 2017, and as 
                                subsequently modified by the 
                                Secretary); or
                                    ``(II) billed under any code that 
                                is implemented after the date of the 
                                enactment of this paragraph and 
                                included in such local coverage 
                                determination or included in 
                                subregulatory guidance as a home 
                                infusion drug described in subparagraph 
                                (A)(i).
                    ``(D) Payment amounts.--
                            ``(i) In general.--Under the payment 
                        methodology, the Secretary shall pay eligible 
                        home infusion suppliers, with respect to items 
                        and services described in subparagraph (A)(i) 
                        furnished during the period described in 
                        subparagraph (A)(ii) by such supplier to an 
                        individual, at amounts equal to the amounts 
                        determined under the physician fee schedule 
                        established under section 1848 for services 
                        furnished during the year for codes and units 
                        of such codes described in clauses (ii), (iii), 
                        and (iv) with respect to drugs included in the 
                        payment category under subparagraph (C) 
                        specified in the respective clause, determined 
                        without application of the geographic 
                        adjustment under subsection (e) of such 
                        section.
                            ``(ii) Payment amount for category 1.--For 
                        purposes of clause (i), the codes and units 
                        described in this clause, with respect to drugs 
                        included in payment category 1 described in 
                        subparagraph (C)(i), are one unit of HCPCS code 
                        96365 plus three units of HCPCS code 96366 (as 
                        identified as of January 1, 2018, and as 
                        subsequently modified by the Secretary).
                            ``(iii) Payment amount for category 2.--For 
                        purposes of clause (i), the codes and units 
                        described in this clause, with respect to drugs 
                        included in payment category 2 described in 
                        subparagraph (C)(i), are one unit of HCPCS code 
                        96369 plus three units of HCPCS code 96370 (as 
                        identified as of January 1, 2018, and as 
                        subsequently modified by the Secretary).
                            ``(iv) Payment amount for category 3.--For 
                        purposes of clause (i), the codes and units 
                        described in this clause, with respect to drugs 
                        included in payment category 3 described in 
                        subparagraph (C)(i), are one unit of HCPCS code 
                        96413 plus three units of HCPCS code 96415 (as 
                        identified as of January 1, 2018, and as 
                        subsequently modified by the Secretary).
                    ``(E) Clarifications.--
                            ``(i) Infusion drug administration day.--
                        For purposes of this subsection, with respect 
                        to the furnishing of transitional home infusion 
                        drugs or home infusion drugs to an individual 
                        by an eligible home infusion supplier or a 
                        qualified home infusion therapy supplier, a 
                        reference to payment to such supplier for an 
                        infusion drug administration calendar day in 
                        the individual's home shall refer to payment 
                        only for the date on which professional 
                        services (as described in section 
                        1861(iii)(2)(A)) were furnished to administer 
                        such drugs to such individual. For purposes of 
                        the previous sentence, an infusion drug 
                        administration calendar day shall include all 
                        such drugs administered to such individual on 
                        such day.
                            ``(ii) Treatment of multiple drugs 
                        administered on same infusion drug 
                        administration day.--In the case that an 
                        eligible home infusion supplier, with respect 
                        to an infusion drug administration calendar day 
                        in an individual's home, furnishes to such 
                        individual transitional home infusion drugs 
                        which are not all assigned to the same payment 
                        category under subparagraph (C), payment to 
                        such supplier for such infusion drug 
                        administration calendar day in the individual's 
                        home shall be a single payment equal to the 
                        amount of payment under this paragraph for the 
                        drug, among all such drugs so furnished to such 
                        individual during such calendar day, for which 
                        the highest payment would be made under this 
                        paragraph.
                    ``(F) Eligible home infusion suppliers.--In this 
                paragraph, the term `eligible home infusion supplier' 
                means a supplier that is enrolled under this part as a 
                pharmacy that provides external infusion pumps and 
                external infusion pump supplies and that maintains all 
                pharmacy licensure requirements in the State in which 
                the applicable infusion drugs are administered.
                    ``(G) Implementation.--Notwithstanding any other 
                provision of law, the Secretary may implement this 
                paragraph by program instruction or otherwise.''.
    (b) Conforming Amendment.--
            (1) Section 1842(b)(6)(I) of the Social Security Act (42 
        U.S.C. 1395u(b)(6)(I)) is amended by inserting ``or, in the 
        case of items and services described in clause (i) of section 
        1834(u)(7)(A) furnished to an individual during the period 
        described in clause (ii) of such section, payment shall be made 
        to the eligible home infusion therapy supplier'' after 
        ``payment shall be made to the qualified home infusion therapy 
        supplier''.
            (2) Section 5012(d) of the 21st Century Cures Act is 
        amended by inserting the following before the period at the end 
        the following: ``, except that the amendments made by 
        paragraphs (1) and (2) of subsection (c) shall apply to items 
        and services furnished on or after January 1, 2019''.

SEC. 2402. ORTHOTIST'S AND PROSTHETIST'S CLINICAL NOTES AS PART OF THE 
              PATIENT'S MEDICAL RECORD.

    Section 1834(h) of the Social Security Act (42 U.S.C. 1395m(h)) is 
amended by adding at the end the following new paragraph:
            ``(5) Documentation created by orthotists and 
        prosthetists.--For purposes of determining the reasonableness 
        and medical necessity of orthotics and prosthetics, 
        documentation created by an orthotist or prosthetist shall be 
        considered part of the individual's medical record to support 
        documentation created by eligible professionals described in 
        section 1848(k)(3)(B).''.

SEC. 2403. INDEPENDENT ACCREDITATION FOR DIALYSIS FACILITIES AND 
              ASSURANCE OF HIGH QUALITY SURVEYS.

    (a) Accreditation and Surveys.--
            (1) In general.--Section 1865 of the Social Security Act 
        (42 U.S.C. 1395bb) is amended--
                    (A) in subsection (a)--
                            (i) in paragraph (1), in the matter 
                        preceding subparagraph (A), by striking ``or 
                        the conditions and requirements under section 
                        1881(b)''; and
                            (ii) in paragraph (4), by inserting 
                        ``(including a renal dialysis facility)'' after 
                        ``facility''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(e) With respect to an accreditation body that has received 
approval from the Secretary under subsection (a)(3)(A) for 
accreditation of provider entities that are required to meet the 
conditions and requirements under section 1881(b), in addition to 
review and oversight authorities otherwise applicable under this title, 
the Secretary shall (as the Secretary determines appropriate) conduct, 
with respect to such accreditation body and provider entities, any or 
all of the following as frequently as is otherwise required to be 
conducted under this title with respect to other accreditation bodies 
or other provider entities:
            ``(1) Validation surveys referred to in subsection (d).
            ``(2) Accreditation program reviews (as defined in section 
        488.8(c) of title 42 of the Code of Federal Regulations, or a 
        successor regulation).
            ``(3) Performance reviews (as defined in section 488.8(a) 
        of title 42 of the Code of Federal Regulations, or a successor 
        regulation).''.
            (2) Timing for acceptance of requests from accreditation 
        organizations.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary of Health and Human 
        Services shall begin accepting requests from national 
        accreditation bodies for a finding described in section 
        1865(a)(3)(A) of the Social Security Act (42 U.S.C. 
        1395bb(a)(3)(A)) for purposes of accrediting provider entities 
        that are required to meet the conditions and requirements under 
        section 1881(b) of such Act (42 U.S.C. 1395rr(b)).
    (b) Requirement for Timing of Surveys of New Dialysis Facilities.--
Section 1881(b)(1) of the Social Security Act (42 U.S.C. 1395rr(b)(1)) 
is amended by adding at the end the following new sentence: ``Beginning 
180 days after the date of the enactment of this sentence, an initial 
survey of a provider of services or a renal dialysis facility to 
determine if the conditions and requirements under this paragraph are 
met shall be initiated not later than 90 days after such date on which 
both the provider enrollment form (without regard to whether such form 
is submitted prior to or after such date of enactment) has been 
determined by the Secretary to be complete and the provider's 
enrollment status indicates approval is pending the results of such 
survey.''.

SEC. 2404. MODERNIZING THE APPLICATION OF THE STARK RULE UNDER 
              MEDICARE.

    (a) Clarification of the Writing Requirement and Signature 
Requirement for Arrangements Pursuant to the Stark Rule.--
            (1) Writing requirement.--Section 1877(h)(1) of the Social 
        Security Act (42 U.S.C. 1395nn(h)(1)) is amended by adding at 
        the end the following new subparagraph:
            ``(D) Written requirement clarified.--In the case of any 
        requirement pursuant to this section for a compensation 
        arrangement to be in writing, such requirement shall be 
        satisfied by such means as determined by the Secretary, 
        including by a collection of documents, including 
        contemporaneous documents evidencing the course of conduct 
        between the parties involved.''.
            (2) Signature requirement.--Section 1877(h)(1) of the 
        Social Security Act (42 U.S.C. 1395nn(h)(1)), as amended by 
        paragraph (1), is further amended by adding at the end the 
        following new subparagraph:
                    ``(E) Special rule for signature requirements.--In 
                the case of any requirement pursuant to this section 
                for a compensation arrangement to be in writing and 
                signed by the parties, such signature requirement shall 
                be met if--
                            ``(i) not later than 90 consecutive 
                        calendar days immediately following the date on 
                        which the compensation arrangement became 
                        noncompliant, the parties obtain the required 
                        signatures; and
                            ``(ii) the compensation arrangement 
                        otherwise complies with all criteria of the 
                        applicable exception.''.
    (b) Indefinite Holdover for Lease Arrangements and Personal 
Services Arrangements Pursuant to the Stark Rule.--Section 1877(e) of 
the Social Security Act (42 U.S.C. 1395nn(e)) is amended--
            (1) in paragraph (1), by adding at the end the following 
        new subparagraph:
                    ``(C) Holdover lease arrangements.--In the case of 
                a holdover lease arrangement for the lease of office 
                space or equipment, which immediately follows a lease 
                arrangement described in subparagraph (A) for the use 
                of such office space or subparagraph (B) for the use of 
                such equipment and that expired after a term of at 
                least 1 year, payments made by the lessee to the lessor 
                pursuant to such holdover lease arrangement, if--
                            ``(i) the lease arrangement met the 
                        conditions of subparagraph (A) for the lease of 
                        office space or subparagraph (B) for the use of 
                        equipment when the arrangement expired;
                            ``(ii) the holdover lease arrangement is on 
                        the same terms and conditions as the 
                        immediately preceding arrangement; and
                            ``(iii) the holdover arrangement continues 
                        to satisfy the conditions of subparagraph (A) 
                        for the lease of office space or subparagraph 
                        (B) for the use of equipment.''; and
            (2) in paragraph (3), by adding at the end the following 
        new subparagraph:
                    ``(C) Holdover personal service arrangement.--In 
                the case of a holdover personal service arrangement, 
                which immediately follows an arrangement described in 
                subparagraph (A) that expired after a term of at least 
                1 year, remuneration from an entity pursuant to such 
                holdover personal service arrangement, if--
                            ``(i) the personal service arrangement met 
                        the conditions of subparagraph (A) when the 
                        arrangement expired;
                            ``(ii) the holdover personal service 
                        arrangement is on the same terms and conditions 
                        as the immediately preceding arrangement; and
                            ``(iii) the holdover arrangement continues 
                        to satisfy the conditions of subparagraph 
                        (A).''.

                   Subtitle B--Additional Provisions

SEC. 2411. MAKING PERMANENT THE REMOVAL OF THE RENTAL CAP FOR DURABLE 
              MEDICAL EQUIPMENT UNDER MEDICARE WITH RESPECT TO SPEECH 
              GENERATING DEVICES.

    Section 1834(a)(2)(A)(iv) of the Social Security Act (42 U.S.C. 
1395m(a)(2)(A)(iv)) is amended by striking ``and before October 1, 
2018,''.

SEC. 2412. INCREASED CIVIL AND CRIMINAL PENALTIES AND INCREASED 
              SENTENCES FOR FEDERAL HEALTH CARE PROGRAM FRAUD AND 
              ABUSE.

    (a) Increased Civil Money Penalties and Criminal Fines.--
            (1) Increased civil money penalties.--Section 1128A of the 
        Social Security Act (42 U.S.C. 1320a-7a) is amended--
                    (A) in subsection (a), in the matter following 
                paragraph (10)--
                            (i) by striking ``$10,000'' and inserting 
                        ``$20,000'' each place it appears;
                            (ii) by striking ``$15,000'' and inserting 
                        ``$30,000''; and
                            (iii) by striking ``$50,000'' and inserting 
                        ``$100,000'' each place it appears; and
                    (B) in subsection (b)--
                            (i) in paragraph (1), in the flush text 
                        following subparagraph (B), by striking 
                        ``$2,000'' and inserting ``$5,000'';
                            (ii) in paragraph (2), by striking 
                        ``$2,000'' and inserting ``$5,000''; and
                            (iii) in paragraph (3)(A)(i), by striking 
                        ``$5,000'' and inserting ``$10,000''.
            (2) Increased criminal fines.--Section 1128B of such Act 
        (42 U.S.C. 1320a-7b) is amended--
                    (A) in subsection (a), in the matter following 
                paragraph (6)--
                            (i) by striking ``$25,000'' and inserting 
                        ``$100,000''; and
                            (ii) by striking ``$10,000'' and inserting 
                        ``$20,000'';
                    (B) in subsection (b)--
                            (i) in paragraph (1), in the flush text 
                        following subparagraph (B), by striking 
                        ``$25,000'' and inserting ``$100,000''; and
                            (ii) in paragraph (2), in the flush text 
                        following subparagraph (B), by striking 
                        ``$25,000'' and inserting ``$100,000'';
                    (C) in subsection (c), by striking ``$25,000'' and 
                inserting ``$100,000'';
                    (D) in subsection (d), in the flush text following 
                paragraph (2), by striking ``$25,000'' and inserting 
                ``$100,000''; and
                    (E) in subsection (e), by striking ``$2,000'' and 
                inserting ``$4,000''.
    (b) Increased Sentences for Felonies Involving Federal Health Care 
Program Fraud and Abuse.--
            (1) False statements and representations.--Section 1128B(a) 
        of the Social Security Act (42 U.S.C. 1320a-7b(a)) is amended, 
        in the matter following paragraph (6), by striking ``not more 
        than five years or both, or (ii)'' and inserting ``not more 
        than 10 years or both, or (ii)''.
            (2) Antikickback.--Section 1128B(b) of such Act (42 U.S.C. 
        1320a-7b(b)) is amended--
                    (A) in paragraph (1), in the flush text following 
                subparagraph (B), by striking ``not more than five 
                years'' and inserting ``not more than 10 years''; and
                    (B) in paragraph (2), in the flush text following 
                subparagraph (B), by striking ``not more than five 
                years'' and inserting ``not more than 10 years''.
            (3) False statement or representation with respect to 
        conditions or operations of facilities.--Section 1128B(c) of 
        such Act (42 U.S.C. 1320a-7b(c)) is amended by striking ``not 
        more than five years'' and inserting ``not more than 10 
        years''.
            (4) Excess charges.--Section 1128B(d) of such Act (42 
        U.S.C. 1320a-7b(d)) is amended, in the flush text following 
        paragraph (2), by striking ``not more than five years'' and 
        inserting ``not more than 10 years''.
    (c) Effective Date.--The amendments made by this section shall 
apply to acts committed after the date of the enactment of this Act.

SEC. 2413. REDUCING THE VOLUME OF FUTURE EHR-RELATED SIGNIFICANT 
              HARDSHIP REQUESTS.

    Section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)(A)) and section 1886(n)(3)(A) of such Act (42 U.S.C. 
1395ww(n)(3)(A)) are each amended in the last sentence by striking ``by 
requiring'' and all that follows through ``this paragraph''.

SEC. 2414. COVERAGE OF CERTAIN DNA SPECIMEN PROVENANCE ASSAY TESTS 
              UNDER MEDICARE.

    (a) Benefit.--
            (1) Coverage.--Section 1861 of the Social Security Act (42 
        U.S.C. 1395x) is amended--
                    (A) in subsection (s)(2)--
                            (i) in subparagraph (FF), by striking 
                        ``and'' at the end;
                            (ii) in subparagraph (GG), by inserting 
                        ``and'' at the end; and
                            (iii) by adding at the end the following 
                        new subparagraph:
            ``(HH) a prostate cancer DNA Specimen Provenance Assay test 
        (DSPA test) (as defined in subsection (jjj)); and''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(jjj) Prostate Cancer DNA Speciment Provenance Assay Test.--The 
term `prostate cancer DNA Specimen Provenance Assay Test' (DSPA test) 
means a test that, after a determination of cancer in one or more 
prostate biopsy specimens obtained from an individual, assesses the 
identity of the DNA in such specimens by comparing such DNA with the 
DNA that was separately taken from such individual at the time of the 
biopsy.''.
            (2) Exclusion from coverage.--Section 1862(a)(1) of the 
        Social Security Act (42 U.S.C. 1395y(a)(1)) is amended--
                    (A) in subparagraph (O), by striking ``and'' at the 
                end;
                    (B) in subparagraph (P), by striking the semicolon 
                at the end and inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
            ``(Q) in the case of a prostate cancer DNA Specimen 
        Provenance Assay test (DSPA test) (as defined in section 
        1861(jjj)), unless such test is furnished on or after January 
        1, 2019, and before January 1, 2024, and such test is ordered 
        by the physician who furnished the prostate cancer biopsy that 
        obtained the specimen tested;''.
    (b) Payment Amount and Related Requirements.--Section 1834 of the 
Social Security Act (42 U.S.C. 1395m), as amended by section 2204, is 
further amended by adding at the end the following new subsection:
    ``(w) Prostate Cancer DNA Specimen Provenance Assay Tests.--
            ``(1) Payment for covered tests.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                payment amount for a prostate cancer DNA Specimen 
                Provenance Assay test (DSPA test) (as defined in 
                section 1861(jjj)) shall be $200. Such payment shall be 
                payment for all of the specimens obtained from the 
                biopsy furnished to an individual that are tested.
                    ``(B) Limitation.--Payment for a DSPA test under 
                subparagraph (A) may only be made on an assignment-
                related basis.
                    ``(C) Prohibition on separate payment.--No separate 
                payment shall be made for obtaining DNA that was 
                separately taken from an individual at the time of a 
                biopsy described in subparagraph (A).
            ``(2) HCPCS code and modifier assignment.--
                    ``(A) In general.--The Secretary shall assign one 
                or more HCPCS codes to a prostate cancer DNA Specimen 
                Provenance Assay test and may use a modifier to 
                facilitate making payment under this section for such 
                test.
                    ``(B) Identification of dna match on claim.--The 
                Secretary shall require an indication on a claim for a 
                prostate cancer DNA Specimen Provenance Assay test of 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individual diagnosed with prostate 
                cancer. Such indication may be made through use of a 
                HCPCS code, a modifier, or other means, as determined 
                appropriate by the Secretary.
            ``(3) DNA match review.--
                    ``(A) In general.--The Secretary shall review at 
                least three years of claims under part B for prostate 
                cancer DNA Specimen Provenance Assay tests to identify 
                whether the DNA of the prostate biopsy specimens match 
                the DNA of the individuals diagnosed with prostate 
                cancer.
                    ``(B) Posting on internet website.--Not later than 
                July 1, 2022, the Secretary shall post on the Internet 
                website of the Centers for Medicare & Medicaid Services 
                the findings of the review conducted under subparagraph 
                (A).''.
    (c) Cost-sharing.--Section 1833(a)(1) of the Social Security Act 
(42 U.S.C. 1395l(a)(1)) is amended--
            (1) by striking ``and (BB)'' and inserting ``(BB)''; and
            (2) by inserting before the semicolon at the end the 
        following: ``, and (CC) with respect to a prostate cancer DNA 
        Specimen Provenance Assay test (DSPA test) (as defined in 
        section 1861(jjj)), the amount paid shall be an amount equal to 
        80 percent of the lesser of the actual charge for the test or 
        the amount specified under section 1834(w)''.

SEC. 2415. STRENGTHENING RULES IN CASE OF COMPETITION FOR DIABETIC 
              TESTING STRIPS.

    (a) Special Rule in Case of Competition for Diabetic Testing 
Strips.--
            (1) In general.--Paragraph (10) of section 1847(b) of the 
        Social Security Act (42 U.S.C. 1395w-3(b)) is amended--
                    (A) in subparagraph (A), by striking the second 
                sentence and inserting the following new sentence: 
                ``With respect to bids to furnish such types of 
                products on or after January 1, 2019, the volume for 
                such types of products shall be determined by the 
                Secretary through the use of multiple sources of data 
                (from mail order and non-mail order Medicare markets), 
                including market-based data measuring sales of diabetic 
                testing strip products that are not exclusively sold by 
                a single retailer from such markets.''; and
                    (B) by adding at the end the following new 
                subparagraphs:
                    ``(C) Demonstration of ability to furnish types of 
                diabetic testing strip products.--With respect to bids 
                to furnish diabetic testing strip products on or after 
                January 1, 2019, an entity shall attest to the 
                Secretary that the entity has the ability to obtain an 
                inventory of the types and quantities of diabetic 
                testing strip products that will allow the entity to 
                furnish such products in a manner consistent with its 
                bid and--
                            ``(i) demonstrate to the Secretary, through 
                        letters of intent with manufacturers, 
                        wholesalers, or other suppliers, or other 
                        evidence as the Secretary may specify, such 
                        ability; or
                            ``(ii) demonstrate to the Secretary that it 
                        made a good faith attempt to obtain such a 
                        letter of intent or such other evidence.
                    ``(D) Use of unlisted types in calculation of 
                percentage.--With respect to bids to furnish diabetic 
                testing strip products on or after January 1, 2019, in 
                determining under subparagraph (A) whether a bid 
                submitted by an entity under such subparagraph covers 
                50 percent (or such higher percentage as the Secretary 
                may specify) of all types of diabetic testing strip 
                products, the Secretary may not attribute a percentage 
                to types of diabetic testing strip products that the 
                Secretary does not identify by brand, model, and market 
                share volume.
                    ``(E) Adherence to demonstration.--
                            ``(i) In general.--In the case of an entity 
                        that is furnishing diabetic testing strip 
                        products on or after January 1, 2019, under a 
                        contract entered into under the competition 
                        conducted pursuant to paragraph (1), the 
                        Secretary shall establish a process to monitor, 
                        on an ongoing basis, the extent to which such 
                        entity continues to cover the product types 
                        included in the entity's bid.
                            ``(ii) Termination.--If the Secretary 
                        determines that an entity described in clause 
                        (i) fails to maintain in inventory, or 
                        otherwise maintain ready access to (through 
                        requirements, contracts, or otherwise) a type 
                        of product included in the entity's bid, the 
                        Secretary may terminate such contract unless 
                        the Secretary finds that the failure of the 
                        entity to maintain inventory of, or ready 
                        access to, the product is the result of the 
                        discontinuation of the product by the product 
                        manufacturer, a market-wide shortage of the 
                        product, or the introduction of a newer model 
                        or version of the product in the market 
                        involved.''.
    (b) Codifying and Expanding Anti-switching Rule.--Section 1847(b) 
of the Social Security Act (42 U.S.C. 1395w-3(b)), as amended by 
subsection (a)(1), is further amended--
            (1) by redesignating paragraph (11) as paragraph (12); and
            (2) by inserting after paragraph (10) the following new 
        paragraph:
            ``(11) Additional special rules in case of competition for 
        diabetic testing strips.--
                    ``(A) In general.--With respect to an entity that 
                is furnishing diabetic testing strip products to 
                individuals under a contract entered into under the 
                competitive acquisition program established under this 
                section, the entity shall furnish to each individual a 
                brand of such products that is compatible with the home 
                blood glucose monitor selected by the individual.
                    ``(B) Prohibition on influencing and 
                incentivizing.--An entity described in subparagraph (A) 
                may not attempt to influence or incentivize an 
                individual to switch the brand of glucose monitor or 
                diabetic testing strip product selected by the 
                individual, including by--
                            ``(i) persuading, pressuring, or advising 
                        the individual to switch; or
                            ``(ii) furnishing information about 
                        alternative brands to the individual where the 
                        individual has not requested such information.
                    ``(C) Provision of information.--
                            ``(i) Standardized information.--Not later 
                        than January 1, 2019, the Secretary shall 
                        develop and make available to entities 
                        described in subparagraph (A) standardized 
                        information that describes the rights of an 
                        individual with respect to such an entity. The 
                        information described in the preceding sentence 
                        shall include information regarding--
                                    ``(I) the requirements established 
                                under subparagraphs (A) and (B);
                                    ``(II) the right of the individual 
                                to purchase diabetic testing strip 
                                products from another mail order 
                                supplier of such products or a retail 
                                pharmacy if the entity is not able to 
                                furnish the brand of such product that 
                                is compatible with the home blood 
                                glucose monitor selected by the 
                                individual; and
                                    ``(III) the right of the individual 
                                to return diabetic testing strip 
                                products furnished to the individual by 
                                the entity.
                            ``(ii) Requirement.--With respect to 
                        diabetic testing strip products furnished on or 
                        after the date on which the Secretary develops 
                        the standardized information under clause (i), 
                        an entity described in subparagraph (A) may not 
                        communicate directly to an individual until the 
                        entity has verbally provided the individual 
                        with such standardized information.
                    ``(D) Order refills.--With respect to diabetic 
                testing strip products furnished on or after January 1, 
                2019, the Secretary shall require an entity furnishing 
                diabetic testing strip products to an individual to 
                contact and receive a request from the individual for 
                such products not more than 14 days prior to dispensing 
                a refill of such products to the individual.''.
    (c) Implementation; Non-application of the Paperwork Reduction 
Act.--
            (1) Implementation.--Notwithstanding any other provision of 
        law, the Secretary of Health and Human Services may implement 
        the provisions of, and amendments made by, this section by 
        program instruction or otherwise.
            (2) Non-application of the paperwork reduction act.--
        Chapter 35 of title 44, United States Code (commonly referred 
        to as the ``Paperwork Reduction Act of 1995''), shall not apply 
        to this section or the amendments made by this section.

                    TITLE V--OTHER HEALTH EXTENDERS

SEC. 2501. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE NATIONAL HEALTH 
              SERVICE CORPS, AND TEACHING HEALTH CENTERS THAT OPERATE 
              GME PROGRAMS.

    (a) Community Health Centers Funding.--Section 10503(b)(1) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(1)), as 
amended by section 3101 of Public Law 115-96, is amended by amending 
subparagraph (F) to read as follows:
                    ``(F) $3,600,000,000 for each of fiscal years 2018 
                and 2019.''.
    (b) Other Community Health Centers Provisions.--Section 330 of the 
Public Health Service Act (42 U.S.C. 254b) is amended--
            (1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and 
        inserting ``use disorder'';
            (2) in subsection (b)(2)(A), by striking ``abuse'' and 
        inserting ``use disorder'';
            (3) in subsection (c)--
                    (A) in paragraph (1), by striking subparagraphs (B) 
                through (D);
                    (B) by striking ``(1) In general'' and all that 
                follows through ``The Secretary'' and inserting the 
                following:
            ``(1) Centers.--The Secretary''; and
                    (C) in paragraph (1), as amended, by redesignating 
                clauses (i) through (v) as subparagraphs (A) through 
                (E) and moving the margin of each of such redesignated 
                subparagraph 2 ems to the left;
            (4) by striking subsection (d) and inserting the following:
    ``(d) Improving Quality of Care.--
            ``(1) Supplemental awards.--The Secretary may award 
        supplemental grant funds to health centers funded under this 
        section to implement evidence-based models for increasing 
        access to high-quality primary care services, which may include 
        models related to--
                    ``(A) improving the delivery of care for 
                individuals with multiple chronic conditions;
                    ``(B) workforce configuration;
                    ``(C) reducing the cost of care;
                    ``(D) enhancing care coordination;
                    ``(E) expanding the use of telehealth and 
                technology-enabled collaborative learning and capacity 
                building models;
                    ``(F) care integration, including integration of 
                behavioral health, mental health, or substance use 
                disorder services; and
                    ``(G) addressing emerging public health or 
                substance use disorder issues to meet the health needs 
                of the population served by the health center.
            ``(2) Sustainability.--In making supplemental awards under 
        this subsection, the Secretary may consider whether the health 
        center involved has submitted a plan for continuing the 
        activities funded under this subsection after supplemental 
        funding is expended.
            ``(3) Special consideration.--The Secretary may give 
        special consideration to applications for supplemental funding 
        under this subsection that seek to address significant barriers 
        to access to care in areas with a greater shortage of health 
        care providers and health services relative to the national 
        average.'';
            (5) in subsection (e)(1)--
                    (A) in subparagraph (B)--
                            (i) by striking ``2 years'' and inserting 
                        ``1 year''; and
                            (ii) by adding at the end the following: 
                        ``The Secretary shall not make a grant under 
                        this paragraph unless the applicant provides 
                        assurances to the Secretary that within 120 
                        days of receiving grant funding for the 
                        operation of the health center, the applicant 
                        will submit, for approval by the Secretary, an 
                        implementation plan to meet the requirements of 
                        subsection (k)(3). The Secretary may extend 
                        such 120-day period for achieving compliance 
                        upon a demonstration of good cause by the 
                        health center.''; and
                    (B) in subparagraph (C)--
                            (i) in the subparagraph heading, by 
                        striking ``and plans'';
                            (ii) by striking ``or plan (as described in 
                        subparagraphs (B) and (C) of subsection 
                        (c)(1))'';
                            (iii) by striking ``or plan, including the 
                        purchase'' and inserting the following: 
                        ``including--
                            ``(i) the purchase'';
                            (iv) by inserting ``, which may include 
                        data and information systems'' after ``of 
                        equipment'';
                            (v) by striking the period at the end and 
                        inserting a semicolon; and
                            (vi) by adding at the end the following:
                            ``(ii) the provision of training and 
                        technical assistance; and
                            ``(iii) other activities that--
                                    ``(I) reduce costs associated with 
                                the provision of health services;
                                    ``(II) improve access to, and 
                                availability of, health services 
                                provided to individuals served by the 
                                centers;
                                    ``(III) enhance the quality and 
                                coordination of health services; or
                                    ``(IV) improve the health status of 
                                communities.'';
            (6) in subsection (e)(5)(B)--
                    (A) in the heading of subparagraph (B), by striking 
                ``and plans''; and
                    (B) by striking ``and subparagraphs (B) and (C) of 
                subsection (c)(1) to a health center or to a network or 
                plan'' and inserting ``to a health center or to a 
                network'';
            (7) in subsection (e), by adding at the end the following:
            ``(6) New access points and expanded services.--
                    ``(A) Approval of new access points.--
                            ``(i) In general.--The Secretary may 
                        approve applications for grants under 
                        subparagraph (A) or (B) of paragraph (1) to 
                        establish new delivery sites.
                            ``(ii) Special consideration.--In carrying 
                        out clause (i), the Secretary may give special 
                        consideration to applicants that have 
                        demonstrated the new delivery site will be 
                        located within a sparsely populated area, or an 
                        area which has a level of unmet need that is 
                        higher relative to other applicants.
                            ``(iii) Consideration of applications.--In 
                        carrying out clause (i), the Secretary shall 
                        approve applications for grants in such a 
                        manner that the ratio of the medically 
                        underserved populations in rural areas which 
                        may be expected to use the services provided by 
                        the applicants involved to the medically 
                        underserved populations in urban areas which 
                        may be expected to use the services provided by 
                        the applicants is not less than two to three or 
                        greater than three to two.
                            ``(iv) Service area overlap.--If in 
                        carrying out clause (i) the applicant proposes 
                        to serve an area that is currently served by 
                        another health center funded under this 
                        section, the Secretary may consider whether the 
                        award of funding to an additional health center 
                        in the area can be justified based on the unmet 
                        need for additional services within the 
                        catchment area.
                    ``(B) Approval of expanded service applications.--
                            ``(i) In general.--The Secretary may 
                        approve applications for grants under 
                        subparagraph (A) or (B) of paragraph (1) to 
                        expand the capacity of the applicant to provide 
                        required primary health services described in 
                        subsection (b)(1) or additional health services 
                        described in subsection (b)(2).
                            ``(ii) Priority expansion projects.--In 
                        carrying out clause (i), the Secretary may give 
                        special consideration to expanded service 
                        applications that seek to address emerging 
                        public health or behavioral health, mental 
                        health, or substance abuse issues through 
                        increasing the availability of additional 
                        health services described in subsection (b)(2) 
                        in an area in which there are significant 
                        barriers to accessing care.
                            ``(iii) Consideration of applications.--In 
                        carrying out clause (i), the Secretary shall 
                        approve applications for grants in such a 
                        manner that the ratio of the medically 
                        underserved populations in rural areas which 
                        may be expected to use the services provided by 
                        the applicants involved to the medically 
                        underserved populations in urban areas which 
                        may be expected to use the services provided by 
                        such applicants is not less than two to three 
                        or greater than three to two.'';
            (8) in subsection (h)--
                    (A) in paragraph (1), by striking ``and children 
                and youth at risk of homelessness'' and inserting ``, 
                children and youth at risk of homelessness, homeless 
                veterans, and veterans at risk of homelessness''; and
                    (B) in paragraph (5)--
                            (i) by striking subparagraph (B);
                            (ii) by redesignating subparagraph (C) as 
                        subparagraph (B); and
                            (iii) in subparagraph (B) (as so 
                        redesignated)--
                                    (I) in the subparagraph heading, by 
                                striking ``abuse'' and inserting ``use 
                                disorder''; and
                                    (II) by striking ``abuse'' and 
                                inserting ``use disorder'';
            (9) in subsection (k)--
                    (A) in paragraph (2)--
                            (i) in the paragraph heading, by inserting 
                        ``unmet'' before ``need'';
                            (ii) in the matter preceding subparagraph 
                        (A), by inserting ``or subsection (e)(6)'' 
                        after ``subsection (e)(1)'';
                            (iii) in subparagraph (A), by inserting 
                        ``unmet'' before ``need for health services'';
                            (iv) in subparagraph (B), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (C), by striking the 
                        period at the end and inserting ``; and''; and
                            (vi) by adding after subparagraph (C) the 
                        following:
                    ``(D) in the case of an application for a grant 
                pursuant to subsection (e)(6), a demonstration that the 
                applicant has consulted with appropriate State and 
                local government agencies, and health care providers 
                regarding the need for the health services to be 
                provided at the proposed delivery site.'';
                    (B) in paragraph (3)--
                            (i) in the matter preceding subparagraph 
                        (A), by inserting ``or subsection (e)(6)'' 
                        after ``subsection (e)(1)(B)'';
                            (ii) in subparagraph (B), by striking ``in 
                        the catchment area of the center'' and 
                        inserting ``, including other health care 
                        providers that provide care within the 
                        catchment area, local hospitals, and specialty 
                        providers in the catchment area of the center, 
                        to provide access to services not available 
                        through the health center and to reduce the 
                        non-urgent use of hospital emergency 
                        departments'';
                            (iii) in subparagraph (H)(ii), by inserting 
                        ``who shall be directly employed by the 
                        center'' after ``approves the selection of a 
                        director for the center'';
                            (iv) in subparagraph (L), by striking 
                        ``and'' at the end;
                            (v) in subparagraph (M), by striking the 
                        period and inserting ``; and''; and
                            (vi) by inserting after subparagraph (M), 
                        the following:
                    ``(N) the center has written policies and 
                procedures in place to ensure the appropriate use of 
                Federal funds in compliance with applicable Federal 
                statutes, regulations, and the terms and conditions of 
                the Federal award.''; and
                    (C) by striking paragraph (4);
            (10) in subsection (l), by adding at the end the following: 
        ``Funds expended to carry out activities under this subsection 
        and operational support activities under subsection (m) shall 
        not exceed 3 percent of the amount appropriated for this 
        section for the fiscal year involved.'';
            (11) in subsection (q)(4), by adding at the end the 
        following: ``A waiver provided by the Secretary under this 
        paragraph may not remain in effect for more than 1 year and may 
        not be extended after such period. An entity may not receive 
        more than one waiver under this paragraph in consecutive 
        years.'';
            (12) in subsection (r)(3)--
                    (A) by striking ``appropriate committees of 
                Congress a report concerning the distribution of funds 
                under this section'' and inserting the following: 
                ``Committee on Health, Education, Labor, and Pensions 
                of the Senate, and the Committee on Energy and Commerce 
                of the House of Representatives, a report including, at 
                a minimum--
                    ``(A) the distribution of funds for carrying out 
                this section'';
                    (B) by striking ``populations. Such report shall 
                include an assessment'' and inserting the following: 
                ``populations;
                    ``(B) an assessment'';
                    (C) by striking ``and the rationale for any 
                substantial changes in the distribution of funds.'' and 
                inserting a semicolon; and
                    (D) by adding at the end the following:
                    ``(C) the distribution of awards and funding for 
                new or expanded services in each of rural areas and 
                urban areas;
                    ``(D) the distribution of awards and funding for 
                establishing new access points, and the number of new 
                access points created;
                    ``(E) the amount of unexpended funding for loan 
                guarantees and loan guarantee authority under title 
                XVI;
                    ``(F) the rationale for any substantial changes in 
                the distribution of funds;
                    ``(G) the rate of closures for health centers and 
                access points;
                    ``(H) the number and reason for any grants awarded 
                pursuant to subsection (e)(1)(B); and
                    ``(I) the number and reason for any waivers 
                provided pursuant to subsection (q)(4).'';
            (13) in subsection (r), by adding at the end the following 
        new paragraph:
            ``(5) Funding for participation of health centers in all of 
        us research program.--In addition to any amounts made available 
        pursuant to paragraph (1) of this subsection, section 402A of 
        this Act, or section 10503 of the Patient Protection and 
        Affordable Care Act, there is authorized to be appropriated, 
        and there is appropriated, out of any monies in the Treasury 
        not otherwise appropriated, to the Secretary $25,000,000 for 
        fiscal year 2018 to support the participation of health centers 
        in the All of Us Research Program under the Precision Medicine 
        Initiative under section 498E of this Act.''; and
            (14) by striking subsection (s).
    (c) National Health Service Corps.--Section 10503(b)(2) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 254b-2(b)(2)), as 
amended by section 3101 of Public Law 115-96, is amended by amending 
subparagraph (F) to read as follows:
                    ``(F) $310,000,000 for each of fiscal years 2018 
                and 2019.''.
    (d) Teaching Health Centers That Operate Graduate Medical Education 
Programs.--
            (1) Payments.--Subsection (a) of section 340H of the Public 
        Health Service Act (42 U.S.C. 256h) is amended to read as 
        follows:
    ``(a) Payments.--
            ``(1) In general.--Subject to subsection (h)(2), the 
        Secretary shall make payments under this section for direct 
        expenses and indirect expenses to qualified teaching health 
        centers that are listed as sponsoring institutions by the 
        relevant accrediting body for, as appropriate--
                    ``(A) maintenance of filled positions at existing 
                approved graduate medical residency training programs;
                    ``(B) expansion of existing approved graduate 
                medical residency training programs; and
                    ``(C) establishment of new approved graduate 
                medical residency training programs.
            ``(2) Per resident amount.--In making payments under 
        paragraph (1), the Secretary shall consider the cost of 
        training residents at teaching health centers and the 
        implications of the per resident amount on approved graduate 
        medical residency training programs at teaching health centers.
            ``(3) Priority.--In making payments under paragraph (1)(C), 
        the Secretary shall give priority to qualified teaching health 
        centers that--
                    ``(A) serve a health professional shortage area 
                with a designation in effect under section 332 or a 
                medically underserved community (as defined in section 
                799B); or
                    ``(B) are located in a rural area (as defined in 
                section 1886(d)(2)(D) of the Social Security Act).''.
            (2) Funding.--Paragraph (1) of section 340H(g) of the 
        Public Health Service Act (42 U.S.C. 256h(g)), as amended by 
        section 3101 of Public Law 115-96, is amended by striking ``and 
        $30,000,000 for the period of the first and second quarters of 
        fiscal year 2018'' and inserting ``and $126,500,000 for each of 
        fiscal years 2018 and 2019''.
            (3) Annual reporting.--Subsection (h)(1) of section 340H of 
        the Public Health Service Act (42 U.S.C. 256h) is amended--
                    (A) by redesignating subparagraph (D) as 
                subparagraph (H); and
                    (B) by inserting after subparagraph (C) the 
                following:
                    ``(D) The number of patients treated by residents 
                described in paragraph (4).
                    ``(E) The number of visits by patients treated by 
                residents described in paragraph (4).
                    ``(F) Of the number of residents described in 
                paragraph (4) who completed their residency training at 
                the end of such residency academic year, the number and 
                percentage of such residents entering primary care 
                practice (meaning any of the areas of practice listed 
                in the definition of a primary care residency program 
                in section 749A).
                    ``(G) Of the number of residents described in 
                paragraph (4) who completed their residency training at 
                the end of such residency academic year, the number and 
                percentage of such residents who entered practice at a 
                health care facility--
                            ``(i) primarily serving a health 
                        professional shortage area with a designation 
                        in effect under section 332 or a medically 
                        underserved community (as defined in section 
                        799B); or
                            ``(ii) located in a rural area (as defined 
                        in section 1886(d)(2)(D) of the Social Security 
                        Act).''.
            (4) Report on training costs.--Not later than March 31, 
        2019, the Secretary of Health and Human Services shall submit 
        to the Congress a report on the direct graduate expenses of 
        approved graduate medical residency training programs, and the 
        indirect expenses associated with the additional costs of 
        teaching residents, of qualified teaching health centers (as 
        such terms are used or defined in section 340H of the Public 
        Health Service Act (42 U.S.C. 256h)).
            (5) Definition.--Subsection (j) of section 340H of the 
        Public Health Service Act (42 U.S.C. 256h) is amended--
                    (A) by redesignating paragraphs (2) and (3) as 
                paragraphs (3) and (4), respectively; and
                    (B) by inserting after paragraph (1) the following:
            ``(2) New approved graduate medical residency training 
        program.--The term `new approved graduate medical residency 
        training program' means an approved graduate medical residency 
        training program for which the sponsoring qualified teaching 
        health center has not received a payment under this section for 
        a previous fiscal year (other than pursuant to subsection 
        (a)(1)(C)).''.
            (6) Technical correction.--Subsection (f) of section 340H 
        (42 U.S.C. 256h) is amended by striking ``hospital'' each place 
        it appears and inserting ``teaching health center''.
            (7) Payments for previous fiscal years.--The provisions of 
        section 340H of the Public Health Service Act (42 U.S.C. 256h), 
        as in effect on the day before the date of enactment of Public 
        Law 115-96, shall continue to apply with respect to payments 
        under such section for fiscal years before fiscal year 2018.
    (e) Application.--Amounts appropriated pursuant to this section for 
fiscal year 2018 or 2019 are subject to the requirements contained in 
Public Law 115-31 for funds for programs authorized under sections 330 
through 340 of the Public Health Service Act (42 U.S.C. 254b-256).
    (f) Conforming Amendment.--Paragraph (4) of section 3014(h) of 
title 18, United States Code, as amended by section 3101 of Public Law 
115-96, is amended by striking ``and section 3101(d) of the CHIP and 
Public Health Funding Extension Act'' and inserting ``and section 
2501(e) of the SUSTAIN Care Act of 2018''.

SEC. 2502. EXTENSION FOR SPECIAL DIABETES PROGRAMS.

    (a) Special Diabetes Program for Type I Diabetes.--Subparagraph (D) 
of section 330B(b)(2) of the Public Health Service Act (42 U.S.C. 254c-
2(b)(2)), as amended by section 3102 of Public Law 115-96, is amended 
to read as follows:
                    ``(D) $150,000,000 for each of fiscal years 2018 
                and 2019, to remain available until expended.''.
    (b) Special Diabetes Program for Indians.--Subparagraph (D) of 
section 330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
3(c)(2)), as amended by section 3102 of Public Law 115-96, is amended 
to read as follows:
                    ``(D) $150,000,000 for each of fiscal years 2018 
                and 2019, to remain available until expended.''.

SEC. 2503. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION CENTERS.

    Section 501(c) of the Social Security Act (42 U.S.C. 701(c)) is 
amended--
            (1) in paragraph (1)(A)--
                    (A) in clause (v), by striking ``and'' at the end;
                    (B) in clause (vi), by striking the period at the 
                end and inserting ``; and''; and
                    (C) by adding at the end the following new clause:
            ``(vii) $6,000,000 for each of fiscal years 2018 and 
        2019.'';
            (2) in paragraph (3)(C), by inserting before the period the 
        following: ``, and with respect to fiscal years 2018 and 2019, 
        such centers shall also be developed in all territories and at 
        least one such center shall be developed for Indian Tribes''; 
        and
            (3) by amending paragraph (5) to read as follows:
    ``(5) For purposes of this subsection--
            ``(A) the term `Indian Tribe' has the meaning given to the 
        term `Indian tribe' in section 4 of the Indian Health Care 
        Improvement Act (25 U.S.C. 1603);
            ``(B) the term `State' means each of the 50 States and the 
        District of Columbia; and
            ``(C) the term `territory' means Puerto Rico, Guam, 
        American Samoa, the United States Virgin Islands, and the 
        Northern Mariana Islands.''.

SEC. 2504. EXTENSION FOR SEXUAL RISK AVOIDANCE EDUCATION.

    (a) In General.--Section 510 of the Social Security Act (42 U.S.C. 
710) is amended to read as follows:

``SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION.

    ``(a) In General.--
            ``(1) Allotments to states.--For the purpose described in 
        subsection (b), the Secretary shall, for each of fiscal years 
        2018 and 2019, allot to each State which has transmitted an 
        application for the fiscal year under section 505(a) an amount 
        equal to the product of--
                    ``(A) the amount appropriated pursuant to 
                subsection (e)(1) for the fiscal year, minus the amount 
                reserved under subsection (e)(2) for the fiscal year; 
                and
                    ``(B) the proportion that the number of low-income 
                children in the State bears to the total of such 
                numbers of children for all the States.
            ``(2) Other allotments.--
                    ``(A) Other entities.--For the purpose described in 
                subsection (b), the Secretary shall, for each of fiscal 
                years 2018 and 2019, for any State which has not 
                transmitted an application for the fiscal year under 
                section 505(a), allot to one or more entities in the 
                State the amount that would have been allotted to the 
                State under paragraph (1) if the State had submitted 
                such an application.
                    ``(B) Process.--The Secretary shall select the 
                recipients of allotments under subparagraph (A) by 
                means of a competitive grant process under which--
                            ``(i) not later than 30 days after the 
                        deadline for the State involved to submit an 
                        application for the fiscal year under section 
                        505(a), the Secretary publishes a notice 
                        soliciting grant applications; and
                            ``(ii) not later than 120 days after such 
                        deadline, all such applications must be 
                        submitted.
    ``(b) Purpose.--
            ``(1) In general.--Except for research under paragraph (5) 
        and information collection and reporting under paragraph (6), 
        the purpose of an allotment under subsection (a) to a State (or 
        to another entity in the State pursuant to subsection (a)(2)) 
        is to enable the State or other entity to implement education 
        exclusively on sexual risk avoidance (meaning voluntarily 
        refraining from sexual activity).
            ``(2) Required components.--Education on sexual risk 
        avoidance pursuant to an allotment under this section shall--
                    ``(A) ensure that the unambiguous and primary 
                emphasis and context for each topic described in 
                paragraph (3) is a message to youth that normalizes the 
                optimal health behavior of avoiding nonmarital sexual 
                activity;
                    ``(B) be medically accurate and complete;
                    ``(C) be age-appropriate;
                    ``(D) be based on adolescent learning and 
                developmental theories for the age group receiving the 
                education; and
                    ``(E) be culturally appropriate, recognizing the 
                experiences of youth from diverse communities, 
                backgrounds, and experiences.
            ``(3) Topics.--Education on sexual risk avoidance pursuant 
        to an allotment under this section shall address each of the 
        following topics:
                    ``(A) The holistic individual and societal benefits 
                associated with personal responsibility, self-
                regulation, goal setting, healthy decisionmaking, and a 
                focus on the future.
                    ``(B) The advantage of refraining from nonmarital 
                sexual activity in order to improve the future 
                prospects and physical and emotional health of youth.
                    ``(C) The increased likelihood of avoiding poverty 
                when youth attain self-sufficiency and emotional 
                maturity before engaging in sexual activity.
                    ``(D) The foundational components of healthy 
                relationships and their impact on the formation of 
                healthy marriages and safe and stable families.
                    ``(E) How other youth risk behaviors, such as drug 
                and alcohol usage, increase the risk for teen sex.
                    ``(F) How to resist and avoid, and receive help 
                regarding, sexual coercion and dating violence, 
                recognizing that even with consent teen sex remains a 
                youth risk behavior.
            ``(4) Contraception.--Education on sexual risk avoidance 
        pursuant to an allotment under this section shall ensure that--
                    ``(A) any information provided on contraception is 
                medically accurate and complete and ensures that 
                students understand that contraception offers physical 
                risk reduction, but not risk elimination; and
                    ``(B) the education does not include 
                demonstrations, simulations, or distribution of 
                contraceptive devices.
            ``(5) Research.--
                    ``(A) In general.--A State or other entity 
                receiving an allotment pursuant to subsection (a) may 
                use up to 20 percent of such allotment to build the 
                evidence base for sexual risk avoidance education by 
                conducting or supporting research.
                    ``(B) Requirements.--Any research conducted or 
                supported pursuant to subparagraph (A) shall be--
                            ``(i) rigorous;
                            ``(ii) evidence-based; and
                            ``(iii) designed and conducted by 
                        independent researchers who have experience in 
                        conducting and publishing research in peer-
                        reviewed outlets.
            ``(6) Information collection and reporting.--A State or 
        other entity receiving an allotment pursuant to subsection (a) 
        shall, as specified by the Secretary--
                    ``(A) collect information on the programs and 
                activities funded through the allotment; and
                    ``(B) submit reports to the Secretary on the data 
                from such programs and activities.
    ``(c) National Evaluation.--
            ``(1) In general.--The Secretary shall--
                    ``(A) in consultation with appropriate State and 
                local agencies, conduct one or more rigorous 
                evaluations of the education funded through this 
                section and associated data; and
                    ``(B) submit a report to the Congress on the 
                results of such evaluations, together with a summary of 
                the information collected pursuant to subsection 
                (b)(6).
            ``(2) Consultation.--In conducting the evaluations required 
        by paragraph (1), including the establishment of rigorous 
        evaluation methodologies, the Secretary shall consult with 
        relevant stakeholders and evaluation experts.
    ``(d) Applicability of Certain Provisions.--
            ``(1) Sections 503, 507, and 508 apply to allotments under 
        subsection (a) to the same extent and in the same manner as 
        such sections apply to allotments under section 502(c).
            ``(2) Sections 505 and 506 apply to allotments under 
        subsection (a) to the extent determined by the Secretary to be 
        appropriate.
    ``(e) Definitions.--In this section:
            ``(1) The term `age-appropriate' means suitable (in terms 
        of topics, messages, and teaching methods) to the developmental 
        and social maturity of the particular age or age group of 
        children or adolescents, based on developing cognitive, 
        emotional, and behavioral capacity typical for the age or age 
        group.
            ``(2) The term `medically accurate and complete' means 
        verified or supported by the weight of research conducted in 
        compliance with accepted scientific methods and--
                    ``(A) published in peer-reviewed journals, where 
                applicable; or
                    ``(B) comprising information that leading 
                professional organizations and agencies with relevant 
                expertise in the field recognize as accurate, 
                objective, and complete.
            ``(3) The term `rigorous', with respect to research or 
        evaluation, means using--
                    ``(A) established scientific methods for measuring 
                the impact of an intervention or program model in 
                changing behavior (specifically sexual activity or 
                other sexual risk behaviors), or reducing pregnancy, 
                among youth; or
                    ``(B) other evidence-based methodologies 
                established by the Secretary for purposes of this 
                section.
            ``(4) The term `youth' refers to one or more individuals 
        who have attained age 10 but not age 20.
    ``(f) Funding.--
            ``(1) In general.--To carry out this section, there is 
        appropriated, out of any money in the Treasury not otherwise 
        appropriated, $75,000,000 for each of fiscal years 2018 and 
        2019.
            ``(2) Reservation.--The Secretary shall reserve, for each 
        of fiscal years 2018 and 2019, not more than 20 percent of the 
        amount appropriated pursuant to paragraph (1) for administering 
        the program under this section, including the conducting of 
        national evaluations and the provision of technical assistance 
        to the recipients of allotments.''.
    (b) Effective Date.--The amendment made by this section takes 
effect on October 1, 2017.

SEC. 2505. EXTENSION FOR PERSONAL RESPONSIBILITY EDUCATION.

    (a) In General.--Section 513 of the Social Security Act (42 U.S.C. 
713) is amended--
            (1) in subsection (a)(1)(A), by striking ``2017'' and 
        inserting ``2019''; and
            (2) in subsection (a)(4)--
                    (A) in subparagraph (A), by striking ``2017'' each 
                place it appears and inserting ``2019''; and
                    (B) in subparagraph (B)--
                            (i) in the subparagraph heading, by 
                        striking ``3-year grants'' and inserting 
                        ``Competitive prep grants''; and
                            (ii) in clause (i), by striking ``solicit 
                        applications to award 3-year grants in each of 
                        fiscal years 2012 through 2017'' and inserting 
                        ``continue through fiscal year 2019 grants 
                        awarded for any of fiscal years 2015 through 
                        2017'';
            (3) in subsection (c)(1), by inserting after ``youth with 
        HIV/AIDS,'' the following: ``victims of human trafficking,''; 
        and
            (4) in subsection (f), by striking ``2017'' and inserting 
        ``2019''.
    (b) Effective Date.--The amendments made by this section take 
effect on October 1, 2017.

            TITLE VI--CHILD AND FAMILY SERVICES AND SUPPORT

            Subtitle A--Family First Prevention Services Act

SEC. 2601. SHORT TITLE.

    This subtitle may be cited as the ``Family First Prevention 
Services Act''.

         CHAPTER 1--INVESTING IN PREVENTION AND FAMILY SERVICES

SEC. 2611. PURPOSE.

    The purpose of this chapter is to enable States to use Federal 
funds available under parts B and E of title IV of the Social Security 
Act to provide enhanced support to children and families and prevent 
foster care placements through the provision of mental health and 
substance abuse prevention and treatment services, in-home parent 
skill-based programs, and kinship navigator services.

          Subchapter A--Prevention Activities Under Title IV-E

SEC. 2621. FOSTER CARE PREVENTION SERVICES AND PROGRAMS.

    (a) State Option.--Section 471 of the Social Security Act (42 
U.S.C. 671) is amended--
            (1) in subsection (a)(1), by striking ``and'' and all that 
        follows through the semicolon and inserting ``, adoption 
        assistance in accordance with section 473, and, at the option 
        of the State, services or programs specified in subsection 
        (e)(1) of this section for children who are candidates for 
        foster care or who are pregnant or parenting foster youth and 
        the parents or kin caregivers of the children, in accordance 
        with the requirements of that subsection;''; and
            (2) by adding at the end the following:
    ``(e) Prevention and Family Services and Programs.--
            ``(1) In general.--Subject to the succeeding provisions of 
        this subsection, the Secretary may make a payment to a State 
        for providing the following services or programs for a child 
        described in paragraph (2) and the parents or kin caregivers of 
        the child when the need of the child, such a parent, or such a 
        caregiver for the services or programs are directly related to 
        the safety, permanence, or well-being of the child or to 
        preventing the child from entering foster care:
                    ``(A) Mental health and substance abuse prevention 
                and treatment services.--Mental health and substance 
                abuse prevention and treatment services provided by a 
                qualified clinician for not more than a 12-month period 
                that begins on any date described in paragraph (3) with 
                respect to the child.
                    ``(B) In-home parent skill-based programs.--In-home 
                parent skill-based programs for not more than a 12-
                month period that begins on any date described in 
                paragraph (3) with respect to the child and that 
                include parenting skills training, parent education, 
                and individual and family counseling.
            ``(2) Child described.--For purposes of paragraph (1), a 
        child described in this paragraph is the following:
                    ``(A) A child who is a candidate for foster care 
                (as defined in section 475(13)) but can remain safely 
                at home or in a kinship placement with receipt of 
                services or programs specified in paragraph (1).
                    ``(B) A child in foster care who is a pregnant or 
                parenting foster youth.
            ``(3) Date described.--For purposes of paragraph (1), the 
        dates described in this paragraph are the following:
                    ``(A) The date on which a child is identified in a 
                prevention plan maintained under paragraph (4) as a 
                child who is a candidate for foster care (as defined in 
                section 475(13)).
                    ``(B) The date on which a child is identified in a 
                prevention plan maintained under paragraph (4) as a 
                pregnant or parenting foster youth in need of services 
                or programs specified in paragraph (1).
            ``(4) Requirements related to providing services and 
        programs.--Services and programs specified in paragraph (1) may 
        be provided under this subsection only if specified in advance 
        in the child's prevention plan described in subparagraph (A) 
        and the requirements in subparagraphs (B) through (E) are met:
                    ``(A) Prevention plan.--The State maintains a 
                written prevention plan for the child that meets the 
                following requirements (as applicable):
                            ``(i) Candidates.--In the case of a child 
                        who is a candidate for foster care described in 
                        paragraph (2)(A), the prevention plan shall--
                                    ``(I) identify the foster care 
                                prevention strategy for the child so 
                                that the child may remain safely at 
                                home, live temporarily with a kin 
                                caregiver until reunification can be 
                                safely achieved, or live permanently 
                                with a kin caregiver;
                                    ``(II) list the services or 
                                programs to be provided to or on behalf 
                                of the child to ensure the success of 
                                that prevention strategy; and
                                    ``(III) comply with such other 
                                requirements as the Secretary shall 
                                establish.
                            ``(ii) Pregnant or parenting foster 
                        youth.--In the case of a child who is a 
                        pregnant or parenting foster youth described in 
                        paragraph (2)(B), the prevention plan shall--
                                    ``(I) be included in the child's 
                                case plan required under section 
                                475(1);
                                    ``(II) list the services or 
                                programs to be provided to or on behalf 
                                of the youth to ensure that the youth 
                                is prepared (in the case of a pregnant 
                                foster youth) or able (in the case of a 
                                parenting foster youth) to be a parent;
                                    ``(III) describe the foster care 
                                prevention strategy for any child born 
                                to the youth; and
                                    ``(IV) comply with such other 
                                requirements as the Secretary shall 
                                establish.
                    ``(B) Trauma-informed.--The services or programs to 
                be provided to or on behalf of a child are provided 
                under an organizational structure and treatment 
                framework that involves understanding, recognizing, and 
                responding to the effects of all types of trauma and in 
                accordance with recognized principles of a trauma-
                informed approach and trauma-specific interventions to 
                address trauma's consequences and facilitate healing.
                    ``(C) Only services and programs provided in 
                accordance with promising, supported, or well-supported 
                practices permitted.--
                            ``(i) In general.--Only State expenditures 
                        for services or programs specified in 
                        subparagraph (A) or (B) of paragraph (1) that 
                        are provided in accordance with practices that 
                        meet the requirements specified in clause (ii) 
                        of this subparagraph and that meet the 
                        requirements specified in clause (iii), (iv), 
                        or (v), respectively, for being a promising, 
                        supported, or well-supported practice, shall be 
                        eligible for a Federal matching payment under 
                        section 474(a)(6)(A).
                            ``(ii) General practice requirements.--The 
                        general practice requirements specified in this 
                        clause are the following:
                                    ``(I) The practice has a book, 
                                manual, or other available writings 
                                that specify the components of the 
                                practice protocol and describe how to 
                                administer the practice.
                                    ``(II) There is no empirical basis 
                                suggesting that, compared to its likely 
                                benefits, the practice constitutes a 
                                risk of harm to those receiving it.
                                    ``(III) If multiple outcome studies 
                                have been conducted, the overall weight 
                                of evidence supports the benefits of 
                                the practice.
                                    ``(IV) Outcome measures are 
                                reliable and valid, and are 
                                administrated consistently and 
                                accurately across all those receiving 
                                the practice.
                                    ``(V) There is no case data 
                                suggesting a risk of harm that was 
                                probably caused by the treatment and 
                                that was severe or frequent.
                            ``(iii) Promising practice.--A practice 
                        shall be considered to be a `promising 
                        practice' if the practice is superior to an 
                        appropriate comparison practice using 
                        conventional standards of statistical 
                        significance (in terms of demonstrated 
                        meaningful improvements in validated measures 
                        of important child and parent outcomes, such as 
                        mental health, substance abuse, and child 
                        safety and well-being), as established by the 
                        results or outcomes of at least one study 
                        that--
                                    ``(I) was rated by an independent 
                                systematic review for the quality of 
                                the study design and execution and 
                                determined to be well-designed and 
                                well-executed; and
                                    ``(II) utilized some form of 
                                control (such as an untreated group, a 
                                placebo group, or a wait list study).
                            ``(iv) Supported practice.--A practice 
                        shall be considered to be a `supported 
                        practice' if--
                                    ``(I) the practice is superior to 
                                an appropriate comparison practice 
                                using conventional standards of 
                                statistical significance (in terms of 
                                demonstrated meaningful improvements in 
                                validated measures of important child 
                                and parent outcomes, such as mental 
                                health, substance abuse, and child 
                                safety and well-being), as established 
                                by the results or outcomes of at least 
                                one study that--
                                            ``(aa) was rated by an 
                                        independent systematic review 
                                        for the quality of the study 
                                        design and execution and 
                                        determined to be well-designed 
                                        and well-executed;
                                            ``(bb) was a rigorous 
                                        random-controlled trial (or, if 
                                        not available, a study using a 
                                        rigorous quasi-experimental 
                                        research design); and
                                            ``(cc) was carried out in a 
                                        usual care or practice setting; 
                                        and
                                    ``(II) the study described in 
                                subclause (I) established that the 
                                practice has a sustained effect (when 
                                compared to a control group) for at 
                                least 6 months beyond the end of the 
                                treatment.
                            ``(v) Well-supported practice.--A practice 
                        shall be considered to be a `well-supported 
                        practice' if--
                                    ``(I) the practice is superior to 
                                an appropriate comparison practice 
                                using conventional standards of 
                                statistical significance (in terms of 
                                demonstrated meaningful improvements in 
                                validated measures of important child 
                                and parent outcomes, such as mental 
                                health, substance abuse, and child 
                                safety and well-being), as established 
                                by the results or outcomes of at least 
                                two studies that--
                                            ``(aa) were rated by an 
                                        independent systematic review 
                                        for the quality of the study 
                                        design and execution and 
                                        determined to be well-designed 
                                        and well-executed;
                                            ``(bb) were rigorous 
                                        random-controlled trials (or, 
                                        if not available, studies using 
                                        a rigorous quasi-experimental 
                                        research design); and
                                            ``(cc) were carried out in 
                                        a usual care or practice 
                                        setting; and
                                    ``(II) at least one of the studies 
                                described in subclause (I) established 
                                that the practice has a sustained 
                                effect (when compared to a control 
                                group) for at least 1 year beyond the 
                                end of treatment.
                    ``(D) Guidance on practices criteria and pre-
                approved services and programs.--
                            ``(i) In general.--Not later than October 
                        1, 2018, the Secretary shall issue guidance to 
                        States regarding the practices criteria 
                        required for services or programs to satisfy 
                        the requirements of subparagraph (C). The 
                        guidance shall include a pre-approved list of 
                        services and programs that satisfy the 
                        requirements.
                            ``(ii) Updates.--The Secretary shall issue 
                        updates to the guidance required by clause (i) 
                        as often as the Secretary determines necessary.
                    ``(E) Outcome assessment and reporting.--The State 
                shall collect and report to the Secretary the following 
                information with respect to each child for whom, or on 
                whose behalf mental health and substance abuse 
                prevention and treatment services or in-home parent 
                skill-based programs are provided during a 12-month 
                period beginning on the date the child is determined by 
                the State to be a child described in paragraph (2):
                            ``(i) The specific services or programs 
                        provided and the total expenditures for each of 
                        the services or programs.
                            ``(ii) The duration of the services or 
                        programs provided.
                            ``(iii) In the case of a child described in 
                        paragraph (2)(A), the child's placement status 
                        at the beginning, and at the end, of the 1-year 
                        period, respectively, and whether the child 
                        entered foster care within 2 years after being 
                        determined a candidate for foster care.
            ``(5) State plan component.--
                    ``(A) In general.--A State electing to provide 
                services or programs specified in paragraph (1) shall 
                submit as part of the State plan required by subsection 
                (a) a prevention services and programs plan component 
                that meets the requirements of subparagraph (B).
                    ``(B) Prevention services and programs plan 
                component.--In order to meet the requirements of this 
                subparagraph, a prevention services and programs plan 
                component, with respect to each 5-year period for which 
                the plan component is in operation in the State, shall 
                include the following:
                            ``(i) How providing services and programs 
                        specified in paragraph (1) is expected to 
                        improve specific outcomes for children and 
                        families.
                            ``(ii) How the State will monitor and 
                        oversee the safety of children who receive 
                        services and programs specified in paragraph 
                        (1), including through periodic risk 
                        assessments throughout the period in which the 
                        services and programs are provided on behalf of 
                        a child and reexamination of the prevention 
                        plan maintained for the child under paragraph 
                        (4) for the provision of the services or 
                        programs if the State determines the risk of 
                        the child entering foster care remains high 
                        despite the provision of the services or 
                        programs.
                            ``(iii) With respect to the services and 
                        programs specified in subparagraphs (A) and (B) 
                        of paragraph (1), information on the specific 
                        promising, supported, or well-supported 
                        practices the State plans to use to provide the 
                        services or programs, including a description 
                        of--
                                    ``(I) the services or programs and 
                                whether the practices used are 
                                promising, supported, or well-
                                supported;
                                    ``(II) how the State plans to 
                                implement the services or programs, 
                                including how implementation of the 
                                services or programs will be 
                                continuously monitored to ensure 
                                fidelity to the practice model and to 
                                determine outcomes achieved and how 
                                information learned from the monitoring 
                                will be used to refine and improve 
                                practices;
                                    ``(III) how the State selected the 
                                services or programs;
                                    ``(IV) the target population for 
                                the services or programs; and
                                    ``(V) how each service or program 
                                provided will be evaluated through a 
                                well-designed and rigorous process, 
                                which may consist of an ongoing, cross-
                                site evaluation approved by the 
                                Secretary.
                            ``(iv) A description of the consultation 
                        that the State agencies responsible for 
                        administering the State plans under this part 
                        and part B engage in with other State agencies 
                        responsible for administering health programs, 
                        including mental health and substance abuse 
                        prevention and treatment services, and with 
                        other public and private agencies with 
                        experience in administering child and family 
                        services, including community-based 
                        organizations, in order to foster a continuum 
                        of care for children described in paragraph (2) 
                        and their parents or kin caregivers.
                            ``(v) A description of how the State shall 
                        assess children and their parents or kin 
                        caregivers to determine eligibility for 
                        services or programs specified in paragraph 
                        (1).
                            ``(vi) A description of how the services or 
                        programs specified in paragraph (1) that are 
                        provided for or on behalf of a child and the 
                        parents or kin caregivers of the child will be 
                        coordinated with other child and family 
                        services provided to the child and the parents 
                        or kin caregivers of the child under the State 
                        plans in effect under subparts 1 and 2 of part 
                        B.
                            ``(vii) Descriptions of steps the State is 
                        taking to support and enhance a competent, 
                        skilled, and professional child welfare 
                        workforce to deliver trauma-informed and 
                        evidence-based services, including--
                                    ``(I) ensuring that staff is 
                                qualified to provide services or 
                                programs that are consistent with the 
                                promising, supported, or well-supported 
                                practice models selected; and
                                    ``(II) developing appropriate 
                                prevention plans, and conducting the 
                                risk assessments required under clause 
                                (iii).
                            ``(viii) A description of how the State 
                        will provide training and support for 
                        caseworkers in assessing what children and 
                        their families need, connecting to the families 
                        served, knowing how to access and deliver the 
                        needed trauma-informed and evidence-based 
                        services, and overseeing and evaluating the 
                        continuing appropriateness of the services.
                            ``(ix) A description of how caseload size 
                        and type for prevention caseworkers will be 
                        determined, managed, and overseen.
                            ``(x) An assurance that the State will 
                        report to the Secretary such information and 
                        data as the Secretary may require with respect 
                        to the provision of services and programs 
                        specified in paragraph (1), including 
                        information and data necessary to determine the 
                        performance measures for the State under 
                        paragraph (6) and compliance with paragraph 
                        (7).
                    ``(C) Reimbursement for services under the 
                prevention plan component.--
                            ``(i) Limitation.--Except as provided in 
                        subclause (ii), a State may not receive a 
                        Federal payment under this part for a given 
                        promising, supported, or well-supported 
                        practice unless (in accordance with 
                        subparagraph (B)(iii)(V)) the plan includes a 
                        well-designed and rigorous evaluation strategy 
                        for that practice.
                            ``(ii) Waiver of limitation.--The Secretary 
                        may waive the requirement for a well-designed 
                        and rigorous evaluation of any well-supported 
                        practice if the Secretary deems the evidence of 
                        the effectiveness of the practice to be 
                        compelling and the State meets the continuous 
                        quality improvement requirements included in 
                        subparagraph (B)(iii)(II) with regard to the 
                        practice.
            ``(6) Prevention services measures.--
                    ``(A) Establishment; annual updates.--Beginning 
                with fiscal year 2021, and annually thereafter, the 
                Secretary shall establish the following prevention 
                services measures based on information and data 
                reported by States that elect to provide services and 
                programs specified in paragraph (1):
                            ``(i) Percentage of candidates for foster 
                        care who do not enter foster care.--The 
                        percentage of candidates for foster care for 
                        whom, or on whose behalf, the services or 
                        programs are provided who do not enter foster 
                        care, including those placed with a kin 
                        caregiver outside of foster care, during the 
                        12-month period in which the services or 
                        programs are provided and through the end of 
                        the succeeding 12-month period.
                            ``(ii) Per-child spending.--The total 
                        amount of expenditures made for mental health 
                        and substance abuse prevention and treatment 
                        services or in-home parent skill-based 
                        programs, respectively, for, or on behalf of, 
                        each child described in paragraph (2).
                    ``(B) Data.--The Secretary shall establish and 
                annually update the prevention services measures--
                            ``(i) based on the median State values of 
                        the information reported under each clause of 
                        subparagraph (A) for the 3 then most recent 
                        years; and
                            ``(ii) taking into account State 
                        differences in the price levels of consumption 
                        goods and services using the most recent 
                        regional price parities published by the Bureau 
                        of Economic Analysis of the Department of 
                        Commerce or such other data as the Secretary 
                        determines appropriate.
                    ``(C) Publication of state prevention services 
                measures.--The Secretary shall annually make available 
                to the public the prevention services measures of each 
                State.
            ``(7) Maintenance of effort for state foster care 
        prevention expenditures.--
                    ``(A) In general.--If a State elects to provide 
                services and programs specified in paragraph (1) for a 
                fiscal year, the State foster care prevention 
                expenditures for the fiscal year shall not be less than 
                the amount of the expenditures for fiscal year 2014 
                (or, at the option of a State described in subparagraph 
                (E), fiscal year 2015 or fiscal year 2016 (whichever 
                the State elects)).
                    ``(B) State foster care prevention expenditures.--
                The term `State foster care prevention expenditures' 
                means the following:
                            ``(i) TANF; iv-b; ssbg.--State expenditures 
                        for foster care prevention services and 
                        activities under the State program funded under 
                        part A (including from amounts made available 
                        by the Federal Government), under the State 
                        plan developed under part B (including any such 
                        amounts), or under the Social Services Block 
                        Grant Programs under subtitle A of title XX 
                        (including any such amounts).
                            ``(ii) Other state programs.--State 
                        expenditures for foster care prevention 
                        services and activities under any State program 
                        that is not described in clause (i) (other than 
                        any State expenditures for foster care 
                        prevention services and activities under the 
                        State program under this part (including under 
                        a waiver of the program)).
                    ``(C) State expenditures.--The term `State 
                expenditures' means all State or local funds that are 
                expended by the State or a local agency including State 
                or local funds that are matched or reimbursed by the 
                Federal Government and State or local funds that are 
                not matched or reimbursed by the Federal Government.
                    ``(D) Determination of prevention services and 
                activities.--The Secretary shall require each State 
                that elects to provide services and programs specified 
                in paragraph (1) to report the expenditures specified 
                in subparagraph (B) for fiscal year 2014 and for such 
                fiscal years thereafter as are necessary to determine 
                whether the State is complying with the maintenance of 
                effort requirement in subparagraph (A). The Secretary 
                shall specify the specific services and activities 
                under each program referred to in subparagraph (B) that 
                are `prevention services and activities' for purposes 
                of the reports.
                    ``(E) State described.--For purposes of 
                subparagraph (A), a State is described in this 
                subparagraph if the population of children in the State 
                in 2014 was less than 200,000 (as determined by the 
                Bureau of the Census).
            ``(8) Prohibition against use of state foster care 
        prevention expenditures and federal iv-e prevention funds for 
        matching or expenditure requirement.--A State that elects to 
        provide services and programs specified in paragraph (1) shall 
        not use any State foster care prevention expenditures for a 
        fiscal year for the State share of expenditures under section 
        474(a)(6) for a fiscal year.
            ``(9) Administrative costs.--Expenditures described in 
        section 474(a)(6)(B)--
                    ``(A) shall not be eligible for payment under 
                subparagraph (A), (B), or (E) of section 474(a)(3); and
                    ``(B) shall be eligible for payment under section 
                474(a)(6)(B) without regard to whether the expenditures 
                are incurred on behalf of a child who is, or is 
                potentially, eligible for foster care maintenance 
                payments under this part.
            ``(10) Application.--
                    ``(A) In general.--The provision of services or 
                programs under this subsection to or on behalf of a 
                child described in paragraph (2) shall not be 
                considered to be receipt of aid or assistance under the 
                State plan under this part for purposes of eligibility 
                for any other program established under this Act.
                    ``(B) Candidates in kinship care.--A child 
                described in paragraph (2) for whom such services or 
                programs under this subsection are provided for more 
                than 6 months while in the home of a kin caregiver, and 
                who would satisfy the AFDC eligibility requirement of 
                section 472(a)(3)(A)(ii)(II) but for residing in the 
                home of the caregiver for more than 6 months, is deemed 
                to satisfy that requirement for purposes of determining 
                whether the child is eligible for foster care 
                maintenance payments under section 472.''.
    (b) Definition.--Section 475 of such Act (42 U.S.C. 675) is amended 
by adding at the end the following:
            ``(13) The term `child who is a candidate for foster care' 
        means, a child who is identified in a prevention plan under 
        section 471(e)(4)(A) as being at imminent risk of entering 
        foster care (without regard to whether the child would be 
        eligible for foster care maintenance payments under section 472 
        or is or would be eligible for adoption assistance or kinship 
        guardianship assistance payments under section 473) but who can 
        remain safely in the child's home or in a kinship placement as 
        long as services or programs specified in section 471(e)(1) 
        that are necessary to prevent the entry of the child into 
        foster care are provided. The term includes a child whose 
        adoption or guardianship arrangement is at risk of a disruption 
        or dissolution that would result in a foster care placement.''.
    (c) Payments Under Title IV-E.--Section 474(a) of such Act (42 
U.S.C. 674(a)) is amended--
            (1) in paragraph (5), by striking the period at the end and 
        inserting ``; plus''; and
            (2) by adding at the end the following:
            ``(6) subject to section 471(e)--
                    ``(A) for each quarter--
                            ``(i) subject to clause (ii)--
                                    ``(I) beginning after September 30, 
                                2019, and before October 1, 2026, an 
                                amount equal to 50 percent of the total 
                                amount expended during the quarter for 
                                the provision of services or programs 
                                specified in subparagraph (A) or (B) of 
                                section 471(e)(1) that are provided in 
                                accordance with promising, supported, 
                                or well-supported practices that meet 
                                the applicable criteria specified for 
                                the practices in section 471(e)(4)(C); 
                                and
                                    ``(II) beginning after September 
                                30, 2026, an amount equal to the 
                                Federal medical assistance percentage 
                                (which shall be as defined in section 
                                1905(b), in the case of a State other 
                                than the District of Columbia, or 70 
                                percent, in the case of the District of 
                                Columbia) of the total amount expended 
                                during the quarter for the provision of 
                                services or programs specified in 
                                subparagraph (A) or (B) of section 
                                471(e)(1) that are provided in 
                                accordance with promising, supported, 
                                or well-supported practices that meet 
                                the applicable criteria specified for 
                                the practices in section 471(e)(4)(C) 
                                (or, with respect to the payments made 
                                during the quarter under a cooperative 
                                agreement or contract entered into by 
                                the State and an Indian tribe, tribal 
                                organization, or tribal consortium for 
                                the administration or payment of funds 
                                under this part, an amount equal to the 
                                Federal medical assistance percentage 
                                that would apply under section 479B(d) 
                                (in this paragraph referred to as the 
                                `tribal FMAP') if the Indian tribe, 
                                tribal organization, or tribal 
                                consortium made the payments under a 
                                program operated under that section, 
                                unless the tribal FMAP is less than the 
                                Federal medical assistance percentage 
                                that applies to the State); except that
                            ``(ii) not less than 50 percent of the 
                        total amount expended by a State under clause 
                        (i) for a fiscal year shall be for the 
                        provision of services or programs specified in 
                        subparagraph (A) or (B) of section 471(e)(1) 
                        that are provided in accordance with well-
                        supported practices; plus
                    ``(B) for each quarter specified in subparagraph 
                (A), an amount equal to the sum of the following 
                proportions of the total amount expended during the 
                quarter--
                            ``(i) 50 percent of so much of the 
                        expenditures as are found necessary by the 
                        Secretary for the proper and efficient 
                        administration of the State plan for the 
                        provision of services or programs specified in 
                        section 471(e)(1), including expenditures for 
                        activities approved by the Secretary that 
                        promote the development of necessary processes 
                        and procedures to establish and implement the 
                        provision of the services and programs for 
                        individuals who are eligible for the services 
                        and programs and expenditures attributable to 
                        data collection and reporting; and
                            ``(ii) 50 percent of so much of the 
                        expenditures with respect to the provision of 
                        services and programs specified in section 
                        471(e)(1) as are for training of personnel 
                        employed or preparing for employment by the 
                        State agency or by the local agency 
                        administering the plan in the political 
                        subdivision and of the members of the staff of 
                        State-licensed or State-approved child welfare 
                        agencies providing services to children 
                        described in section 471(e)(2) and their 
                        parents or kin caregivers, including on how to 
                        determine who are individuals eligible for the 
                        services or programs, how to identify and 
                        provide appropriate services and programs, and 
                        how to oversee and evaluate the ongoing 
                        appropriateness of the services and 
                        programs.''.
    (d) Technical Assistance and Best Practices, Clearinghouse, and 
Data Collection and Evaluations.--Section 476 of such Act (42 U.S.C. 
676) is amended by adding at the end the following:
    ``(d) Technical Assistance and Best Practices, Clearinghouse, Data 
Collection, and Evaluations Relating to Prevention Services and 
Programs.--
            ``(1) Technical assistance and best practices.--The 
        Secretary shall provide to States and, as applicable, to Indian 
        tribes, tribal organizations, and tribal consortia, technical 
        assistance regarding the provision of services and programs 
        described in section 471(e)(1) and shall disseminate best 
        practices with respect to the provision of the services and 
        programs, including how to plan and implement a well-designed 
        and rigorous evaluation of a promising, supported, or well-
        supported practice.
            ``(2) Clearinghouse of promising, supported, and well-
        supported practices.--The Secretary shall, directly or through 
        grants, contracts, or interagency agreements, evaluate research 
        on the practices specified in clauses (iii), (iv), and (v), 
        respectively, of section 471(e)(4)(C), and programs that meet 
        the requirements described in section 427(a)(1), including 
        culturally specific, or location- or population-based 
        adaptations of the practices, to identify and establish a 
        public clearinghouse of the practices that satisfy each 
        category described by such clauses. In addition, the 
        clearinghouse shall include information on the specific 
        outcomes associated with each practice, including whether the 
        practice has been shown to prevent child abuse and neglect and 
        reduce the likelihood of foster care placement by supporting 
        birth families and kinship families and improving targeted 
        supports for pregnant and parenting youth and their children.
            ``(3) Data collection and evaluations.--The Secretary, 
        directly or through grants, contracts, or interagency 
        agreements, may collect data and conduct evaluations with 
        respect to the provision of services and programs described in 
        section 471(e)(1) for purposes of assessing the extent to which 
        the provision of the services and programs--
                    ``(A) reduces the likelihood of foster care 
                placement;
                    ``(B) increases use of kinship care arrangements; 
                or
                    ``(C) improves child well-being.
            ``(4) Reports to congress.--
                    ``(A) In general.--The Secretary shall submit to 
                the Committee on Finance of the Senate and the 
                Committee on Ways and Means of the House of 
                Representatives periodic reports based on the provision 
                of services and programs described in section 471(e)(1) 
                and the activities carried out under this subsection.
                    ``(B) Public availability.--The Secretary shall 
                make the reports to the Congress submitted under this 
                paragraph publicly available.
            ``(5) Appropriation.--Out of any money in the Treasury of 
        the United States not otherwise appropriated, there are 
        appropriated to the Secretary $1,000,000 for fiscal year 2018 
        and each fiscal year thereafter to carry out this 
        subsection.''.
    (e) Application to Programs Operated by Indian Tribal 
Organizations.--
            (1) In general.--Section 479B of such Act (42 U.S.C. 679c) 
        is amended--
                    (A) in subsection (c)(1)--
                            (i) in subparagraph (C)(i)--
                                    (I) in subclause (II), by striking 
                                ``and'' after the semicolon;
                                    (II) in subclause (III), by 
                                striking the period at the end and 
                                inserting ``; and''; and
                                    (III) by adding at the end the 
                                following:
                                    ``(IV) at the option of the tribe, 
                                organization, or consortium, services 
                                and programs specified in section 
                                471(e)(1) to children described in 
                                section 471(e)(2) and their parents or 
                                kin caregivers, in accordance with 
                                section 471(e) and subparagraph (E).''; 
                                and
                            (ii) by adding at the end the following:
                    ``(E) Prevention services and programs for children 
                and their parents and kin caregivers.--
                            ``(i) In general.--In the case of a tribe, 
                        organization, or consortium that elects to 
                        provide services and programs specified in 
                        section 471(e)(1) to children described in 
                        section 471(e)(2) and their parents or kin 
                        caregivers under the plan, the Secretary shall 
                        specify the requirements applicable to the 
                        provision of the services and programs. The 
                        requirements shall, to the greatest extent 
                        practicable, be consistent with the 
                        requirements applicable to States under section 
                        471(e) and shall permit the provision of the 
                        services and programs in the form of services 
                        and programs that are adapted to the culture 
                        and context of the tribal communities served.
                            ``(ii) Performance measures.--The Secretary 
                        shall establish specific performance measures 
                        for each tribe, organization, or consortium 
                        that elects to provide services and programs 
                        specified in section 471(e)(1). The performance 
                        measures shall, to the greatest extent 
                        practicable, be consistent with the prevention 
                        services measures required for States under 
                        section 471(e)(6) but shall allow for 
                        consideration of factors unique to the 
                        provision of the services by tribes, 
                        organizations, or consortia.''; and
                    (B) in subsection (d)(1), by striking ``and (5)'' 
                and inserting ``(5), and (6)(A)''.
            (2) Conforming amendment.--The heading for subsection (d) 
        of section 479B of such Act (42 U.S.C. 679c) is amended by 
        striking ``for Foster Care Maintenance and Adoption Assistance 
        Payments''.
    (f) Application to Programs Operated by Territories.--Section 
1108(a)(2) of the Social Security Act (42 U.S.C. 1308(a)(2)) is amended 
by striking ``or 413(f)'' and inserting ``413(f), or 474(a)(6)''.

SEC. 2622. FOSTER CARE MAINTENANCE PAYMENTS FOR CHILDREN WITH PARENTS 
              IN A LICENSED RESIDENTIAL FAMILY-BASED TREATMENT FACILITY 
              FOR SUBSTANCE ABUSE.

    (a) In General.--Section 472 of the Social Security Act (42 U.S.C. 
672) is amended--
            (1) in subsection (a)(2)(C), by striking ``or'' and 
        inserting ``, with a parent residing in a licensed residential 
        family-based treatment facility, but only to the extent 
        permitted under subsection (j), or in a''; and
            (2) by adding at the end the following:
    ``(j) Children Placed With a Parent Residing in a Licensed 
Residential Family-based Treatment Facility for Substance Abuse.--
            ``(1) In general.--Notwithstanding the preceding provisions 
        of this section, a child who is eligible for foster care 
        maintenance payments under this section, or who would be 
        eligible for the payments if the eligibility were determined 
        without regard to paragraphs (1)(B) and (3) of subsection (a), 
        shall be eligible for the payments for a period of not more 
        than 12 months during which the child is placed with a parent 
        who is in a licensed residential family-based treatment 
        facility for substance abuse, but only if--
                    ``(A) the recommendation for the placement is 
                specified in the child's case plan before the 
                placement;
                    ``(B) the treatment facility provides, as part of 
                the treatment for substance abuse, parenting skills 
                training, parent education, and individual and family 
                counseling; and
                    ``(C) the substance abuse treatment, parenting 
                skills training, parent education, and individual and 
                family counseling is provided under an organizational 
                structure and treatment framework that involves 
                understanding, recognizing, and responding to the 
                effects of all types of trauma and in accordance with 
                recognized principles of a trauma-informed approach and 
                trauma-specific interventions to address the 
                consequences of trauma and facilitate healing.
            ``(2) Application.--With respect to children for whom 
        foster care maintenance payments are made under paragraph (1), 
        only the children who satisfy the requirements of paragraphs 
        (1)(B) and (3) of subsection (a) shall be considered to be 
        children with respect to whom foster care maintenance payments 
        are made under this section for purposes of subsection (h) or 
        section 473(b)(3)(B).''.
    (b) Conforming Amendment.--Section 474(a)(1) of such Act (42 U.S.C. 
674(a)(1)) is amended by inserting ``subject to section 472(j),'' 
before ``an amount equal to the Federal'' the first place it appears.

SEC. 2623. TITLE IV-E PAYMENTS FOR EVIDENCE-BASED KINSHIP NAVIGATOR 
              PROGRAMS.

    Section 474(a) of the Social Security Act (42 U.S.C. 674(a)), as 
amended by section 2621(c) of this Act, is amended--
            (1) in paragraph (6), by striking the period at the end and 
        inserting ``; plus''; and
            (2) by adding at the end the following:
            ``(7) an amount equal to 50 percent of the amounts expended 
        by the State during the quarter as the Secretary determines are 
        for kinship navigator programs that meet the requirements 
        described in section 427(a)(1) and that the Secretary 
        determines are operated in accordance with promising, 
        supported, or well-supported practices that meet the applicable 
        criteria specified for the practices in section 471(e)(4)(C), 
        without regard to whether the expenditures are incurred on 
        behalf of children who are, or are potentially, eligible for 
        foster care maintenance payments under this part.''.

            Subchapter B--Enhanced Support Under Title IV-B

SEC. 2631. ELIMINATION OF TIME LIMIT FOR FAMILY REUNIFICATION SERVICES 
              WHILE IN FOSTER CARE AND PERMITTING TIME-LIMITED FAMILY 
              REUNIFICATION SERVICES WHEN A CHILD RETURNS HOME FROM 
              FOSTER CARE.

    (a) In General.--Section 431(a)(7) of the Social Security Act (42 
U.S.C. 629a(a)(7)) is amended--
            (1) in the paragraph heading, by striking ``Time-limited 
        family'' and inserting ``Family''; and
            (2) in subparagraph (A)--
                    (A) by striking ``time-limited family'' and 
                inserting ``family'';
                    (B) by inserting ``or a child who has been returned 
                home'' after ``child care institution''; and
                    (C) by striking ``, but only during the 15-month 
                period that begins on the date that the child, pursuant 
                to section 475(5)(F), is considered to have entered 
                foster care'' and inserting ``and to ensure the 
                strength and stability of the reunification. In the 
                case of a child who has been returned home, the 
                services and activities shall only be provided during 
                the 15-month period that begins on the date that the 
                child returns home''.
    (b) Conforming Amendments.--
            (1) Section 430 of such Act (42 U.S.C. 629) is amended in 
        the matter preceding paragraph (1), by striking ``time-
        limited''.
            (2) Subsections (a)(4), (a)(5)(A), and (b)(1) of section 
        432 of such Act (42 U.S.C. 629b) are amended by striking 
        ``time-limited'' each place it appears.

SEC. 2632. REDUCING BUREAUCRACY AND UNNECESSARY DELAYS WHEN PLACING 
              CHILDREN IN HOMES ACROSS STATE LINES.

    (a) State Plan Requirement.--
            (1) In general.--Section 471(a)(25) of the Social Security 
        Act (42 U.S.C. 671(a)(25)) is amended--
                    (A) by striking ``provide'' and inserting 
                ``provides''; and
                    (B) by inserting ``, which, in the case of a State 
                other than the Commonwealth of Puerto Rico, the United 
                States Virgin Islands, Guam, and American Samoa, not 
                later than October 1, 2027, shall include the use of an 
                electronic interstate case-processing system'' before 
                the first semicolon.
            (2) Exemption of indian tribes.--Section 479B(c) of such 
        Act (42 U.S.C. 679c(c)) is amended by adding at the end the 
        following:
            ``(4) Inapplicability of state plan requirement to have in 
        effect procedures providing for the use of an electronic 
        interstate case-processing system.--The requirement in section 
        471(a)(25) that a State plan provide that the State shall have 
        in effect procedures providing for the use of an electronic 
        interstate case-processing system shall not apply to an Indian 
        tribe, tribal organization, or tribal consortium that elects to 
        operate a program under this part.''.
    (b) Funding for the Development of an Electronic Interstate Case-
processing System to Expedite the Interstate Placement of Children in 
Foster Care or Guardianship, or for Adoption.--Section 437 of such Act 
(42 U.S.C. 629g) is amended by adding at the end the following:
    ``(g) Funding for the Development of an Electronic Interstate Case-
processing System to Expedite the Interstate Placement of Children in 
Foster Care or Guardianship, or for Adoption.--
            ``(1) Purpose.--The purpose of this subsection is to 
        facilitate the development of an electronic interstate case-
        processing system for the exchange of data and documents to 
        expedite the placements of children in foster, guardianship, or 
        adoptive homes across State lines.
            ``(2) Requirements.--A State that seeks funding under this 
        subsection shall submit to the Secretary the following 
        information:
                    ``(A) A description of the goals and outcomes to be 
                achieved, which goals and outcomes must result in--
                            ``(i) reducing the time it takes for a 
                        child to be provided with a safe and 
                        appropriate permanent living arrangement across 
                        State lines;
                            ``(ii) improving administrative processes 
                        and reducing costs in the foster care system; 
                        and
                            ``(iii) the secure exchange of relevant 
                        case files and other necessary materials in 
                        real time, and timely communications and 
                        placement decisions regarding interstate 
                        placements of children.
                    ``(B) A description of the activities to be funded 
                in whole or in part with the funds, including the 
                sequencing of the activities.
                    ``(C) A description of the strategies for 
                integrating programs and services for children who are 
                placed across State lines.
                    ``(D) Such other information as the Secretary may 
                require.
            ``(3) Funding authority.--The Secretary may provide funds 
        to a State that complies with paragraph (2). In providing funds 
        under this subsection, the Secretary shall prioritize States 
        that are not yet connected with the electronic interstate case-
        processing system referred to in paragraph (1).
            ``(4) Use of funds.--A State to which funding is provided 
        under this subsection shall use the funding to support the 
        State in connecting with, or enhancing or expediting services 
        provided under, the electronic interstate case-processing 
        system referred to in paragraph (1).
            ``(5) Evaluations.--Not later than 1 year after the final 
        year in which funds are awarded under this subsection, the 
        Secretary shall submit to the Congress, and make available to 
        the general public by posting on a website, a report that 
        contains the following information:
                    ``(A) How using the electronic interstate case-
                processing system developed pursuant to paragraph (4) 
                has changed the time it takes for children to be placed 
                across State lines.
                    ``(B) The number of cases subject to the Interstate 
                Compact on the Placement of Children that were 
                processed through the electronic interstate case-
                processing system, and the number of interstate child 
                placement cases that were processed outside the 
                electronic interstate case-processing system, by each 
                State in each year.
                    ``(C) The progress made by States in implementing 
                the electronic interstate case-processing system.
                    ``(D) How using the electronic interstate case-
                processing system has affected various metrics related 
                to child safety and well-being, including the time it 
                takes for children to be placed across State lines.
                    ``(E) How using the electronic interstate case-
                processing system has affected administrative costs and 
                caseworker time spent on placing children across State 
                lines.
            ``(6) Data integration.--The Secretary, in consultation 
        with the Secretariat for the Interstate Compact on the 
        Placement of Children and the States, shall assess how the 
        electronic interstate case-processing system developed pursuant 
        to paragraph (4) could be used to better serve and protect 
        children that come to the attention of the child welfare 
        system, by--
                    ``(A) connecting the system with other data systems 
                (such as systems operated by State law enforcement and 
                judicial agencies, systems operated by the Federal 
                Bureau of Investigation for the purposes of the 
                Innocence Lost National Initiative, and other systems);
                    ``(B) simplifying and improving reporting related 
                to paragraphs (34) and (35) of section 471(a) regarding 
                children or youth who have been identified as being a 
                sex trafficking victim or children missing from foster 
                care; and
                    ``(C) improving the ability of States to quickly 
                comply with background check requirements of section 
                471(a)(20), including checks of child abuse and neglect 
                registries as required by section 471(a)(20)(B).''.
    (c) Reservation of Funds to Improve the Interstate Placement of 
Children.--Section 437(b) of such Act (42 U.S.C. 629g(b)) is amended by 
adding at the end the following:
            ``(4) Improving the interstate placement of children.--The 
        Secretary shall reserve $5,000,000 of the amount made available 
        for fiscal year 2018 for grants under subsection (g), and the 
        amount so reserved shall remain available through fiscal year 
        2022.''.

SEC. 2633. ENHANCEMENTS TO GRANTS TO IMPROVE WELL-BEING OF FAMILIES 
              AFFECTED BY SUBSTANCE ABUSE.

    Section 437(f) of the Social Security Act (42 U.S.C. 629g(f)) is 
amended--
            (1) in the subsection heading, by striking ``Increase the 
        Well-being of, and to Improve the Permanency Outcomes for, 
        Children Affected by'' and inserting ``Implement IV-E 
        Prevention Services, and Improve the Well-being of, and Improve 
        Permanency Outcomes for, Children and Families Affected by 
        Heroin, Opioids, and Other'';
            (2) by striking paragraph (2) and inserting the following:
            ``(2) Regional partnership defined.--In this subsection, 
        the term `regional partnership' means a collaborative agreement 
        (which may be established on an interstate, State, or 
        intrastate basis) entered into by the following:
                    ``(A) Mandatory partners for all partnership 
                grants.--
                            ``(i) The State child welfare agency that 
                        is responsible for the administration of the 
                        State plan under this part and part E.
                            ``(ii) The State agency responsible for 
                        administering the substance abuse prevention 
                        and treatment block grant provided under 
                        subpart II of part B of title XIX of the Public 
                        Health Service Act.
                    ``(B) Mandatory partners for partnership grants 
                proposing to serve children in out-of-home 
                placements.--If the partnership proposes to serve 
                children in out-of-home placements, the Juvenile Court 
                or Administrative Office of the Court that is most 
                appropriate to oversee the administration of court 
                programs in the region to address the population of 
                families who come to the attention of the court due to 
                child abuse or neglect.
                    ``(C) Optional partners.--At the option of the 
                partnership, any of the following:
                            ``(i) An Indian tribe or tribal consortium.
                            ``(ii) Nonprofit child welfare service 
                        providers.
                            ``(iii) For-profit child welfare service 
                        providers.
                            ``(iv) Community health service providers, 
                        including substance abuse treatment providers.
                            ``(v) Community mental health providers.
                            ``(vi) Local law enforcement agencies.
                            ``(vii) School personnel.
                            ``(viii) Tribal child welfare agencies (or 
                        a consortia of the agencies).
                            ``(ix) Any other providers, agencies, 
                        personnel, officials, or entities that are 
                        related to the provision of child and family 
                        services under a State plan approved under this 
                        subpart.
                    ``(D) Exception for regional partnerships where the 
                lead applicant is an indian tribe or tribal 
                consortia.--If an Indian tribe or tribal consortium 
                enters into a regional partnership for purposes of this 
                subsection, the Indian tribe or tribal consortium--
                            ``(i) may (but is not required to) include 
                        the State child welfare agency as a partner in 
                        the collaborative agreement;
                            ``(ii) may not enter into a collaborative 
                        agreement only with tribal child welfare 
                        agencies (or a consortium of the agencies); and
                            ``(iii) if the condition described in 
                        paragraph (2)(B) applies, may include tribal 
                        court organizations in lieu of other judicial 
                        partners.'';
            (3) in paragraph (3)--
                    (A) in subparagraph (A)--
                            (i) by striking ``2012 through 2016'' and 
                        inserting ``2017 through 2021''; and
                            (ii) by striking ``$500,000 and not more 
                        than $1,000,000'' and inserting ``$250,000 and 
                        not more than $1,000,000'';
                    (B) in subparagraph (B)--
                            (i) in the subparagraph heading, by 
                        inserting ``; planning'' after ``approval'';
                            (ii) in clause (i), by striking ``clause 
                        (ii)'' and inserting ``clauses (ii) and 
                        (iii)''; and
                            (iii) by adding at the end the following:
                            ``(iii) Sufficient planning.--A grant 
                        awarded under this subsection shall be 
                        disbursed in two phases: a planning phase (not 
                        to exceed 2 years) and an implementation phase. 
                        The total disbursement to a grantee for the 
                        planning phase may not exceed $250,000, and may 
                        not exceed the total anticipated funding for 
                        the implementation phase.''; and
                    (C) by adding at the end the following:
                    ``(D) Limitation on payment for a fiscal year.--No 
                payment shall be made under subparagraph (A) or (C) for 
                a fiscal year until the Secretary determines that the 
                eligible partnership has made sufficient progress in 
                meeting the goals of the grant and that the members of 
                the eligible partnership are coordinating to a 
                reasonable degree with the other members of the 
                eligible partnership.'';
            (4) in paragraph (4)--
                    (A) in subparagraph (B)--
                            (i) in clause (i), by inserting ``, 
                        parents, and families'' after ``children'';
                            (ii) in clause (ii), by striking ``safety 
                        and permanence for such children; and'' and 
                        inserting ``safe, permanent caregiving 
                        relationships for the children;'';
                            (iii) in clause (iii), by striking ``or'' 
                        and inserting ``increase reunification rates 
                        for children who have been placed in out-of-
                        home care, or decrease''; and
                            (iv) by redesignating clause (iii) as 
                        clause (v) and inserting after clause (ii) the 
                        following:
                            ``(iii) improve the substance abuse 
                        treatment outcomes for parents including 
                        retention in treatment and successful 
                        completion of treatment;
                            ``(iv) facilitate the implementation, 
                        delivery, and effectiveness of prevention 
                        services and programs under section 471(e); 
                        and'';
                    (B) in subparagraph (D), by striking ``where 
                appropriate,''; and
                    (C) by striking subparagraphs (E) and (F) and 
                inserting the following:
                    ``(E) A description of a plan for sustaining the 
                services provided by or activities funded under the 
                grant after the conclusion of the grant period, 
                including through the use of prevention services and 
                programs under section 471(e) and other funds provided 
                to the State for child welfare and substance abuse 
                prevention and treatment services.
                    ``(F) Additional information needed by the 
                Secretary to determine that the proposed activities and 
                implementation will be consistent with research or 
                evaluations showing which practices and approaches are 
                most effective.'';
            (5) in paragraph (5)(A), by striking ``abuse treatment'' 
        and inserting ``use disorder treatment including medication 
        assisted treatment and in-home substance abuse disorder 
        treatment and recovery'';
            (6) in paragraph (7)--
                    (A) by striking ``and'' at the end of subparagraph 
                (C); and
                    (B) by redesignating subparagraph (D) as 
                subparagraph (E) and inserting after subparagraph (C) 
                the following:
                    ``(D) demonstrate a track record of successful 
                collaboration among child welfare, substance abuse 
                disorder treatment and mental health agencies; and'';
            (7) in paragraph (8)--
                    (A) in subparagraph (A)--
                            (i) by striking ``establish indicators that 
                        will be'' and inserting ``review indicators 
                        that are''; and
                            (ii) by striking ``in using funds made 
                        available under such grants to achieve the 
                        purpose of this subsection'' and inserting 
                        ``and establish a set of core indicators 
                        related to child safety, parental recovery, 
                        parenting capacity, and family well-being. In 
                        developing the core indicators, to the extent 
                        possible, indicators shall be made consistent 
                        with the outcome measures described in section 
                        471(e)(6)''; and
                    (B) in subparagraph (B)--
                            (i) in the matter preceding clause (i), by 
                        inserting ``base the performance measures on 
                        lessons learned from prior rounds of regional 
                        partnership grants under this subsection, and'' 
                        before ``consult''; and
                            (ii) by striking clauses (iii) and (iv) and 
                        inserting the following:
                            ``(iii) Other stakeholders or 
                        constituencies as determined by the 
                        Secretary.'';
            (8) in paragraph (9)(A), by striking clause (i) and 
        inserting the following:
                            ``(i) Semiannual reports.--Not later than 
                        September 30 of each fiscal year in which a 
                        recipient of a grant under this subsection is 
                        paid funds under the grant, and every 6 months 
                        thereafter, the grant recipient shall submit to 
                        the Secretary a report on the services provided 
                        and activities carried out during the reporting 
                        period, progress made in achieving the goals of 
                        the program, the number of children, adults, 
                        and families receiving services, and such 
                        additional information as the Secretary 
                        determines is necessary. The report due not 
                        later than September 30 of the last such fiscal 
                        year shall include, at a minimum, data on each 
                        of the performance indicators included in the 
                        evaluation of the regional partnership.''; and
            (9) in paragraph (10), by striking ``2012 through 2016'' 
        and inserting ``2017 through 2021''.

                      Subchapter C--Miscellaneous

SEC. 2641. REVIEWING AND IMPROVING LICENSING STANDARDS FOR PLACEMENT IN 
              A RELATIVE FOSTER FAMILY HOME.

    (a) Identification of Reputable Model Licensing Standards.--Not 
later than October 1, 2018, the Secretary of Health and Human Services 
shall identify reputable model licensing standards with respect to the 
licensing of foster family homes (as defined in section 472(c)(1) of 
the Social Security Act).
    (b) State Plan Requirement.--Section 471(a) of the Social Security 
Act (42 U.S.C. 671(a)) is amended--
            (1) in paragraph (34)(B), by striking ``and'' after the 
        semicolon;
            (2) in paragraph (35)(B), by striking the period at the end 
        and inserting a semicolon; and
            (3) by adding at the end the following:
            ``(36) provides that, not later than April 1, 2019, the 
        State shall submit to the Secretary information addressing--
                    ``(A) whether the State licensing standards are in 
                accord with model standards identified by the 
                Secretary, and if not, the reason for the specific 
                deviation and a description as to why having a standard 
                that is reasonably in accord with the corresponding 
                national model standards is not appropriate for the 
                State;
                    ``(B) whether the State has elected to waive 
                standards established in 471(a)(10)(A) for relative 
                foster family homes (pursuant to waiver authority 
                provided by 471(a)(10)(D)), a description of which 
                standards the State most commonly waives, and if the 
                State has not elected to waive the standards, the 
                reason for not waiving these standards;
                    ``(C) if the State has elected to waive standards 
                specified in subparagraph (B), how caseworkers are 
                trained to use the waiver authority and whether the 
                State has developed a process or provided tools to 
                assist caseworkers in waiving nonsafety standards per 
                the authority provided in 471(a)(10)(D) to quickly 
                place children with relatives; and
                    ``(D) a description of the steps the State is 
                taking to improve caseworker training or the process, 
                if any; and''.

SEC. 2642. DEVELOPMENT OF A STATEWIDE PLAN TO PREVENT CHILD ABUSE AND 
              NEGLECT FATALITIES.

    Section 422(b)(19) of the Social Security Act (42 U.S.C. 
622(b)(19)) is amended to read as follows:
            ``(19) document steps taken to track and prevent child 
        maltreatment deaths by including--
                    ``(A) a description of the steps the State is 
                taking to compile complete and accurate information on 
                the deaths required by Federal law to be reported by 
                the State agency referred to in paragraph (1), 
                including gathering relevant information on the deaths 
                from the relevant organizations in the State including 
                entities such as State vital statistics department, 
                child death review teams, law enforcement agencies, 
                offices of medical examiners, or coroners; and
                    ``(B) a description of the steps the State is 
                taking to develop and implement a comprehensive, 
                statewide plan to prevent the fatalities that involves 
                and engages relevant public and private agency 
                partners, including those in public health, law 
                enforcement, and the courts.''.

SEC. 2643. MODERNIZING THE TITLE AND PURPOSE OF TITLE IV-E.

    (a) Part Heading.--The heading for part E of title IV of the Social 
Security Act (42 U.S.C. 670 et seq.) is amended to read as follows:

      ``PART E--FEDERAL PAYMENTS FOR FOSTER CARE, PREVENTION, AND 
                             PERMANENCY''.

    (b) Purpose.--The first sentence of section 470 of such Act (42 
U.S.C. 670) is amended--
            (1) by striking ``1995) and'' and inserting ``1995),'';
            (2) by inserting ``kinship guardianship assistance, and 
        prevention services or programs specified in section 
        471(e)(1),'' after ``needs,''; and
            (3) by striking ``(commencing with the fiscal year which 
        begins October 1, 1980)''.

SEC. 2644. EFFECTIVE DATES.

    (a) Effective Dates.--
            (1) In general.--Except as provided in paragraph (2), 
        subject to subsection (b), the amendments made by this chapter 
        shall take effect on October 1, 2018.
            (2) Exceptions.--The amendments made by sections 2621(d), 
        2641, and 2643 shall take effect on the date of enactment of 
        this Act.
    (b) Transition Rule.--
            (1) In general.--In the case of a State plan under part B 
        or E of title IV of the Social Security Act which the Secretary 
        of Health and Human Services determines requires State 
        legislation (other than legislation appropriating funds) in 
        order for the plan to meet the additional requirements imposed 
        by the amendments made by this chapter, the State plan shall 
        not be regarded as failing to comply with the requirements of 
        such part solely on the basis of the failure of the plan to 
        meet such additional requirements before the first day of the 
        first calendar quarter beginning after the close of the first 
        regular session of the State legislature that begins after the 
        date of enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of the session shall be deemed to be a 
        separate regular session of the State legislature.
            (2) Application to programs operated by indian tribal 
        organizations.--In the case of an Indian tribe, tribal 
        organization, or tribal consortium which the Secretary of 
        Health and Human Services determines requires time to take 
        action necessary to comply with the additional requirements 
        imposed by the amendments made by this chapter (whether the 
        tribe, organization, or tribal consortium has a plan under 
        section 479B of the Social Security Act or a cooperative 
        agreement or contract entered into with a State), the Secretary 
        shall provide the tribe, organization, or tribal consortium 
        with such additional time as the Secretary determines is 
        necessary for the tribe, organization, or tribal consortium to 
        take the action to comply with the additional requirements 
        before being regarded as failing to comply with the 
        requirements.

   CHAPTER 2--ENSURING THE NECESSITY OF A PLACEMENT THAT IS NOT IN A 
                           FOSTER FAMILY HOME

SEC. 2651. LIMITATION ON FEDERAL FINANCIAL PARTICIPATION FOR PLACEMENTS 
              THAT ARE NOT IN FOSTER FAMILY HOMES.

    (a) Limitation on Federal Financial Participation.--
            (1) In general.--Section 472 of the Social Security Act (42 
        U.S.C. 672), as amended by section 2622 of this Act, is 
        amended--
                    (A) in subsection (a)(2)(C), by inserting ``, but 
                only to the extent permitted under subsection (k)'' 
                after ``institution''; and
                    (B) by adding at the end the following:
    ``(k) Limitation on Federal Financial Participation.--
            ``(1) In general.--Beginning with the third week for which 
        foster care maintenance payments are made under this section on 
        behalf of a child placed in a child-care institution, no 
        Federal payment shall be made to the State under section 
        474(a)(1) for amounts expended for foster care maintenance 
        payments on behalf of the child unless--
                    ``(A) the child is placed in a child-care 
                institution that is a setting specified in paragraph 
                (2) (or is placed in a licensed residential family-
                based treatment facility consistent with subsection 
                (j)); and
                    ``(B) in the case of a child placed in a qualified 
                residential treatment program (as defined in paragraph 
                (4)), the requirements specified in paragraph (3) and 
                section 475A(c) are met.
            ``(2) Specified settings for placement.--The settings for 
        placement specified in this paragraph are the following:
                    ``(A) A qualified residential treatment program (as 
                defined in paragraph (4)).
                    ``(B) A setting specializing in providing prenatal, 
                post-partum, or parenting supports for youth.
                    ``(C) In the case of a child who has attained 18 
                years of age, a supervised setting in which the child 
                is living independently.
                    ``(D) A setting providing high-quality residential 
                care and supportive services to children and youth who 
                have been found to be, or are at risk of becoming, sex 
                trafficking victims, in accordance with section 
                471(a)(9)(C).
            ``(3) Assessment to determine appropriateness of placement 
        in a qualified residential treatment program.--
                    ``(A) Deadline for assessment.--In the case of a 
                child who is placed in a qualified residential 
                treatment program, if the assessment required under 
                section 475A(c)(1) is not completed within 30 days 
                after the placement is made, no Federal payment shall 
                be made to the State under section 474(a)(1) for any 
                amounts expended for foster care maintenance payments 
                on behalf of the child during the placement.
                    ``(B) Deadline for transition out of placement.--If 
                the assessment required under section 475A(c)(1) 
                determines that the placement of a child in a qualified 
                residential treatment program is not appropriate, a 
                court disapproves such a placement under section 
                475A(c)(2), or a child who has been in an approved 
                placement in a qualified residential treatment program 
                is going to return home or be placed with a fit and 
                willing relative, a legal guardian, or an adoptive 
                parent, or in a foster family home, Federal payments 
                shall be made to the State under section 474(a)(1) for 
                amounts expended for foster care maintenance payments 
                on behalf of the child while the child remains in the 
                qualified residential treatment program only during the 
                period necessary for the child to transition home or to 
                such a placement. In no event shall a State receive 
                Federal payments under section 474(a)(1) for amounts 
                expended for foster care maintenance payments on behalf 
                of a child who remains placed in a qualified 
                residential treatment program after the end of the 30-
                day period that begins on the date a determination is 
                made that the placement is no longer the recommended or 
                approved placement for the child.
            ``(4) Qualified residential treatment program.--For 
        purposes of this part, the term `qualified residential 
        treatment program' means a program that--
                    ``(A) has a trauma-informed treatment model that is 
                designed to address the needs, including clinical needs 
                as appropriate, of children with serious emotional or 
                behavioral disorders or disturbances and, with respect 
                to a child, is able to implement the treatment 
                identified for the child by the assessment of the child 
                required under section 475A(c);
                    ``(B) subject to paragraphs (5) and (6), has 
                registered or licensed nursing staff and other licensed 
                clinical staff who--
                            ``(i) provide care within the scope of 
                        their practice as defined by State law;
                            ``(ii) are on-site in accordance with the 
                        treatment model referred to in subparagraph 
                        (A); and
                            ``(iii) are available 24 hours a day and 7 
                        days a week;
                    ``(C) to extent appropriate, and in accordance with 
                the child's best interests, facilitates participation 
                of family members in the child's treatment program;
                    ``(D) facilitates outreach to the family members of 
                the child, including siblings, documents how the 
                outreach is made (including contact information), and 
                maintains contact information for any known biological 
                family and fictive kin of the child;
                    ``(E) documents how family members are integrated 
                into the treatment process for the child, including 
                post-discharge, and how sibling connections are 
                maintained;
                    ``(F) provides discharge planning and family-based 
                aftercare support for at least 6 months post-discharge; 
                and
                    ``(G) is licensed in accordance with section 
                471(a)(10) and is accredited by any of the following 
                independent, not-for-profit organizations:
                            ``(i) The Commission on Accreditation of 
                        Rehabilitation Facilities (CARF).
                            ``(ii) The Joint Commission on 
                        Accreditation of Healthcare Organizations 
                        (JCAHO).
                            ``(iii) The Council on Accreditation (COA).
                            ``(iv) Any other independent, not-for-
                        profit accrediting organization approved by the 
                        Secretary.
            ``(5) Administrative costs.--The prohibition in paragraph 
        (1) on Federal payments under section 474(a)(1) shall not be 
        construed as prohibiting Federal payments for administrative 
        expenditures incurred on behalf of a child placed in a child-
        care institution and for which payment is available under 
        section 474(a)(3).
            ``(6) Rule of construction.--The requirements in paragraph 
        (4)(B) shall not be construed as requiring a qualified 
        residential treatment program to acquire nursing and behavioral 
        health staff solely through means of a direct employer to 
        employee relationship.''.
            (2) Conforming amendment.--Section 474(a)(1) of such Act 
        (42 U.S.C. 674(a)(1)), as amended by section 2622(b) of this 
        Act, is amended by striking ``section 472(j)'' and inserting 
        ``subsections (j) and (k) of section 472''.
    (b) Definition of Foster Family Home, Child-care Institution.--
Section 472(c) of such Act (42 U.S.C. 672(c)(1)) is amended to read as 
follows:
    ``(c) Definitions.--For purposes of this part:
            ``(1) Foster family home.--
                    ``(A) In general.--The term `foster family home' 
                means the home of an individual or family--
                            ``(i) that is licensed or approved by the 
                        State in which it is situated as a foster 
                        family home that meets the standards 
                        established for the licensing or approval; and
                            ``(ii) in which a child in foster care has 
                        been placed in the care of an individual, who 
                        resides with the child and who has been 
                        licensed or approved by the State to be a 
                        foster parent--
                                    ``(I) that the State deems capable 
                                of adhering to the reasonable and 
                                prudent parent standard;
                                    ``(II) that provides 24-hour 
                                substitute care for children placed 
                                away from their parents or other 
                                caretakers; and
                                    ``(III) that provides the care for 
                                not more than six children in foster 
                                care.
                    ``(B) State flexibility.--The number of foster 
                children that may be cared for in a home under 
                subparagraph (A) may exceed the numerical limitation in 
                subparagraph (A)(ii)(III), at the option of the State, 
                for any of the following reasons:
                            ``(i) To allow a parenting youth in foster 
                        care to remain with the child of the parenting 
                        youth.
                            ``(ii) To allow siblings to remain 
                        together.
                            ``(iii) To allow a child with an 
                        established meaningful relationship with the 
                        family to remain with the family.
                            ``(iv) To allow a family with special 
                        training or skills to provide care to a child 
                        who has a severe disability.
                    ``(C) Rule of construction.--Subparagraph (A) shall 
                not be construed as prohibiting a foster parent from 
                renting the home in which the parent cares for a foster 
                child placed in the parent's care.
            ``(2) Child-care institution.--
                    ``(A) In general.--The term `child-care 
                institution' means a private child-care institution, or 
                a public child-care institution which accommodates no 
                more than 25 children, which is licensed by the State 
                in which it is situated or has been approved by the 
                agency of the State responsible for licensing or 
                approval of institutions of this type as meeting the 
                standards established for the licensing.
                    ``(B) Supervised settings.--In the case of a child 
                who has attained 18 years of age, the term shall 
                include a supervised setting in which the individual is 
                living independently, in accordance with such 
                conditions as the Secretary shall establish in 
                regulations.
                    ``(C) Exclusions.--The term shall not include 
                detention facilities, forestry camps, training schools, 
                or any other facility operated primarily for the 
                detention of children who are determined to be 
                delinquent.''.
    (c) Training for State Judges, Attorneys, and Other Legal Personnel 
in Child Welfare Cases.--Section 438(b)(1) of such Act (42 U.S.C. 
629h(b)(1)) is amended in the matter preceding subparagraph (A) by 
inserting ``shall provide for the training of judges, attorneys, and 
other legal personnel in child welfare cases on Federal child welfare 
policies and payment limitations with respect to children in foster 
care who are placed in settings that are not a foster family home,'' 
after ``with respect to the child,''.
    (d) Assurance of Nonimpact on Juvenile Justice System.--
            (1) State plan requirement.--Section 471(a) of such Act (42 
        U.S.C. 671(a)), as amended by section 2641 of this Act, is 
        further amended by adding at the end the following:
            ``(37) includes a certification that, in response to the 
        limitation imposed under section 472(k) with respect to foster 
        care maintenance payments made on behalf of any child who is 
        placed in a setting that is not a foster family home, the State 
        will not enact or advance policies or practices that would 
        result in a significant increase in the population of youth in 
        the State's juvenile justice system.''.
            (2) GAO study and report.--The Comptroller General of the 
        United States shall evaluate the impact, if any, on State 
        juvenile justice systems of the limitation imposed under 
        section 472(k) of the Social Security Act (as added by 
        subsection (a)(1) of this section) on foster care maintenance 
        payments made on behalf of any child who is placed in a setting 
        that is not a foster family home, in accordance with the 
        amendments made by subsections (a) and (b) of this section. In 
        particular, the Comptroller General shall evaluate the extent 
        to which children in foster care who also are subject to the 
        juvenile justice system of the State are placed in a facility 
        under the jurisdiction of the juvenile justice system and 
        whether the lack of available congregate care placements under 
        the jurisdiction of the child welfare systems is a contributing 
        factor to that result. Not later than December 31, 2024, the 
        Comptroller General shall submit to Congress a report on the 
        results of the evaluation.

SEC. 2652. ASSESSMENT AND DOCUMENTATION OF THE NEED FOR PLACEMENT IN A 
              QUALIFIED RESIDENTIAL TREATMENT PROGRAM.

    Section 475A of the Social Security Act (42 U.S.C. 675a) is amended 
by adding at the end the following:
    ``(c) Assessment, Documentation, and Judicial Determination 
Requirements for Placement in a Qualified Residential Treatment 
Program.--In the case of any child who is placed in a qualified 
residential treatment program (as defined in section 472(k)(4)), the 
following requirements shall apply for purposes of approving the case 
plan for the child and the case system review procedure for the child:
            ``(1)(A) Within 30 days of the start of each placement in 
        such a setting, a qualified individual (as defined in 
        subparagraph (D)) shall--
                    ``(i) assess the strengths and needs of the child 
                using an age-appropriate, evidence-based, validated, 
                functional assessment tool approved by the Secretary;
                    ``(ii) determine whether the needs of the child can 
                be met with family members or through placement in a 
                foster family home or, if not, which setting from among 
                the settings specified in section 472(k)(2) would 
                provide the most effective and appropriate level of 
                care for the child in the least restrictive environment 
                and be consistent with the short- and long-term goals 
                for the child, as specified in the permanency plan for 
                the child; and
                    ``(iii) develop a list of child-specific short- and 
                long-term mental and behavioral health goals.
            ``(B)(i) The State shall assemble a family and permanency 
        team for the child in accordance with the requirements of 
        clauses (ii) and (iii). The qualified individual conducting the 
        assessment required under subparagraph (A) shall work in 
        conjunction with the family of, and permanency team for, the 
        child while conducting and making the assessment.
            ``(ii) The family and permanency team shall consist of all 
        appropriate biological family members, relative, and fictive 
        kin of the child, as well as, as appropriate, professionals who 
        are a resource to the family of the child, such as teachers, 
        medical or mental health providers who have treated the child, 
        or clergy. In the case of a child who has attained age 14, the 
        family and permanency team shall include the members of the 
        permanency planning team for the child that are selected by the 
        child in accordance with section 475(5)(C)(iv).
            ``(iii) The State shall document in the child's case plan--
                    ``(I) the reasonable and good faith effort of the 
                State to identify and include all such individuals on 
                the family of, and permanency team for, the child;
                    ``(II) all contact information for members of the 
                family and permanency team, as well as contact 
                information for other family members and fictive kin 
                who are not part of the family and permanency team;
                    ``(III) evidence that meetings of the family and 
                permanency team, including meetings relating to the 
                assessment required under subparagraph (A), are held at 
                a time and place convenient for family;
                    ``(IV) if reunification is the goal, evidence 
                demonstrating that the parent from whom the child was 
                removed provided input on the members of the family and 
                permanency team;
                    ``(V) evidence that the assessment required under 
                subparagraph (A) is determined in conjunction with the 
                family and permanency team;
                    ``(VI) the placement preferences of the family and 
                permanency team relative to the assessment that 
                recognizes children should be placed with their 
                siblings unless there is a finding by the court that 
                such placement is contrary to their best interest; and
                    ``(VII) if the placement preferences of the family 
                and permanency team and child are not the placement 
                setting recommended by the qualified individual 
                conducting the assessment under subparagraph (A), the 
                reasons why the preferences of the team and of the 
                child were not recommended.
            ``(C) In the case of a child who the qualified individual 
        conducting the assessment under subparagraph (A) determines 
        should not be placed in a foster family home, the qualified 
        individual shall specify in writing the reasons why the needs 
        of the child cannot be met by the family of the child or in a 
        foster family home. A shortage or lack of foster family homes 
        shall not be an acceptable reason for determining that the 
        needs of the child cannot be met in a foster family home. The 
        qualified individual also shall specify in writing why the 
        recommended placement in a qualified residential treatment 
        program is the setting that will provide the child with the 
        most effective and appropriate level of care in the least 
        restrictive environment and how that placement is consistent 
        with the short- and long-term goals for the child, as specified 
        in the permanency plan for the child.
            ``(D)(i) Subject to clause (ii), in this subsection, the 
        term `qualified individual' means a trained professional or 
        licensed clinician who is not an employee of the State agency 
        and who is not connected to, or affiliated with, any placement 
        setting in which children are placed by the State.
            ``(ii) The Secretary may approve a request of a State to 
        waive any requirement in clause (i) upon a submission by the 
        State, in accordance with criteria established by the 
        Secretary, that certifies that the trained professionals or 
        licensed clinicians with responsibility for performing the 
        assessments described in subparagraph (A) shall maintain 
        objectivity with respect to determining the most effective and 
        appropriate placement for a child.
            ``(2) Within 60 days of the start of each placement in a 
        qualified residential treatment program, a family or juvenile 
        court or another court (including a tribal court) of competent 
        jurisdiction, or an administrative body appointed or approved 
        by the court, independently, shall--
                    ``(A) consider the assessment, determination, and 
                documentation made by the qualified individual 
                conducting the assessment under paragraph (1);
                    ``(B) determine whether the needs of the child can 
                be met through placement in a foster family home or, if 
                not, whether placement of the child in a qualified 
                residential treatment program provides the most 
                effective and appropriate level of care for the child 
                in the least restrictive environment and whether that 
                placement is consistent with the short- and long-term 
                goals for the child, as specified in the permanency 
                plan for the child; and
                    ``(C) approve or disapprove the placement.
            ``(3) The written documentation made under paragraph (1)(C) 
        and documentation of the determination and approval or 
        disapproval of the placement in a qualified residential 
        treatment program by a court or administrative body under 
        paragraph (2) shall be included in and made part of the case 
        plan for the child.
            ``(4) As long as a child remains placed in a qualified 
        residential treatment program, the State agency shall submit 
        evidence at each status review and each permanency hearing held 
        with respect to the child--
                    ``(A) demonstrating that ongoing assessment of the 
                strengths and needs of the child continues to support 
                the determination that the needs of the child cannot be 
                met through placement in a foster family home, that the 
                placement in a qualified residential treatment program 
                provides the most effective and appropriate level of 
                care for the child in the least restrictive 
                environment, and that the placement is consistent with 
                the short- and long-term goals for the child, as 
                specified in the permanency plan for the child;
                    ``(B) documenting the specific treatment or service 
                needs that will be met for the child in the placement 
                and the length of time the child is expected to need 
                the treatment or services; and
                    ``(C) documenting the efforts made by the State 
                agency to prepare the child to return home or to be 
                placed with a fit and willing relative, a legal 
                guardian, or an adoptive parent, or in a foster family 
                home.
            ``(5) In the case of any child who is placed in a qualified 
        residential treatment program for more than 12 consecutive 
        months or 18 nonconsecutive months (or, in the case of a child 
        who has not attained age 13, for more than 6 consecutive or 
        nonconsecutive months), the State agency shall submit to the 
        Secretary--
                    ``(A) the most recent versions of the evidence and 
                documentation specified in paragraph (4); and
                    ``(B) the signed approval of the head of the State 
                agency for the continued placement of the child in that 
                setting.''.

SEC. 2653. PROTOCOLS TO PREVENT INAPPROPRIATE DIAGNOSES.

    (a) State Plan Requirement.--Section 422(b)(15)(A) of the Social 
Security Act (42 U.S.C. 622(b)(15)(A)) is amended--
            (1) in clause (vi), by striking ``and'' after the 
        semicolon;
            (2) by redesignating clause (vii) as clause (viii); and
            (3) by inserting after clause (vi) the following:
                            ``(vii) the procedures and protocols the 
                        State has established to ensure that children 
                        in foster care placements are not 
                        inappropriately diagnosed with mental illness, 
                        other emotional or behavioral disorders, 
                        medically fragile conditions, or developmental 
                        disabilities, and placed in settings that are 
                        not foster family homes as a result of the 
                        inappropriate diagnoses; and''.
    (b) Evaluation.--Section 476 of such Act (42 U.S.C. 676), as 
amended by section 2621(d) of this Act, is further amended by adding at 
the end the following:
    ``(e) Evaluation of State Procedures and Protocols to Prevent 
Inappropriate Diagnoses of Mental Illness or Other Conditions.--The 
Secretary shall conduct an evaluation of the procedures and protocols 
established by States in accordance with the requirements of section 
422(b)(15)(A)(vii). The evaluation shall analyze the extent to which 
States comply with and enforce the procedures and protocols and the 
effectiveness of various State procedures and protocols and shall 
identify best practices. Not later than January 1, 2020, the Secretary 
shall submit a report on the results of the evaluation to Congress.''.

SEC. 2654. ADDITIONAL DATA AND REPORTS REGARDING CHILDREN PLACED IN A 
              SETTING THAT IS NOT A FOSTER FAMILY HOME.

    Section 479A(a)(7)(A) of the Social Security Act (42 U.S.C. 
679b(a)(7)(A)) is amended by striking clauses (i) through (vi) and 
inserting the following:
                            ``(i) with respect to each such placement--
                                    ``(I) the type of the placement 
                                setting, including whether the 
                                placement is shelter care, a group home 
                                and if so, the range of the child 
                                population in the home, a residential 
                                treatment facility, a hospital or 
                                institution providing medical, 
                                rehabilitative, or psychiatric care, a 
                                setting specializing in providing 
                                prenatal, post-partum, or parenting 
                                supports, or some other kind of child-
                                care institution and if so, what kind;
                                    ``(II) the number of children in 
                                the placement setting and the age, 
                                race, ethnicity, and gender of each of 
                                the children;
                                    ``(III) for each child in the 
                                placement setting, the length of the 
                                placement of the child in the setting, 
                                whether the placement of the child in 
                                the setting is the first placement of 
                                the child and if not, the number and 
                                type of previous placements of the 
                                child, and whether the child has 
                                special needs or another diagnosed 
                                mental or physical illness or 
                                condition; and
                                    ``(IV) the extent of any 
                                specialized education, treatment, 
                                counseling, or other services provided 
                                in the setting; and
                            ``(ii) separately, the number and ages of 
                        children in the placements who have a 
                        permanency plan of another planned permanent 
                        living arrangement; and''.

SEC. 2655. CRIMINAL RECORDS CHECKS AND CHECKS OF CHILD ABUSE AND 
              NEGLECT REGISTRIES FOR ADULTS WORKING IN CHILD-CARE 
              INSTITUTIONS AND OTHER GROUP CARE SETTINGS.

    (a) State Plan Requirement.--Section 471(a)(20) of the Social 
Security Act (42 U.S.C. 671(a)(20)) is amended--
            (1) in each of subparagraphs (A)(ii) and (B)(iii), by 
        striking ``and'' after the semicolon;
            (2) in subparagraph (C), by adding ``and'' after the 
        semicolon; and
            (3) by inserting after subparagraph (C) the following:
            ``(D) provides procedures for any child care institution, 
        including a group home, residential treatment center, shelter, 
        or other congregate care setting, to conduct criminal records 
        checks, including fingerprint-based checks of national crime 
        information databases (as defined in section 534(f)(3)(A) of 
        title 28, United States Code), and checks described in 
        subparagraph (B) of this paragraph, on any adult working in a 
        child-care institution, including a group home, residential 
        treatment center, shelter, or other congregate care setting, 
        unless the State reports to the Secretary the alternative 
        criminal records checks and child abuse registry checks the 
        State conducts on any adult working in a child-care 
        institution, including a group home, residential treatment 
        center, shelter, or other congregate care setting, and why the 
        checks specified in this subparagraph are not appropriate for 
        the State;''.
    (b) Technical Amendments.--Subparagraphs (A) and (C) of section 
471(a)(20) of the Social Security Act (42 U.S.C. 671(a)(20)) are each 
amended by striking ``section 534(e)(3)(A)'' and inserting ``section 
534(f)(3)(A)''.

SEC. 2656. EFFECTIVE DATES; APPLICATION TO WAIVERS.

    (a) Effective Dates.--
            (1) In general.--Subject to paragraph (2) and subsections 
        (b) through (d), the amendments made by this chapter shall take 
        effect on January 1, 2018.
            (2) Transition rule.--In the case of a State plan under 
        part B or E of title IV of the Social Security Act which the 
        Secretary of Health and Human Services determines requires 
        State legislation (other than legislation appropriating funds) 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by this chapter, the State plan 
        shall not be regarded as failing to comply with the 
        requirements of such part solely on the basis of the failure of 
        the plan to meet the additional requirements before the first 
        day of the first calendar quarter beginning after the close of 
        the first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session shall be deemed 
        to be a separate regular session of the State legislature.
    (b) Limitation on Federal Financial Participation for Placements 
That Are Not in Foster Family Homes and Related Provisions.--
            (1) In general.--The amendments made by sections 2651(a), 
        2651(b), 2651(d), and 2652 shall take effect on October 1, 
        2019.
            (2) State option to delay effective date for not more than 
        2 years.--If a State requests a delay in the effective date 
        provided for in paragraph (1), the Secretary of Health and 
        Human Services shall delay the effective date with respect to 
        the State for the amount of time requested by the State not to 
        exceed 2 years. If the effective date is so delayed for a 
        period with respect to a State under the preceding sentence, 
        then--
                    (A) notwithstanding section 2644, the date that the 
                amendments made by section 2621(c) take effect with 
                respect to the State shall be delayed for the period; 
                and
                    (B) in applying section 474(a)(6) of the Social 
                Security Act with respect to the State, ``on or after 
                the date this paragraph takes effect with respect to 
                the State'' is deemed to be substituted for ``after 
                September 30, 2019'' in subparagraph (A)(i)(I) of such 
                section.
    (c) Criminal Records Checks and Checks of Child Abuse and Neglect 
Registries for Adults Working in Child-care Institutions and Other 
Group Care Settings.--The amendments made by section 2655 shall take 
effect on October 1, 2018.
    (d) Application to States With Waivers.--In the case of a State 
that, on the date of enactment of this Act, has in effect a waiver 
approved under section 1130 of the Social Security Act (42 U.S.C. 
1320a-9), the amendments made by this chapter shall not apply with 
respect to the State before the expiration (determined without regard 
to any extensions) of the waiver to the extent the amendments are 
inconsistent with the terms of the waiver.

      CHAPTER 3--CONTINUING SUPPORT FOR CHILD AND FAMILY SERVICES

SEC. 2661. SUPPORTING AND RETAINING FOSTER FAMILIES FOR CHILDREN.

    (a) Supporting and Retaining Foster Parents as a Family Support 
Service.--Section 431(a)(2)(B) of the Social Security Act (42 U.S.C. 
631(a)(2)(B)) is amended by redesignating clauses (iii) through (vi) as 
clauses (iv) through (vii), respectively, and inserting after clause 
(ii) the following:
                            ``(iii) To support and retain foster 
                        families so they can provide quality family-
                        based settings for children in foster care.''.
    (b) Support for Foster Family Homes.--Section 436 of such Act (42 
U.S.C. 629f) is amended by adding at the end the following:
    ``(c) Support for Foster Family Homes.--Out of any money in the 
Treasury of the United States not otherwise appropriated, there are 
appropriated to the Secretary for fiscal year 2018, $8,000,000 for the 
Secretary to make competitive grants to States, Indian tribes, or 
tribal consortia to support the recruitment and retention of high-
quality foster families to increase their capacity to place more 
children in family settings, focused on States, Indian tribes, or 
tribal consortia with the highest percentage of children in non-family 
settings. The amount appropriated under this subparagraph shall remain 
available through fiscal year 2022.''.

SEC. 2662. EXTENSION OF CHILD AND FAMILY SERVICES PROGRAMS.

    (a) Extension of Stephanie Tubbs Jones Child Welfare Services 
Program.--Section 425 of the Social Security Act (42 U.S.C. 625) is 
amended by striking ``2012 through 2016'' and inserting ``2017 through 
2021''.
    (b) Extension of Promoting Safe and Stable Families Program 
Authorizations.--
            (1) In general.--Section 436(a) of such Act (42 U.S.C. 
        629f(a)) is amended by striking all that follows 
        ``$345,000,000'' and inserting ``for each of fiscal years 2017 
        through 2021.''.
            (2) Discretionary grants.--Section 437(a) of such Act (42 
        U.S.C. 629g(a)) is amended by striking ``2012 through 2016'' 
        and inserting ``2017 through 2021''.
    (c) Extension of Funding Reservations for Monthly Caseworker Visits 
and Regional Partnership Grants.--Section 436(b) of such Act (42 U.S.C. 
629f(b)) is amended--
            (1) in paragraph (4)(A), by striking ``2012 through 2016'' 
        and inserting ``2017 through 2021''; and
            (2) in paragraph (5), by striking ``2012 through 2016'' and 
        inserting ``2017 through 2021''.
    (d) Reauthorization of Funding for State Courts.--
            (1) Extension of program.--Section 438(c)(1) of such Act 
        (42 U.S.C. 629h(c)(1)) is amended by striking ``2012 through 
        2016'' and inserting ``2017 through 2021''.
            (2) Extension of federal share.--Section 438(d) of such Act 
        (42 U.S.C. 629h(d)) is amended by striking ``2012 through 
        2016'' and inserting ``2017 through 2021''.
    (e) Repeal of Expired Provisions.--Section 438(e) of such Act (42 
U.S.C. 629h(e)) is repealed.

SEC. 2663. IMPROVEMENTS TO THE JOHN H. CHAFEE FOSTER CARE INDEPENDENCE 
              PROGRAM AND RELATED PROVISIONS.

    (a) Authority to Serve Former Foster Youth up to Age 23.--Section 
477 of the Social Security Act (42 U.S.C. 677) is amended--
            (1) in subsection (a)(5), by inserting ``(or 23 years of 
        age, in the case of a State with a certification under 
        subsection (b)(3)(A)(ii) to provide assistance and services to 
        youths who have aged out of foster care and have not attained 
        such age, in accordance with such subsection)'' after ``21 
        years of age'';
            (2) in subsection (b)(3)(A)--
                    (A) by inserting ``(i)'' before ``A 
                certification'';
                    (B) by striking ``children who have left foster 
                care'' and all that follows through the period and 
                inserting ``youths who have aged out of foster care and 
                have not attained 21 years of age.''; and
                    (C) by adding at the end the following:
                    ``(ii) If the State has elected under section 
                475(8)(B) to extend eligibility for foster care to all 
                children who have not attained 21 years of age, or if 
                the Secretary determines that the State agency 
                responsible for administering the State plans under 
                this part and part B uses State funds or any other 
                funds not provided under this part to provide services 
                and assistance for youths who have aged out of foster 
                care that are comparable to the services and assistance 
                the youths would receive if the State had made such an 
                election, the certification required under clause (i) 
                may provide that the State will provide assistance and 
                services to youths who have aged out of foster care and 
                have not attained 23 years of age.''; and
            (3) in subsection (b)(3)(B), by striking ``children who 
        have left foster care'' and all that follows through the period 
        and inserting ``youths who have aged out of foster care and 
        have not attained 21 years of age (or 23 years of age, in the 
        case of a State with a certification under subparagraph (A)(i) 
        to provide assistance and services to youths who have aged out 
        of foster care and have not attained such age, in accordance 
        with subparagraph (A)(ii)).''.
    (b) Authority to Redistribute Unspent Funds.--Section 477(d) of 
such Act (42 U.S.C. 677(d)) is amended--
            (1) in paragraph (4), by inserting ``or does not expend 
        allocated funds within the time period specified under section 
        477(d)(3)'' after ``provided by the Secretary''; and
            (2) by adding at the end the following:
            ``(5) Redistribution of unexpended amounts.--
                    ``(A) Availability of amounts.--To the extent that 
                amounts paid to States under this section in a fiscal 
                year remain unexpended by the States at the end of the 
                succeeding fiscal year, the Secretary may make the 
                amounts available for redistribution in the second 
                succeeding fiscal year among the States that apply for 
                additional funds under this section for that second 
                succeeding fiscal year.
                    ``(B) Redistribution.--
                            ``(i) In general.--The Secretary shall 
                        redistribute the amounts made available under 
                        subparagraph (A) for a fiscal year among 
                        eligible applicant States. In this 
                        subparagraph, the term `eligible applicant 
                        State' means a State that has applied for 
                        additional funds for the fiscal year under 
                        subparagraph (A) if the Secretary determines 
                        that the State will use the funds for the 
                        purpose for which originally allotted under 
                        this section.
                            ``(ii) Amount to be redistributed.--The 
                        amount to be redistributed to each eligible 
                        applicant State shall be the amount so made 
                        available multiplied by the State foster care 
                        ratio, (as defined in subsection (c)(4), except 
                        that, in such subsection, `all eligible 
                        applicant States (as defined in subsection 
                        (d)(5)(B)(i))' shall be substituted for `all 
                        States').
                            ``(iii) Treatment of redistributed 
                        amount.--Any amount made available to a State 
                        under this paragraph shall be regarded as part 
                        of the allotment of the State under this 
                        section for the fiscal year in which the 
                        redistribution is made.
                    ``(C) Tribes.--For purposes of this paragraph, the 
                term `State' includes an Indian tribe, tribal 
                organization, or tribal consortium that receives an 
                allotment under this section.''.
    (c) Expanding and Clarifying the Use of Education and Training 
Vouchers.--
            (1) In general.--Section 477(i)(3) of such Act (42 U.S.C. 
        677(i)(3)) is amended--
                    (A) by striking ``on the date'' and all that 
                follows through ``23'' and inserting ``to remain 
                eligible until they attain 26''; and
                    (B) by inserting ``, but in no event may a youth 
                participate in the program for more than 5 years 
                (whether or not consecutive)'' before the period.
            (2) Conforming amendment.--Section 477(i)(1) of such Act 
        (42 U.S.C. 677(i)(1)) is amended by inserting ``who have 
        attained 14 years of age'' before the period.
    (d) Other Improvements.--Section 477 of such Act (42 U.S.C. 677), 
as amended by subsections (a), (b), and (c) of this section, is 
amended--
            (1) in the section heading, by striking ``independence 
        program'' and inserting ``program for successful transition to 
        adulthood'';
            (2) in subsection (a)--
                    (A) in paragraph (1)--
                            (i) by striking ``identify children who are 
                        likely to remain in foster care until 18 years 
                        of age and to help these children make the 
                        transition to self-sufficiency by providing 
                        services'' and inserting ``support all youth 
                        who have experienced foster care at age 14 or 
                        older in their transition to adulthood through 
                        transitional services'';
                            (ii) by inserting ``and post-secondary 
                        education'' after ``high school diploma''; and
                            (iii) by striking ``training in daily 
                        living skills, training in budgeting and 
                        financial management skills'' and inserting 
                        ``training and opportunities to practice daily 
                        living skills (such as financial literacy 
                        training and driving instruction)'';
                    (B) in paragraph (2), by striking ``who are likely 
                to remain in foster care until 18 years of age receive 
                the education, training, and services necessary to 
                obtain employment'' and inserting ``who have 
                experienced foster care at age 14 or older achieve 
                meaningful, permanent connections with a caring 
                adult'';
                    (C) in paragraph (3), by striking ``who are likely 
                to remain in foster care until 18 years of age prepare 
                for and enter postsecondary training and education 
                institutions'' and inserting ``who have experienced 
                foster care at age 14 or older engage in age or 
                developmentally appropriate activities, positive youth 
                development, and experiential learning that reflects 
                what their peers in intact families experience''; and
                    (D) by striking paragraph (4) and redesignating 
                paragraphs (5) through (8) as paragraphs (4) through 
                (7);
            (3) in subsection (b)--
                    (A) in paragraph (2)(D), by striking 
                ``adolescents'' and inserting ``youth''; and
                    (B) in paragraph (3)--
                            (i) in subparagraph (D)--
                                    (I) by inserting ``including 
                                training on youth development'' after 
                                ``to provide training''; and
                                    (II) by striking ``adolescents 
                                preparing for independent living'' and 
                                all that follows through the period and 
                                inserting ``youth preparing for a 
                                successful transition to adulthood and 
                                making a permanent connection with a 
                                caring adult.'';
                            (ii) in subparagraph (H), by striking 
                        ``adolescents'' each place it appears and 
                        inserting ``youth''; and
                            (iii) in subparagraph (K)--
                                    (I) by striking ``an adolescent'' 
                                and inserting ``a youth''; and
                                    (II) by striking ``the adolescent'' 
                                each place it appears and inserting 
                                ``the youth''; and
            (4) in subsection (f), by striking paragraph (2) and 
        inserting the following:
            ``(2) Report to congress.--Not later than October 1, 2019, 
        the Secretary shall submit to the Committee on Ways and Means 
        of the House of Representatives and the Committee on Finance of 
        the Senate a report on the National Youth in Transition 
        Database and any other databases in which States report outcome 
        measures relating to children in foster care and children who 
        have aged out of foster care or left foster care for kinship 
        guardianship or adoption. The report shall include the 
        following:
                    ``(A) A description of the reasons for entry into 
                foster care and of the foster care experiences, such as 
                length of stay, number of placement settings, case 
                goal, and discharge reason of 17-year-olds who are 
                surveyed by the National Youth in Transition Database 
                and an analysis of the comparison of that description 
                with the reasons for entry and foster care experiences 
                of children of other ages who exit from foster care 
                before attaining age 17.
                    ``(B) A description of the characteristics of the 
                individuals who report poor outcomes at ages 19 and 21 
                to the National Youth in Transition Database.
                    ``(C) Benchmarks for determining what constitutes a 
                poor outcome for youth who remain in or have exited 
                from foster care and plans the executive branch will 
                take to incorporate these benchmarks in efforts to 
                evaluate child welfare agency performance in providing 
                services to children transitioning from foster care.
                    ``(D) An analysis of the association between types 
                of placement, number of overall placements, time spent 
                in foster care, and other factors, and outcomes at ages 
                19 and 21.
                    ``(E) An analysis of the differences in outcomes 
                for children in and formerly in foster care at age 19 
                and 21 among States.''.
    (e) Clarifying Documentation Provided to Foster Youth Leaving 
Foster Care.--Section 475(5)(I) of such Act (42 U.S.C. 675(5)(I)) is 
amended by inserting after ``REAL ID Act of 2005'' the following: ``, 
and any official documentation necessary to prove that the child was 
previously in foster care''.

  CHAPTER 4--CONTINUING INCENTIVES TO STATES TO PROMOTE ADOPTION AND 
                           LEGAL GUARDIANSHIP

SEC. 2665. REAUTHORIZING ADOPTION AND LEGAL GUARDIANSHIP INCENTIVE 
              PROGRAMS.

    (a) In General.--Section 473A of the Social Security Act (42 U.S.C. 
673b) is amended--
            (1) in subsection (b)(4), by striking ``2013 through 2015'' 
        and inserting ``2016 through 2020'';
            (2) in subsection (h)(1)(D), by striking ``2016'' and 
        inserting ``2021''; and
            (3) in subsection (h)(2), by striking ``2016'' and 
        inserting ``2021''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect as if enacted on October 1, 2017.

                    CHAPTER 5--TECHNICAL CORRECTIONS

SEC. 2667. TECHNICAL CORRECTIONS TO DATA EXCHANGE STANDARDS TO IMPROVE 
              PROGRAM COORDINATION.

    (a) In General.--Section 440 of the Social Security Act (42 U.S.C. 
629m) is amended to read as follows:

``SEC. 440. DATA EXCHANGE STANDARDS FOR IMPROVED INTEROPERABILITY.

    ``(a) Designation.--The Secretary shall, in consultation with an 
interagency work group established by the Office of Management and 
Budget and considering State government perspectives, by rule, 
designate data exchange standards to govern, under this part and part 
E--
            ``(1) necessary categories of information that State 
        agencies operating programs under State plans approved under 
        this part are required under applicable Federal law to 
        electronically exchange with another State agency; and
            ``(2) Federal reporting and data exchange required under 
        applicable Federal law.
    ``(b) Requirements.--The data exchange standards required by 
paragraph (1) shall, to the extent practicable--
            ``(1) incorporate a widely accepted, non-proprietary, 
        searchable, computer-readable format, such as the Extensible 
        Markup Language;
            ``(2) contain interoperable standards developed and 
        maintained by intergovernmental partnerships, such as the 
        National Information Exchange Model;
            ``(3) incorporate interoperable standards developed and 
        maintained by Federal entities with authority over contracting 
        and financial assistance;
            ``(4) be consistent with and implement applicable 
        accounting principles;
            ``(5) be implemented in a manner that is cost-effective and 
        improves program efficiency and effectiveness; and
            ``(6) be capable of being continually upgraded as 
        necessary.
    ``(c) Rule of Construction.--Nothing in this subsection shall be 
construed to require a change to existing data exchange standards found 
to be effective and efficient.''.
    (b) Effective Date.--Not later than the date that is 24 months 
after the date of the enactment of this section, the Secretary of 
Health and Human Services shall issue a proposed rule that--
            (1) identifies federally required data exchanges, include 
        specification and timing of exchanges to be standardized, and 
        address the factors used in determining whether and when to 
        standardize data exchanges; and
            (2) specifies State implementation options and describes 
        future milestones.

SEC. 2668. TECHNICAL CORRECTIONS TO STATE REQUIREMENT TO ADDRESS THE 
              DEVELOPMENTAL NEEDS OF YOUNG CHILDREN.

    Section 422(b)(18) of the Social Security Act (42 U.S.C. 
622(b)(18)) is amended by striking ``such children'' and inserting 
``all vulnerable children under 5 years of age''.

CHAPTER 6--ENSURING STATES REINVEST SAVINGS RESULTING FROM INCREASE IN 
                          ADOPTION ASSISTANCE

SEC. 2669. DELAY OF ADOPTION ASSISTANCE PHASE-IN.

    (a) In General.--The table in section 473(e)(1)(B) of the Social 
Security Act (42 U.S.C. 673(e)(1)(B)) is amended by striking the last 2 
rows and inserting the following:

 
 
----------------------------------------------------------------------------------------------------------------
``2017 through 2023..........................  2
2024.........................................  2 (or, in the case of a child for whom an adoption assistance
                                                agreement is entered into under this section on or after July 1,
                                                2024, any age)
2025 or thereafter...........................  any age.''.
----------------------------------------------------------------------------------------------------------------

    (b) Effective Date.--The amendment made by this section shall take 
effect on January 1, 2018.

SEC. 2670. GAO STUDY AND REPORT ON STATE REINVESTMENT OF SAVINGS 
              RESULTING FROM INCREASE IN ADOPTION ASSISTANCE.

    (a) Study.--The Comptroller General of the United States shall 
study the extent to which States are complying with the requirements of 
section 473(a)(8) of the Social Security Act relating to the effects of 
phasing out the AFDC income eligibility requirements for adoption 
assistance payments under section 473 of the Social Security Act, as 
enacted by section 402 of the Fostering Connections to Success and 
Increasing Adoptions Act of 2008 (Public Law 110-351; 122 Stat. 3975) 
and amended by section 206 of the Preventing Sex Trafficking and 
Strengthening Families Act (Public Law 113-183; 128 Stat. 1919). In 
particular, the Comptroller General shall analyze the extent to which 
States are complying with the following requirements under section 
473(a)(8)(D) of the Social Security Act:
            (1) The requirement to spend an amount equal to the amount 
        of the savings (if any) in State expenditures under part E of 
        title IV of the Social Security Act resulting from phasing out 
        the AFDC income eligibility requirements for adoption 
        assistance payments under section 473 of such Act to provide to 
        children of families any service that may be provided under 
        part B or E of title IV of such Act.
            (2) The requirement that a State shall spend not less than 
        30 percent of the amount of any savings described in paragraph 
        (1) on post-adoption services, post-guardianship services, and 
        services to support and sustain positive permanent outcomes for 
        children who otherwise might enter into foster care under the 
        responsibility of the State, with at least \2/3\ of the 
        spending by the State to comply with the 30 percent requirement 
        being spent on post-adoption and post-guardianship services.
    (b) Report.--The Comptroller General of the United States shall 
submit to the Committee on Finance of the Senate, the Committee on Ways 
and Means of the House of Representatives, and the Secretary of Health 
and Human Services a report that contains the results of the study 
required by subsection (a), including recommendations to ensure 
compliance with laws referred to in subsection (a).

  Subtitle B--Supporting Social Impact Partnerships to Pay for Results

SEC. 2681. SUPPORTING SOCIAL IMPACT PARTNERSHIPS TO PAY FOR RESULTS.

    Title XX of the Social Security Act (42 U.S.C. 1397 et seq.) is 
amended--
            (1) in the title heading, by striking ``TO STATES'' and 
        inserting ``AND PROGRAMS''; and
            (2) by adding at the end the following:

           ``Subtitle C--Social Impact Demonstration Projects

                               ``purposes

    ``Sec. 2051. The purposes of this subtitle are the following:
            ``(1) To improve the lives of families and individuals in 
        need in the United States by funding social programs that 
        achieve real results.
            ``(2) To redirect funds away from programs that, based on 
        objective data, are ineffective, and into programs that achieve 
        demonstrable, measurable results.
            ``(3) To ensure Federal funds are used effectively on 
        social services to produce positive outcomes for both service 
        recipients and taxpayers.
            ``(4) To establish the use of social impact partnerships to 
        address some of our Nation's most pressing problems.
            ``(5) To facilitate the creation of public-private 
        partnerships that bundle philanthropic or other private 
        resources with existing public spending to scale up effective 
        social interventions already being implemented by private 
        organizations, nonprofits, charitable organizations, and State 
        and local governments across the country.
            ``(6) To bring pay-for-performance to the social sector, 
        allowing the United States to improve the impact and 
        effectiveness of vital social services programs while 
        redirecting inefficient or duplicative spending.
            ``(7) To incorporate outcomes measurement and randomized 
        controlled trials or other rigorous methodologies for assessing 
        program impact.

                ``social impact partnership application

    ``Sec. 2052.  (a) Notice.--Not later than 1 year after the date of 
the enactment of this subtitle, the Secretary of the Treasury, in 
consultation with the Federal Interagency Council on Social Impact 
Partnerships, shall publish in the Federal Register a request for 
proposals from States or local governments for social impact 
partnership projects in accordance with this section.
    ``(b) Required Outcomes for Social Impact Partnership Project.--To 
qualify as a social impact partnership project under this subtitle, a 
project must produce one or more measurable, clearly defined outcomes 
that result in social benefit and Federal, State, or local savings 
through any of the following:
            ``(1) Increasing work and earnings by individuals in the 
        United States who are unemployed for more than 6 consecutive 
        months.
            ``(2) Increasing employment and earnings of individuals who 
        have attained 16 years of age but not 25 years of age.
            ``(3) Increasing employment among individuals receiving 
        Federal disability benefits.
            ``(4) Reducing the dependence of low-income families on 
        Federal means-tested benefits.
            ``(5) Improving rates of high school graduation.
            ``(6) Reducing teen and unplanned pregnancies.
            ``(7) Improving birth outcomes and early childhood health 
        and development among low-income families and individuals.
            ``(8) Reducing rates of asthma, diabetes, or other 
        preventable diseases among low-income families and individuals 
        to reduce the utilization of emergency and other high-cost 
        care.
            ``(9) Increasing the proportion of children living in two-
        parent families.
            ``(10) Reducing incidences and adverse consequences of 
        child abuse and neglect.
            ``(11) Reducing the number of youth in foster care by 
        increasing adoptions, permanent guardianship arrangements, 
        reunifications, or placements with a fit and willing relative, 
        or by avoiding placing children in foster care by ensuring they 
        can be cared for safely in their own homes.
            ``(12) Reducing the number of children and youth in foster 
        care residing in group homes, child care institutions, agency-
        operated foster homes, or other non-family foster homes, unless 
        it is determined that it is in the interest of the child's 
        long-term health, safety, or psychological well-being to not be 
        placed in a family foster home.
            ``(13) Reducing the number of children returning to foster 
        care.
            ``(14) Reducing recidivism among juvenile offenders, 
        individuals released from prison, or other high-risk 
        populations.
            ``(15) Reducing the rate of homelessness among our most 
        vulnerable populations.
            ``(16) Improving the health and well-being of those with 
        mental, emotional, and behavioral health needs.
            ``(17) Improving the educational outcomes of special-needs 
        or low-income children.
            ``(18) Improving the employment and well-being of returning 
        United States military members.
            ``(19) Increasing the financial stability of low-income 
        families.
            ``(20) Increasing the independence and employability of 
        individuals who are physically or mentally disabled.
            ``(21) Other measurable outcomes defined by the State or 
        local government that result in positive social outcomes and 
        Federal savings.
    ``(c) Application Required.--The notice described in subsection (a) 
shall require a State or local government to submit an application for 
the social impact partnership project that addresses the following:
            ``(1) The outcome goals of the project.
            ``(2) A description of each intervention in the project and 
        anticipated outcomes of the intervention.
            ``(3) Rigorous evidence demonstrating that the intervention 
        can be expected to produce the desired outcomes.
            ``(4) The target population that will be served by the 
        project.
            ``(5) The expected social benefits to participants who 
        receive the intervention and others who may be impacted.
            ``(6) Projected Federal, State, and local government costs 
        and other costs to conduct the project.
            ``(7) Projected Federal, State, and local government 
        savings and other savings, including an estimate of the savings 
        to the Federal Government, on a program-by-program basis and in 
        the aggregate, if the project is implemented and the outcomes 
        are achieved as a result of the intervention.
            ``(8) If savings resulting from the successful completion 
        of the project are estimated to accrue to the State or local 
        government, the likelihood of the State or local government to 
        realize those savings.
            ``(9) A plan for delivering the intervention through a 
        social impact partnership model.
            ``(10) A description of the expertise of each service 
        provider that will administer the intervention, including a 
        summary of the experience of the service provider in delivering 
        the proposed intervention or a similar intervention, or 
        demonstrating that the service provider has the expertise 
        necessary to deliver the proposed intervention.
            ``(11) An explanation of the experience of the State or 
        local government, the intermediary, or the service provider in 
        raising private and philanthropic capital to fund social 
        service investments.
            ``(12) The detailed roles and responsibilities of each 
        entity involved in the project, including any State or local 
        government entity, intermediary, service provider, independent 
        evaluator, investor, or other stakeholder.
            ``(13) A summary of the experience of the service provider 
        in delivering the proposed intervention or a similar 
        intervention, or a summary demonstrating the service provider 
        has the expertise necessary to deliver the proposed 
        intervention.
            ``(14) A summary of the unmet need in the area where the 
        intervention will be delivered or among the target population 
        who will receive the intervention.
            ``(15) The proposed payment terms, the methodology used to 
        calculate outcome payments, the payment schedule, and 
        performance thresholds.
            ``(16) The project budget.
            ``(17) The project timeline.
            ``(18) The criteria used to determine the eligibility of an 
        individual for the project, including how selected populations 
        will be identified, how they will be referred to the project, 
        and how they will be enrolled in the project.
            ``(19) The evaluation design.
            ``(20) The metrics that will be used in the evaluation to 
        determine whether the outcomes have been achieved as a result 
        of the intervention and how the metrics will be measured.
            ``(21) An explanation of how the metrics used in the 
        evaluation to determine whether the outcomes achieved as a 
        result of the intervention are independent, objective 
        indicators of impact and are not subject to manipulation by the 
        service provider, intermediary, or investor.
            ``(22) A summary explaining the independence of the 
        evaluator from the other entities involved in the project and 
        the evaluator's experience in conducting rigorous evaluations 
        of program effectiveness including, where available, well-
        implemented randomized controlled trials on the intervention or 
        similar interventions.
            ``(23) The capacity of the service provider to deliver the 
        intervention to the number of participants the State or local 
        government proposes to serve in the project.
            ``(24) A description of whether and how the State or local 
        government and service providers plan to sustain the 
        intervention, if it is timely and appropriate to do so, to 
        ensure that successful interventions continue to operate after 
        the period of the social impact partnership.
    ``(d) Project Intermediary Information Required.--The application 
described in subsection (c) shall also contain the following 
information about any intermediary for the social impact partnership 
project (whether an intermediary is a service provider or other 
entity):
            ``(1) Experience and capacity for providing or facilitating 
        the provision of the type of intervention proposed.
            ``(2) The mission and goals.
            ``(3) Information on whether the intermediary is already 
        working with service providers that provide this intervention 
        or an explanation of the capacity of the intermediary to begin 
        working with service providers to provide the intervention.
            ``(4) Experience working in a collaborative environment 
        across government and nongovernmental entities.
            ``(5) Previous experience collaborating with public or 
        private entities to implement evidence-based programs.
            ``(6) Ability to raise or provide funding to cover 
        operating costs (if applicable to the project).
            ``(7) Capacity and infrastructure to track outcomes and 
        measure results, including--
                    ``(A) capacity to track and analyze program 
                performance and assess program impact; and
                    ``(B) experience with performance-based awards or 
                performance-based contracting and achieving project 
                milestones and targets.
            ``(8) Role in delivering the intervention.
            ``(9) How the intermediary would monitor program success, 
        including a description of the interim benchmarks and outcome 
        measures.
    ``(e) Feasibility Studies Funded Through Other Sources.--The notice 
described in subsection (a) shall permit a State or local government to 
submit an application for social impact partnership funding that 
contains information from a feasibility study developed for purposes 
other than applying for funding under this subtitle.

            ``awarding social impact partnership agreements

    ``Sec. 2053.  (a) Timeline in Awarding Agreement.--Not later than 6 
months after receiving an application in accordance with section 2052, 
the Secretary, in consultation with the Federal Interagency Council on 
Social Impact Partnerships, shall determine whether to enter into an 
agreement for a social impact partnership project with a State or local 
government.
    ``(b) Considerations in Awarding Agreement.--In determining whether 
to enter into an agreement for a social impact partnership project (the 
application for which was submitted under section 2052) the Secretary, 
in consultation with the Federal Interagency Council on Social Impact 
Partnerships and the head of any Federal agency administering a similar 
intervention or serving a population similar to that served by the 
project, shall consider each of the following:
            ``(1) The recommendations made by the Commission on Social 
        Impact Partnerships.
            ``(2) The value to the Federal Government of the outcomes 
        expected to be achieved if the outcomes specified in the 
        agreement are achieved as a result of the intervention.
            ``(3) The likelihood, based on evidence provided in the 
        application and other evidence, that the State or local 
        government in collaboration with the intermediary and the 
        service providers will achieve the outcomes.
            ``(4) The savings to the Federal Government if the outcomes 
        specified in the agreement are achieved as a result of the 
        intervention.
            ``(5) The savings to the State and local governments if the 
        outcomes specified in the agreement are achieved as a result of 
        the intervention.
            ``(6) The expected quality of the evaluation that would be 
        conducted with respect to the agreement.
            ``(7) The capacity and commitment of the State or local 
        government to sustain the intervention, if appropriate and 
        timely and if the intervention is successful, beyond the period 
        of the social impact partnership.
    ``(c) Agreement Authority.--
            ``(1) Agreement requirements.--In accordance with this 
        section, the Secretary, in consultation with the Federal 
        Interagency Council on Social Impact Partnerships and the head 
        of any Federal agency administering a similar intervention or 
        serving a population similar to that served by the project, may 
        enter into an agreement for a social impact partnership project 
        with a State or local government if the Secretary, in 
        consultation with the Federal Interagency Council on Social 
        Impact Partnerships, determines that each of the following 
        requirements are met:
                    ``(A) The State or local government agrees to 
                achieve one or more outcomes as a result of the 
                intervention, as specified in the agreement and 
                validated by independent evaluation, in order to 
                receive payment.
                    ``(B) The Federal payment to the State or local 
                government for each specified outcome achieved as a 
                result of the intervention is less than or equal to the 
                value of the outcome to the Federal Government over a 
                period not to exceed 10 years, as determined by the 
                Secretary, in consultation with the State or local 
                government.
                    ``(C) The duration of the project does not exceed 
                10 years.
                    ``(D) The State or local government has 
                demonstrated, through the application submitted under 
                section 2052, that, based on prior rigorous 
                experimental evaluations or rigorous quasi-experimental 
                studies, the intervention can be expected to achieve 
                each outcome specified in the agreement.
                    ``(E) The State, local government, intermediary, or 
                service provider has experience raising private or 
                philanthropic capital to fund social service 
                investments (if applicable to the project).
                    ``(F) The State or local government has shown that 
                each service provider has experience delivering the 
                intervention, a similar intervention, or has otherwise 
                demonstrated the expertise necessary to deliver the 
                intervention.
            ``(2) Payment.--The Secretary shall pay the State or local 
        government only if the independent evaluator described in 
        section 2055 determines that the social impact partnership 
        project has met the requirements specified in the agreement and 
        achieved an outcome as a result of the intervention, as 
        specified in the agreement and validated by independent 
        evaluation.
    ``(d) Notice of Agreement Award.--Not later than 30 days after 
entering into an agreement under this section the Secretary shall 
publish a notice in the Federal Register that includes, with regard to 
the agreement, the following:
            ``(1) The outcome goals of the social impact partnership 
        project.
            ``(2) A description of each intervention in the project.
            ``(3) The target population that will be served by the 
        project.
            ``(4) The expected social benefits to participants who 
        receive the intervention and others who may be impacted.
            ``(5) The detailed roles, responsibilities, and purposes of 
        each Federal, State, or local government entity, intermediary, 
        service provider, independent evaluator, investor, or other 
        stakeholder.
            ``(6) The payment terms, the methodology used to calculate 
        outcome payments, the payment schedule, and performance 
        thresholds.
            ``(7) The project budget.
            ``(8) The project timeline.
            ``(9) The project eligibility criteria.
            ``(10) The evaluation design.
            ``(11) The metrics that will be used in the evaluation to 
        determine whether the outcomes have been achieved as a result 
        of each intervention and how these metrics will be measured.
            ``(12) The estimate of the savings to the Federal, State, 
        and local government, on a program-by-program basis and in the 
        aggregate, if the agreement is entered into and implemented and 
        the outcomes are achieved as a result of each intervention.
    ``(e) Authority to Transfer Administration of Agreement.--The 
Secretary may transfer to the head of another Federal agency the 
authority to administer (including making payments under) an agreement 
entered into under subsection (c), and any funds necessary to do so.
    ``(f) Requirement on Funding Used to Benefit Children.--Not less 
than 50 percent of all Federal payments made to carry out agreements 
under this section shall be used for initiatives that directly benefit 
children.

                      ``feasibility study funding

    ``Sec. 2054.  (a) Requests for Funding for Feasibility Studies.--
The Secretary shall reserve a portion of the amount made available to 
carry out this subtitle to assist States or local governments in 
developing feasibility studies to apply for social impact partnership 
funding under section 2052. To be eligible to receive funding to assist 
with completing a feasibility study, a State or local government shall 
submit an application for feasibility study funding addressing the 
following:
            ``(1) A description of the outcome goals of the social 
        impact partnership project.
            ``(2) A description of the intervention, including 
        anticipated program design, target population, an estimate 
        regarding the number of individuals to be served, and setting 
        for the intervention.
            ``(3) Evidence to support the likelihood that the 
        intervention will produce the desired outcomes.
            ``(4) A description of the potential metrics to be used.
            ``(5) The expected social benefits to participants who 
        receive the intervention and others who may be impacted.
            ``(6) Estimated costs to conduct the project.
            ``(7) Estimates of Federal, State, and local government 
        savings and other savings if the project is implemented and the 
        outcomes are achieved as a result of each intervention.
            ``(8) An estimated timeline for implementation and 
        completion of the project, which shall not exceed 10 years.
            ``(9) With respect to a project for which the State or 
        local government selects an intermediary to operate the 
        project, any partnerships needed to successfully execute the 
        project and the ability of the intermediary to foster the 
        partnerships.
            ``(10) The expected resources needed to complete the 
        feasibility study for the State or local government to apply 
        for social impact partnership funding under section 2052.
    ``(b) Federal Selection of Applications for Feasibility Study.--Not 
later than 6 months after receiving an application for feasibility 
study funding under subsection (a), the Secretary, in consultation with 
the Federal Interagency Council on Social Impact Partnerships and the 
head of any Federal agency administering a similar intervention or 
serving a population similar to that served by the project, shall 
select State or local government feasibility study proposals for 
funding based on the following:
            ``(1) The recommendations made by the Commission on Social 
        Impact Partnerships.
            ``(2) The likelihood that the proposal will achieve the 
        desired outcomes.
            ``(3) The value of the outcomes expected to be achieved as 
        a result of each intervention.
            ``(4) The potential savings to the Federal Government if 
        the social impact partnership project is successful.
            ``(5) The potential savings to the State and local 
        governments if the project is successful.
    ``(c) Public Disclosure.--Not later than 30 days after selecting a 
State or local government for feasibility study funding under this 
section, the Secretary shall cause to be published on the website of 
the Federal Interagency Council on Social Impact Partnerships 
information explaining why a State or local government was granted 
feasibility study funding.
    ``(d) Funding Restriction.--
            ``(1) Feasibility study restriction.--The Secretary may not 
        provide feasibility study funding under this section for more 
        than 50 percent of the estimated total cost of the feasibility 
        study reported in the State or local government application 
        submitted under subsection (a).
            ``(2) Aggregate restriction.--Of the total amount made 
        available to carry out this subtitle, the Secretary may not use 
        more than $10,000,000 to provide feasibility study funding to 
        States or local governments under this section.
            ``(3) No guarantee of funding.--The Secretary shall have 
        the option to award no funding under this section.
    ``(e) Submission of Feasibility Study Required.--Not later than 9 
months after the receipt of feasibility study funding under this 
section, a State or local government receiving the funding shall 
complete the feasibility study and submit the study to the Federal 
Interagency Council on Social Impact Partnerships.
    ``(f) Delegation of Authority.--The Secretary may transfer to the 
head of another Federal agency the authorities provided in this section 
and any funds necessary to exercise the authorities.

                             ``evaluations

    ``Sec. 2055.  (a) Authority to Enter Into Agreements.--For each 
State or local government awarded a social impact partnership project 
approved by the Secretary under this subtitle, the head of the relevant 
agency, as recommended by the Federal Interagency Council on Social 
Impact Partnerships and determined by the Secretary, shall enter into 
an agreement with the State or local government to pay for all or part 
of the independent evaluation to determine whether the State or local 
government project has achieved a specific outcome as a result of the 
intervention in order for the State or local government to receive 
outcome payments under this subtitle.
    ``(b) Evaluator Qualifications.--The head of the relevant agency 
may not enter into an agreement with a State or local government unless 
the head determines that the evaluator is independent of the other 
parties to the agreement and has demonstrated substantial experience in 
conducting rigorous evaluations of program effectiveness including, 
where available and appropriate, well-implemented randomized controlled 
trials on the intervention or similar interventions.
    ``(c) Methodologies to Be Used.--The evaluation used to determine 
whether a State or local government will receive outcome payments under 
this subtitle shall use experimental designs using random assignment or 
other reliable, evidence-based research methodologies, as certified by 
the Federal Interagency Council on Social Impact Partnerships, that 
allow for the strongest possible causal inferences when random 
assignment is not feasible.
    ``(d) Progress Report.--
            ``(1) Submission of report.--The independent evaluator 
        shall--
                    ``(A) not later than 2 years after a project has 
                been approved by the Secretary and biannually 
                thereafter until the project is concluded, submit to 
                the head of the relevant agency and the Federal 
                Interagency Council on Social Impact Partnerships a 
                written report summarizing the progress that has been 
                made in achieving each outcome specified in the 
                agreement; and
                    ``(B) before the scheduled time of the first 
                outcome payment and before the scheduled time of each 
                subsequent payment, submit to the head of the relevant 
                agency and the Federal Interagency Council on Social 
                Impact Partnerships a written report that includes the 
                results of the evaluation conducted to determine 
                whether an outcome payment should be made along with 
                information on the unique factors that contributed to 
                achieving or failing to achieve the outcome, the 
                challenges faced in attempting to achieve the outcome, 
                and information on the improved future delivery of this 
                or similar interventions.
            ``(2) Submission to the secretary and congress.--Not later 
        than 30 days after receipt of the written report pursuant to 
        paragraph (1)(B), the Federal Interagency Council on Social 
        Impact Partnerships shall submit the report to the Secretary 
        and each committee of jurisdiction in the House of 
        Representatives and the Senate.
    ``(e) Final Report.--
            ``(1) Submission of report.--Within 6 months after the 
        social impact partnership project is completed, the independent 
        evaluator shall--
                    ``(A) evaluate the effects of the activities 
                undertaken pursuant to the agreement with regard to 
                each outcome specified in the agreement; and
                    ``(B) submit to the head of the relevant agency and 
                the Federal Interagency Council on Social Impact 
                Partnerships a written report that includes the results 
                of the evaluation and the conclusion of the evaluator 
                as to whether the State or local government has 
                fulfilled each obligation of the agreement, along with 
                information on the unique factors that contributed to 
                the success or failure of the project, the challenges 
                faced in attempting to achieve the outcome, and 
                information on the improved future delivery of this or 
                similar interventions.
            ``(2) Submission to the secretary and congress.--Not later 
        than 30 days after receipt of the written report pursuant to 
        paragraph (1)(B), the Federal Interagency Council on Social 
        Impact Partnerships shall submit the report to the Secretary 
        and each committee of jurisdiction in the House of 
        Representatives and the Senate.
    ``(f) Limitation on Cost of Evaluations.--Of the amount made 
available under this subtitle for social impact partnership projects, 
the Secretary may not obligate more than 15 percent to evaluate the 
implementation and outcomes of the projects.
    ``(g) Delegation of Authority.--The Secretary may transfer to the 
head of another Federal agency the authorities provided in this section 
and any funds necessary to exercise the authorities.

      ``federal interagency council on social impact partnerships

    ``Sec. 2056.  (a) Establishment.--There is established the Federal 
Interagency Council on Social Impact Partnerships (in this section 
referred to as the `Council') to--
            ``(1) coordinate with the Secretary on the efforts of 
        social impact partnership projects funded under this subtitle;
            ``(2) advise and assist the Secretary in the development 
        and implementation of the projects;
            ``(3) advise the Secretary on specific programmatic and 
        policy matter related to the projects;
            ``(4) provide subject-matter expertise to the Secretary 
        with regard to the projects;
            ``(5) certify to the Secretary that each State or local 
        government that has entered into an agreement with the 
        Secretary for a social impact partnership project under this 
        subtitle and each evaluator selected by the head of the 
        relevant agency under section 2055 has access to Federal 
        administrative data to assist the State or local government and 
        the evaluator in evaluating the performance and outcomes of the 
        project;
            ``(6) address issues that will influence the future of 
        social impact partnership projects in the United States;
            ``(7) provide guidance to the executive branch on the 
        future of social impact partnership projects in the United 
        States;
            ``(8) prior to approval by the Secretary, certify that each 
        State and local government application for a social impact 
        partnership contains rigorous, independent data and reliable, 
        evidence-based research methodologies to support the conclusion 
        that the project will yield savings to the State or local 
        government or the Federal Government if the project outcomes 
        are achieved;
            ``(9) certify to the Secretary, in the case of each 
        approved social impact partnership that is expected to yield 
        savings to the Federal Government, that the project will yield 
        a projected savings to the Federal Government if the project 
        outcomes are achieved, and coordinate with the relevant Federal 
        agency to produce an after-action accounting once the project 
        is complete to determine the actual Federal savings realized, 
        and the extent to which actual savings aligned with projected 
        savings; and
            ``(10) provide periodic reports to the Secretary and make 
        available reports periodically to Congress and the public on 
        the implementation of this subtitle.
    ``(b) Composition of Council.--The Council shall have 11 members, 
as follows:
            ``(1) Chair.--The Chair of the Council shall be the 
        Director of the Office of Management and Budget.
            ``(2) Other members.--The head of each of the following 
        entities shall designate one officer or employee of the entity 
        to be a Council member:
                    ``(A) The Department of Labor.
                    ``(B) The Department of Health and Human Services.
                    ``(C) The Social Security Administration.
                    ``(D) The Department of Agriculture.
                    ``(E) The Department of Justice.
                    ``(F) The Department of Housing and Urban 
                Development.
                    ``(G) The Department of Education.
                    ``(H) The Department of Veterans Affairs.
                    ``(I) The Department of the Treasury.
                    ``(J) The Corporation for National and Community 
                Service.

               ``commission on social impact partnerships

    ``Sec. 2057.  (a) Establishment.--There is established the 
Commission on Social Impact Partnerships (in this section referred to 
as the `Commission').
    ``(b) Duties.--The duties of the Commission shall be to--
            ``(1) assist the Secretary and the Federal Interagency 
        Council on Social Impact Partnerships in reviewing applications 
        for funding under this subtitle;
            ``(2) make recommendations to the Secretary and the Federal 
        Interagency Council on Social Impact Partnerships regarding the 
        funding of social impact partnership agreements and feasibility 
        studies; and
            ``(3) provide other assistance and information as requested 
        by the Secretary or the Federal Interagency Council on Social 
        Impact Partnerships.
    ``(c) Composition.--The Commission shall be composed of nine 
members, of whom--
            ``(1) one shall be appointed by the President, who will 
        serve as the Chair of the Commission;
            ``(2) one shall be appointed by the Majority Leader of the 
        Senate;
            ``(3) one shall be appointed by the Minority Leader of the 
        Senate;
            ``(4) one shall be appointed by the Speaker of the House of 
        Representatives;
            ``(5) one shall be appointed by the Minority Leader of the 
        House of Representatives;
            ``(6) one shall be appointed by the Chairman of the 
        Committee on Finance of the Senate;
            ``(7) one shall be appointed by the ranking member of the 
        Committee on Finance of the Senate;
            ``(8) one member shall be appointed by the Chairman of the 
        Committee on Ways and Means of the House of Representatives; 
        and
            ``(9) one shall be appointed by the ranking member of the 
        Committee on Ways and Means of the House of Representatives.
    ``(d) Qualifications of Commission Members.--The members of the 
Commission shall--
            ``(1) be experienced in finance, economics, pay for 
        performance, or program evaluation;
            ``(2) have relevant professional or personal experience in 
        a field related to one or more of the outcomes listed in this 
        subtitle; or
            ``(3) be qualified to review applications for social impact 
        partnership projects to determine whether the proposed metrics 
        and evaluation methodologies are appropriately rigorous and 
        reliant upon independent data and evidence-based research.
    ``(e) Timing of Appointments.--The appointments of the members of 
the Commission shall be made not later than 120 days after the date of 
the enactment of this subtitle, or, in the event of a vacancy, not 
later than 90 days after the date the vacancy arises. If a member of 
Congress fails to appoint a member by that date, the President may 
select a member of the President's choice on behalf of the member of 
Congress. Notwithstanding the preceding sentence, if not all 
appointments have been made to the Commission as of that date, the 
Commission may operate with no fewer than five members until all 
appointments have been made.
    ``(f) Term of Appointments.--
            ``(1) In general.--The members appointed under subsection 
        (c) shall serve as follows:
                    ``(A) Three members shall serve for 2 years.
                    ``(B) Three members shall serve for 3 years.
                    ``(C) Three members (one of which shall be Chair of 
                the Commission appointed by the President) shall serve 
                for 4 years.
            ``(2) Assignment of terms.--The Commission shall designate 
        the term length that each member appointed under subsection (c) 
        shall serve by unanimous agreement. In the event that unanimous 
        agreement cannot be reached, term lengths shall be assigned to 
        the members by a random process.
    ``(g) Vacancies.--Subject to subsection (e), in the event of a 
vacancy in the Commission, whether due to the resignation of a member, 
the expiration of a member's term, or any other reason, the vacancy 
shall be filled in the manner in which the original appointment was 
made and shall not affect the powers of the Commission.
    ``(h) Appointment Power.--Members of the Commission appointed under 
subsection (c) shall not be subject to confirmation by the Senate.

                      ``limitation on use of funds

    ``Sec. 2058. Of the amounts made available to carry out this 
subtitle, the Secretary may not use more than $2,000,000 in any fiscal 
year to support the review, approval, and oversight of social impact 
partnership projects, including activities conducted by--
            ``(1) the Federal Interagency Council on Social Impact 
        Partnerships; and
            ``(2) any other agency consulted by the Secretary before 
        approving a social impact partnership project or a feasibility 
        study under section 2054.

              ``no federal funding for credit enhancements

    ``Sec. 2059. No amount made available to carry out this subtitle 
may be used to provide any insurance, guarantee, or other credit 
enhancement to a State or local government under which a Federal 
payment would be made to a State or local government as the result of a 
State or local government failing to achieve an outcome specified in an 
agreement.

                        ``availability of funds

    ``Sec. 2060. Amounts made available to carry out this subtitle 
shall remain available until 10 years after the date of the enactment 
of this subtitle.

                               ``website

    ``Sec. 2061. The Federal Interagency Council on Social Impact 
Partnerships shall establish and maintain a public website that shall 
display the following:
            ``(1) A copy of, or method of accessing, each notice 
        published regarding a social impact partnership project 
        pursuant to this subtitle.
            ``(2) A copy of each feasibility study funded under this 
        subtitle.
            ``(3) For each State or local government that has entered 
        into an agreement with the Secretary for a social impact 
        partnership project, the website shall contain the following 
        information:
                    ``(A) The outcome goals of the project.
                    ``(B) A description of each intervention in the 
                project.
                    ``(C) The target population that will be served by 
                the project.
                    ``(D) The expected social benefits to participants 
                who receive the intervention and others who may be 
                impacted.
                    ``(E) The detailed roles, responsibilities, and 
                purposes of each Federal, State, or local government 
                entity, intermediary, service provider, independent 
                evaluator, investor, or other stakeholder.
                    ``(F) The payment terms, methodology used to 
                calculate outcome payments, the payment schedule, and 
                performance thresholds.
                    ``(G) The project budget.
                    ``(H) The project timeline.
                    ``(I) The project eligibility criteria.
                    ``(J) The evaluation design.
                    ``(K) The metrics used to determine whether the 
                proposed outcomes have been achieved and how these 
                metrics are measured.
            ``(4) A copy of the progress reports and the final reports 
        relating to each social impact partnership project.
            ``(5) An estimate of the savings to the Federal, State, and 
        local government, on a program-by-program basis and in the 
        aggregate, resulting from the successful completion of the 
        social impact partnership project.

                             ``regulations

    ``Sec. 2062. The Secretary, in consultation with the Federal 
Interagency Council on Social Impact Partnerships, may issue 
regulations as necessary to carry out this subtitle.

                             ``definitions

    ``Sec. 2063. In this subtitle:
            ``(1) Agency.--The term `agency' has the meaning given that 
        term in section 551 of title 5, United States Code.
            ``(2) Intervention.--The term `intervention' means a 
        specific service delivered to achieve an impact through a 
        social impact partnership project.
            ``(3) Secretary.--The term `Secretary' means the Secretary 
        of the Treasury.
            ``(4) Social impact partnership project.--The term `social 
        impact partnership project' means a project that finances 
        social services using a social impact partnership model.
            ``(5) Social impact partnership model.--The term `social 
        impact partnership model' means a method of financing social 
        services in which--
                    ``(A) Federal funds are awarded to a State or local 
                government only if a State or local government achieves 
                certain outcomes agreed on by the State or local 
                government and the Secretary; and
                    ``(B) the State or local government coordinates 
                with service providers, investors (if applicable to the 
                project), and (if necessary) an intermediary to 
                identify--
                            ``(i) an intervention expected to produce 
                        the outcome;
                            ``(ii) a service provider to deliver the 
                        intervention to the target population; and
                            ``(iii) investors to fund the delivery of 
                        the intervention.
            ``(6) State.--The term `State' means each State of the 
        United States, the District of Columbia, each commonwealth, 
        territory or possession of the United States, and each 
        federally recognized Indian tribe.

                               ``funding

    ``Sec. 2064. Out of any money in the Treasury of the United States 
not otherwise appropriated, there is hereby appropriated $92,000,000 
for fiscal year 2018 to carry out this subtitle.''.

         Subtitle C--Modernizing Child Support Enforcement Fees

SEC. 2691. MODERNIZING CHILD SUPPORT ENFORCEMENT FEES.

    (a) In General.-- Section 454(6)(B)(ii) of the Social Security Act 
(42 U.S.C. 654(6)(B)(ii)) is amended--
            (1) by striking ``$25'' and inserting ``$35''; and
            (2) by striking ``$500'' each place it appears and 
        inserting ``$550''.
    (b) Effective Date.--
            (1) In general.--The amendment made by subsection (a) shall 
        take effect on the 1st day of the 1st fiscal year that begins 
        on or after the date of the enactment of this Act, and shall 
        apply to payments under part D of title IV of the Social 
        Security Act for calendar quarters beginning on or after such 
        1st day.
            (2) Delay permitted if state legislation required.--If the 
        Secretary of Health and Human Services determines that State 
        legislation (other than legislation appropriating funds) is 
        required in order for a State plan developed pursuant to part D 
        of title IV of the Social Security Act to meet the requirement 
        imposed by the amendment made by subsection (a), the plan shall 
        not be regarded as failing to meet the requirement before the 
        1st day of the 1st calendar quarter beginning after the first 
        regular session of the State legislature that begins after the 
        date of the enactment of this Act. For purposes of the 
        preceding sentence, if the State has a 2-year legislative 
        session, each year of the session is deemed to be a separate 
        regular session of the State legislature.

       Subtitle D--Increasing Efficiency of Prison Data Reporting

SEC. 2699. INCREASING EFFICIENCY OF PRISON DATA REPORTING.

    (a) In General.--Section 1611(e)(1)(I)(i)(II) of the Social 
Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) is amended by striking 
``30 days'' each place it appears and inserting ``15 days''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to any payment made by the Commissioner of Social 
Security pursuant to section 1611(e)(1)(I)(i)(II) of the Social 
Security Act (as amended by such subsection) on or after the date that 
is 6 months after the date of enactment of this Act.

                           TITLE VII--OFFSETS

SEC. 2701. PAYMENT FOR EARLY DISCHARGES TO HOSPICE CARE.

    (a) In General.--Section 1886(d)(5)(J) of the Social Security Act 
(42 U.S.C. 1395ww(d)(5)(J)) is amended--
            (1) in clause (ii)--
                    (A) in subclause (III), by striking ``or'' at the 
                end;
                    (B) by redesignating subclause (IV) as subclause 
                (V); and
                    (C) by inserting after subclause (III) the 
                following new subclause:
                                    ``(IV) for discharges occurring on 
                                or after October 1, 2022, is provided 
                                hospice care by a hospice program; 
                                or''; and
            (2) in clause (iv)--
                    (A) by inserting after the first sentence the 
                following new sentence: ``The Secretary shall include 
                in the proposed rule published for fiscal year 2023, a 
                description of the effect of clause (ii)(IV).''; and
                    (B) in subclause (I), by striking ``and (III)'' and 
                inserting ``(III), and, in the case of proposed and 
                final rules for fiscal year 2023 and subsequent fiscal 
                years, (IV)''.
    (b) MedPAC Evaluation and Report on Hospital to Hospice 
Transfers.--
            (1) Evaluation.--The Medicare Payment Advisory Commission 
        (in this subsection referred to as the ``Commission'') shall 
        conduct an evaluation of the effects of the amendments made by 
        subsection (a), including the effects on--
                    (A) the numbers of discharges of patients from an 
                inpatient hospital setting to a hospice program;
                    (B) the lengths of stays of patients in an 
                inpatient hospital setting who are discharged to a 
                hospice program;
                    (C) spending under the Medicare program under title 
                XVIII of the Social Security Act; and
                    (D) other areas determined appropriate by the 
                Commission.
            (2) Consideration.--In conducting the evaluation under 
        paragraph (1), the Commission shall consider factors such as 
        whether the timely access to hospice care by patients admitted 
        to a hospital has been affected through changes to hospital 
        policies or behaviors made as a result of such amendments.
            (3) Preliminary results.--Not later than March 15, 2024, 
        the Commission shall provide Congress with preliminary results 
        on the evaluation being conducted under paragraph (1).
            (4) Report.--Not later than March 15, 2025, the Commission 
        shall submit to Congress a report on the evaluation conducted 
        under paragraph (1).

SEC. 2702. HOME HEALTH MARKET BASKET REDUCTION.

    Section 1895(b)(3)(B) of the Social Security Act (42 U.S.C. 
1395fff(b)(3)(B)) is amended--
            (1) in clause (iii), in the last sentence, by inserting 
        before the period at the end the following: ``and for 2020 
        shall be 1.5 percent''; and
            (2) in clause (vi), by inserting ``and 2020'' after 
        ``except 2018''.

SEC. 2703. REDUCTION FOR NON-EMERGENCY ESRD AMBULANCE TRANSPORTS.

    Section 1834(l)(15) of the Social Security Act (42. U.S.C. 
1395m(l)(15)) is amended by striking ``on or after October 1, 2013'' 
and inserting ``during the period beginning on October 1, 2013, and 
ending on September 30, 2018, and by 23 percent for such services 
furnished on or after October 1, 2018''.

SEC. 2704. EXTENSION OF TARGET FOR RELATIVE VALUE ADJUSTMENTS FOR 
              MISVALUED SERVICES AND TRANSITIONAL PAYMENT RULES FOR 
              CERTAIN RADIATION THERAPY SERVICES UNDER THE PHYSICIAN 
              FEE SCHEDULE.

    Section 1848 of the Social Security Act (42 U.S.C. 1395w-4) is 
amended--
            (1) in subsection (b)(11), by striking ``2017 and 2018'' 
        and inserting ``2017, 2018, and 2019''; and
            (2) in subsection (c)(2)--
                    (A) in subparagraph (K)(iv), by striking ``2017 and 
                2018'' and inserting ``2017, 2018, and 2019''; and
                    (B) in subparagraph (O), by striking ``2018'' and 
                inserting ``2019''.

SEC. 2705. DELAY IN AUTHORITY TO TERMINATE CONTRACTS FOR MEDICARE 
              ADVANTAGE PLANS FAILING TO ACHIEVE MINIMUM QUALITY 
              RATINGS.

    Section 1857(h)(3) of the Social Security Act (42 U.S.C. 1395w-
27(h)(3)) is amended by striking ``2018'' and inserting ``2027''.

SEC. 2706. MEDICARE IMPROVEMENT FUND.

    Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ``during and after fiscal year 
2021'' and all that follows through the period at the end and inserting 
``during and after fiscal year 2021, $0.''.

SEC. 2707. PAYMENT FOR OUTPATIENT PHYSICAL THERAPY SERVICES AND 
              OUTPATIENT OCCUPATIONAL THERAPY SERVICES FURNISHED BY A 
              THERAPY ASSISTANT.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m), as 
amended by sections 2204 and 2414, is further amended by adding at the 
end the following new subsection:
    ``(x) Payment for Outpatient Physical Therapy Services and 
Outpatient Occupational Therapy Services Furnished by a Therapy 
Assistant.--
            ``(1) In general.--In the case of an outpatient physical 
        therapy service or outpatient occupational therapy service 
        furnished on or after January 1, 2022, for which payment is 
        made under section 1848 or subsection (k), that is furnished in 
        whole or in part by a therapy assistant (as defined by the 
        Secretary), the amount of payment for such service shall be an 
        amount equal to 85 percent of the amount of payment otherwise 
        applicable for the service under this part. Nothing in the 
        preceding sentence shall be construed to change applicable 
        requirements with respect to such services.
            ``(2) Use of modifier.--
                    ``(A) Establishment.--Not later than January 1, 
                2019, the Secretary shall establish a modifier to 
                indicate (in a form and manner specified by the 
                Secretary), in the case of an outpatient physical 
                therapy service or outpatient occupational therapy 
                service furnished in whole or in part by a therapy 
                assistant (as so defined), that the service was 
                furnished by a therapy assistant.
                    ``(B) Required use.--Each request for payment, or 
                bill submitted, for an outpatient physical therapy 
                service or outpatient occupational therapy service 
                furnished in whole or in part by a therapy assistant 
                (as so defined) on or after January 1, 2020, shall 
                include the modifier established under subparagraph (A) 
                for each such service.
            ``(3) Implementation.--The Secretary shall implement this 
        subsection through notice and comment rulemaking.''.

SEC. 2708. CHANGES TO LONG-TERM CARE HOSPITAL PAYMENTS.

    (a) Extension.--Section 1886(m)(6)(B)(i) of the Social Security Act 
(42 U.S.C. 1395ww(m)(6)(B)(i)) is amended--
            (1) in subclause (I), by striking ``fiscal year 2016 or 
        fiscal year 2017'' and inserting ``fiscal years 2016 through 
        2019''; and
            (2) in subclause (II), by striking ``2018'' and inserting 
        ``2020''.
    (b) Temporary Adjustment to Site Neutral Payment Rates.--Section 
1886(m)(6)(B) of the Social Security Act (42 U.S.C. 1395ww(m)(6)(B)) is 
amended--
            (1) in clause (ii), in the matter preceding subclause (I), 
        by striking ``In this paragraph'' and inserting ``Subject to 
        clause (iv), in this paragraph''; and
            (2) by adding at the end the following new clause:
                            ``(iv) Adjustment.--For each of fiscal 
                        years 2018 through 2026, the amount that would 
                        otherwise apply under clause (ii)(I) for the 
                        year (determined without regard to this clause) 
                        shall be reduced by 4.6 percent.''.

SEC. 2709. NON-BUDGET NEUTRAL TRANSITIONAL PASS-THROUGH PAYMENT CHANGE 
              FOR CERTAIN PRODUCTS.

    (a) In General.--Subsection 1833(t)(6)(A)(iv) of the Social 
Security Act (42 U.S.C. 1395l(t)(6)(A)(iv)) is amended by inserting 
``(except, beginning as of April 1, 2018, a biosimilar biological 
product (as defined under section 1847A(c)(6)(H)))'' after 
``biological''.
    (b) Application.--The amendment made by subsection (a) shall apply 
with respect to biosimilar biological products beginning on April 1, 
2018, regardless of whether such products were receiving pass-through 
status for an additional payment under section 1833(t)(6) of the Social 
Security Act (42 U.S.C. 1395l(t)(6)) before such date. In the case of a 
product that was receiving such an additional payment pursuant to 
clause (iv) of subparagraph (A) of such section as of the day before 
such date and after application of the amendment under subsection (a) 
is not eligible for such an additional payment as of such date, such 
product may not be eligible for such an additional payment pursuant to 
any other clause of such subparagraph (A).

SEC. 2710. THIRD PARTY LIABILITY IN MEDICAID AND CHIP.

    (a) Modification of Third Party Liability Rules Related to Special 
Treatment of Certain Types of Care and Payments.--
            (1) In general.--Section 1902(a)(25)(E) of the Social 
        Security Act (42 U.S.C. 1396a(a)(25)(E)) is amended, in the 
        matter preceding clause (i), by striking ``prenatal or''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on the date of enactment of this Act.
    (b) Delay in Effective Date and Repeal of Certain Bipartisan Budget 
Act of 2013 Amendments.--
            (1) Repeal.--Effective as of September 30, 2017, subsection 
        (b) of section 202 of the Bipartisan Budget Act of 2013 (Public 
        Law 113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) (including 
        any amendments made by such subsection) is repealed and the 
        provisions amended by such subsection shall be applied and 
        administered as if such amendments had never been enacted.
            (2) Delay in effective date.--Subsection (c) of section 202 
        of the Bipartisan Budget Act of 2013 (Public Law 113-67; 127 
        Stat. 1177; 42 U.S.C. 1396a note) is amended to read as 
        follows:
    ``(c) Effective Date.--The amendments made by subsection (a) shall 
take effect on October 1, 2019.''.
            (3) Effective date; treatment.--The repeal and amendment 
        made by this subsection shall take effect as if enacted on 
        September 30, 2017, and shall apply with respect to any open 
        claims, including claims pending, generated, or filed, after 
        such date. The amendments made by subsections (a) and (b) of 
        section 202 of the Bipartisan Budget Act of 2013 (Public Law 
        113-67; 127 Stat. 1177; 42 U.S.C. 1396a note) that took effect 
        on October 1, 2017, are null and void and section 1902(a)(25) 
        of the Social Security Act (42 U.S.C. 1396a(a)(25)) shall be 
        applied and administered as if such amendments had not taken 
        effect on such date.
    (c) GAO Study and Report.--Not later than 18 months after the date 
of enactment of this Act, the Comptroller General of the United States 
shall submit a report to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Finance of the Senate on 
the impacts of the amendments made by subsections (a)(1) and (b)(2), 
including--
            (1) the impact, or potential effect, of such amendments on 
        access to prenatal and preventive pediatric care (including 
        early and periodic screening, diagnostic, and treatment 
        services) covered under State plans under such title (or 
        waivers of such plans);
            (2) the impact, or potential effect, of such amendments on 
        access to services covered under such plans or waivers for 
        individuals on whose behalf child support enforcement is being 
        carried out by a State agency under part D of title IV of such 
        Act; and
            (3) the impact, or potential effect, on providers of 
        services under such plans or waivers of delays in payment or 
        related issues that result from such amendments.
    (d) Application to CHIP.--
            (1) In general.--Section 2107(e)(1) of the Social Security 
        Act (42 U.S.C. 1397gg(e)(1)) is amended--
                    (A) by redesignating subparagraphs (B) through (R) 
                as subparagraphs (C) through (S), respectively; and
                    (B) by inserting after subparagraph (A) the 
                following new subparagraph:
                    ``(B) Section 1902(a)(25) (relating to third party 
                liability).''.
            (2) Mandatory reporting.--Section 1902(a)(25)(I)(i) of the 
        Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)) is amended--
                    (A) by striking ``medical assistance under the 
                State plan'' and inserting ``medical assistance under a 
                State plan (or under a waiver of the plan)'';
                    (B) by striking ``(and, at State option, child'' 
                and inserting ``and child''; and
                    (C) by striking ``title XXI)'' and inserting 
                ``title XXI''.

SEC. 2711. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM INCOME FOR 
              PURPOSES OF INCOME ELIGIBILITY UNDER MEDICAID.

    (a) In General.--Section 1902 of the Social Security Act (42 U.S.C. 
1396a) is amended--
            (1) in subsection (a)(17), by striking ``(e)(14), (e)(14)'' 
        and inserting ``(e)(14), (e)(15)''; and
            (2) in subsection (e)(14), by adding at the end the 
        following new subparagraph:
                    ``(K) Treatment of certain lottery winnings and 
                income received as a lump sum.--
                            ``(i) In general.--In the case of an 
                        individual who is the recipient of qualified 
                        lottery winnings (pursuant to lotteries 
                        occurring on or after January 1, 2018) or 
                        qualified lump sum income (received on or after 
                        such date) and whose eligibility for medical 
                        assistance is determined based on the 
                        application of modified adjusted gross income 
                        under subparagraph (A), a State shall, in 
                        determining such eligibility, include such 
                        winnings or income (as applicable) as income 
                        received--
                                    ``(I) in the month in which such 
                                winnings or income (as applicable) is 
                                received if the amount of such winnings 
                                or income is less than $80,000;
                                    ``(II) over a period of 2 months if 
                                the amount of such winnings or income 
                                (as applicable) is greater than or 
                                equal to $80,000 but less than $90,000;
                                    ``(III) over a period of 3 months 
                                if the amount of such winnings or 
                                income (as applicable) is greater than 
                                or equal to $90,000 but less than 
                                $100,000; and
                                    ``(IV) over a period of 3 months 
                                plus 1 additional month for each 
                                increment of $10,000 of such winnings 
                                or income (as applicable) received, not 
                                to exceed a period of 120 months (for 
                                winnings or income of $1,260,000 or 
                                more), if the amount of such winnings 
                                or income is greater than or equal to 
                                $100,000.
                            ``(ii) Counting in equal installments.--For 
                        purposes of subclauses (II), (III), and (IV) of 
                        clause (i), winnings or income to which such 
                        subclause applies shall be counted in equal 
                        monthly installments over the period of months 
                        specified under such subclause.
                            ``(iii) Hardship exemption.--An individual 
                        whose income, by application of clause (i), 
                        exceeds the applicable eligibility threshold 
                        established by the State, shall continue to be 
                        eligible for medical assistance to the extent 
                        that the State determines, under procedures 
                        established by the State (in accordance with 
                        standards specified by the Secretary), that the 
                        denial of eligibility of the individual would 
                        cause an undue medical or financial hardship as 
                        determined on the basis of criteria established 
                        by the Secretary.
                            ``(iv) Notifications and assistance 
                        required in case of loss of eligibility.--A 
                        State shall, with respect to an individual who 
                        loses eligibility for medical assistance under 
                        the State plan (or a waiver of such plan) by 
                        reason of clause (i)--
                                    ``(I) before the date on which the 
                                individual loses such eligibility, 
                                inform the individual--
                                            ``(aa) of the individual's 
                                        opportunity to enroll in a 
                                        qualified health plan offered 
                                        through an Exchange established 
                                        under title I of the Patient 
                                        Protection and Affordable Care 
                                        Act during the special 
                                        enrollment period specified in 
                                        section 9801(f)(3) of the 
                                        Internal Revenue Code of 1986 
                                        (relating to loss of Medicaid 
                                        or CHIP coverage); and
                                            ``(bb) of the date on which 
                                        the individual would no longer 
                                        be considered ineligible by 
                                        reason of clause (i) to receive 
                                        medical assistance under the 
                                        State plan or under any waiver 
                                        of such plan and be eligible to 
                                        reapply to receive such medical 
                                        assistance; and
                                    ``(II) provide technical assistance 
                                to the individual seeking to enroll in 
                                such a qualified health plan.
                            ``(v) Qualified lottery winnings defined.--
                        In this subparagraph, the term `qualified 
                        lottery winnings' means winnings from a 
                        sweepstakes, lottery, or pool described in 
                        paragraph (3) of section 4402 of the Internal 
                        Revenue Code of 1986 or a lottery operated by a 
                        multistate or multijurisdictional lottery 
                        association, including amounts awarded as a 
                        lump sum payment.
                            ``(vi) Qualified lump sum income defined.--
                        In this subparagraph, the term `qualified lump 
                        sum income' means income that is received as a 
                        lump sum from monetary winnings from gambling 
                        (as defined by the Secretary and including 
                        gambling activities described in section 
                        1955(b)(4) of title 18, United States Code).''.
    (b) Rules of Construction.--
            (1) Interception of lottery winnings allowed.--Nothing in 
        the amendment made by subsection (a)(2) shall be construed as 
        preventing a State from intercepting the State lottery winnings 
        awarded to an individual in the State to recover amounts paid 
        by the State under the State Medicaid plan under title XIX of 
        the Social Security Act (42 U.S.C. 1396 et seq.) for medical 
        assistance furnished to the individual.
            (2) Applicability limited to eligibility of recipient of 
        lottery winnings or lump sum income.--Nothing in the amendment 
        made by subsection (a)(2) shall be construed, with respect to a 
        determination of household income for purposes of a 
        determination of eligibility for medical assistance under the 
        State plan under title XIX of the Social Security Act (42 
        U.S.C. 1396 et seq.) (or a waiver of such plan) made by 
        applying modified adjusted gross income under subparagraph (A) 
        of section 1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), as 
        limiting the eligibility for such medical assistance of any 
        individual that is a member of the household other than the 
        individual who received qualified lottery winnings or qualified 
        lump-sum income (as defined in subparagraph (K) of such section 
        1902(e)(14), as added by subsection (a)(2) of this section).

SEC. 2712. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.

    Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C. 1396r-
4(f)(7)(A)) is amended--
            (1) in clause (i), in the matter preceding subclause (I), 
        by striking ``2018'' and inserting ``2020''; and
            (2) in clause (ii), by striking subclauses (I) through 
        (VIII) and inserting the following:
                                    ``(I) $4,000,000,000 for fiscal 
                                year 2020; and
                                    ``(II) $8,000,000,000 for each of 
                                fiscal years 2021 through 2025.''.

SEC. 2713. MEDICAID IMPROVEMENT FUND RESCISSION.

    Section 1941(b) of the Social Security Act (42 U.S.C 1396w-1(b)) is 
amended--
            (1) in paragraph (1), by striking ``$5,000,000'' and 
        inserting ``$0''; and
            (2) in paragraph (3)(A) (as added by section 3006(2)(B) of 
        the Helping Ensure Access for Little Ones, Toddlers, and 
        Hopeful Youth by Keeping Insurance Delivery Stable Act (Public 
        Law 115-120)), by striking ``$980,000,000'' and inserting 
        ``$0''.

SEC. 2714. SUNSETTING EXCLUSION OF BIOSIMILARS FROM MEDICARE PART D 
              COVERAGE GAP DISCOUNT PROGRAM.

    Section 1860D-14A(g)(2)(A) of the Social Security Act (42 U.S.C. 
1395w-114a(g)(2)(A)) is amended by inserting ``, with respect to a plan 
year before 2019,'' after ``other than''.

SEC. 2715. PREVENTION AND PUBLIC HEALTH FUND.

    Section 4002(b) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 300u-11(b)) is amended by striking paragraphs (1) through 
(9) and inserting the following new paragraphs:
            ``(1) for each of fiscal years 2018 and 2019, $900,000,000;
            ``(2) for each of fiscal years 2020 and 2021, 
        $1,000,000,000;
            ``(3) for each of fiscal years 2022 through 2027, 
        $1,100,000,000; and
            ``(4) for fiscal year 2028 and each subsequent fiscal year, 
        $2,000,000,000.''.

                     DIVISION G--BUDGETARY EFFECTS

SEC. 3001. BUDGETARY EFFECTS.

    (a) In General.--The budgetary effects of division D and each 
succeeding division shall not be entered on either PAYGO scorecard 
maintained pursuant to section 4(d) of the Statutory Pay-As-You-Go Act 
of 2010.
    (b) Senate PAYGO Scorecards.--The budgetary effects of division D 
and each succeeding division shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. Con. Res. 71 
(115th Congress).
    (c) Classification of Budgetary Effects.--Notwithstanding Rule 3 of 
the Budget Scorekeeping Guidelines set forth in the joint explanatory 
statement of the committee of conference accompanying Conference Report 
105-217 and section 250(c)(8) of the Balanced Budget and Emergency 
Deficit Control Act of 1985, the budgetary effects of division D and 
each succeeding division shall not be estimated--
            (1) for purposes of section 251 of such Act; and
            (2) for purposes of paragraph (4)(C) of section 3 of the 
        Statutory Pay-As-You-Go Act of 2010 as being included in an 
        appropriation Act.

            Attest:

                                                                 Clerk.
115th CONGRESS

  2d Session

                               H.R. 1892

_______________________________________________________________________

                  HOUSE AMENDMENT TO SENATE AMENDMENT
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