H. R. 1892—213 
‘‘(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 admin-
istering 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 govern-
ments 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 feasi-
bility study reported in the State or local government applica-
tion 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 partner-
ship project approved by the Secretary under this subtitle, the 
head of the relevant agency, as recommended by the Federal Inter-
agency 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.
H. R. 1892—214 
‘‘(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 inde-
pendent of the other parties to the agreement and has demonstrated 
substantial experience in conducting rigorous evaluations of pro-
gram 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 meth-
odologies, 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 Partner-
ships 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 Representa-
tives 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 Partner-
ships 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
H. R. 1892—215 
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 Representa-
tives 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 Fed-
eral 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 govern-
ment 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 conclu-
sion 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 pro-
jected savings to the Federal Government if the project out-
comes 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
H. R. 1892—216 
‘‘(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 Develop-
ment. 
‘‘(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 Fed-
eral 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 Com-
mittee 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 Representa-
tives; and
H. R. 1892—217 
‘‘(9) one shall be appointed by the ranking member of 
the Committee on Ways and Means of the House of Representa-
tives. 
‘‘(d) QUALIFICATIONS OF COMMISSION MEMBERS.—The members 
of the Commission shall— 
‘‘(1) be experienced in finance, economics, pay for perform-
ance, 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 mem-
bers 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 sub-
section (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 des-
ignate 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 Part-
nerships; and
H. R. 1892—219 
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 regu-
lations 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 spe-
cific 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 govern-
ment 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 out-
come; 
‘‘(ii) a service provider to deliver the intervention 
to the target population; and 
‘‘(iii) investors to fund the delivery of the interven-
tion. 
‘‘(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 
$100,000,000 for fiscal year 2018 to carry out this subtitle.’’. 
TITLE IX—PUBLIC HEALTH PROGRAMS 
SEC. 50901. 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)(F) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 254b–2(b)(1)(F)), as amended by section 3101 of Public 
Law 115–96, is amended to read as follows:
H. R. 1892—220 
‘‘(F) 
$3,800,000,000 
for 
fiscal 
year 
2018 
and 
$4,000,000,000 for fiscal year 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 behav-
ioral health, mental health, or substance use disorder serv-
ices; and 
‘‘(G) addressing emerging public health or substance 
use disorder issues to meet the health needs of the popu-
lation 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 spe-
cial 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 aver-
age.’’; 
(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 Sec-
retary shall not make a grant under this paragraph
H. R. 1892—221 
unless the applicant provides assurances to the Sec-
retary 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 sub-
section (k)(3). The Secretary may extend such 120- 
day period for achieving compliance upon a demonstra-
tion 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 subpara-
graphs (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 assist-
ance; 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 commu-
nities.’’; 
(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 car-
rying 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 pro-
vided by the applicants involved to the medically
H. R. 1892—222 
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 consider-
ation 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 car-
rying 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 pro-
vided 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 subpara-
graph (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 dis-
order’’; 
(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)’’;
H. R. 1892—223 
(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 pro-
viders 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 fol-
lowing: 
‘‘(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 Rep-
resentatives, a report including, at a minimum—
H. R. 1892—224 
‘‘(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 semi-
colon; 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 estab-
lishing 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 Protec-
tion and Affordable Care Act, there is authorized to be appro-
priated, 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)(F) 
of the Patient Protection and Affordable Care Act (42 U.S.C. 254b– 
2(b)(2)(F)), as amended by section 3101 of Public Law 115–96, 
is amended to read as follows: 
‘‘(F) $310,000,000 for each of fiscal years 2018 and 
2019.’’. 
(d) TEACHING HEALTH CENTERS THAT OPERATE GRADUATE MED-
ICAL 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 Sec-
retary 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—
H. R. 1892—225 
‘‘(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 resi-
dency 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 subpara-
graph (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 resi-
dents 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 short-
age 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
H. R. 1892—226 
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 para-
graphs (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 med-
ical residency training program for which the sponsoring quali-
fied 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 sec-
tion 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
AMENDMENTS.—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 50901(e) of the Advancing Chronic Care, 
Extenders, and Social Services Act’’. 
SEC. 50902. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 
(a) SPECIAL DIABETES PROGRAM FOR TYPE I DIABETES.—Section 
330B(b)(2)(D) of the Public Health Service Act (42 U.S.C. 254c– 
2(b)(2)(D)), 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.’’. 
TITLE X—MISCELLANEOUS HEALTH 
CARE POLICIES 
SEC. 51001. HOME HEALTH PAYMENT REFORM. 
(a) BUDGET NEUTRAL TRANSITION TO A 30-DAY UNIT OF PAY-
MENT FOR HOME HEALTH SERVICES.—Section 1895(b) of the Social 
Security Act (42 U.S.C. 1395fff(b)) is amended—
H. R. 1892—227 
(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 subpara-
graph: 
‘‘(B) 30-DAY UNIT OF SERVICE.—For purposes of imple-
menting the prospective payment system with respect to 
home health units of service furnished during a year begin-
ning with 2020, the Secretary shall apply a 30-day unit 
of service as the unit of service applied under this para-
graph.’’; 
(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 expendi-
tures under the system during such period with 
application of paragraph (2)(B) is equal to the esti-
mated aggregate amount of expenditures that other-
wise 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 calcu-
lating 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 rule-
making used to implement this clause.’’; and 
(B) by adding at the end the following new subpara-
graph: 
‘‘(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 appro-
priate, through notice and comment rulemaking, pro-
vide 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)).
H. R. 1892—228 
‘‘(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 tem-
porary 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 esti-
mated 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 Sec-
retary 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 elimi-
nate 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 Meth-
odology Refinements; Home Health Value-Based Pur-
chasing 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 com-
ments in response to proposed rule making, including 
patient-focused factors that consider the risks of hos-
pitalization 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 Fed-
eral Advisory Committee Act (5 U.S.C. App.) shall not apply 
to the technical expert panel under paragraph (1).
H. R. 1892—232 
(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 subpara-
graph (B); 
‘‘(ii) may provide individuals and stakeholder enti-
ties 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 feed-
back provided under subclause (I); and 
‘‘(iii) shall prepare comments and recommenda-
tions regarding whether such models meet the criteria 
described in subparagraph (A) and submit such com-
ments and recommendations to the Secretary.’’. 
SEC. 51004. EXPANDED ACCESS TO MEDICARE INTENSIVE CARDIAC 
REHABILITATION PROGRAMS. 
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 cov-
ered for a cardiac rehabilitation program, that such cov-
erage is not supported by the clinical evidence.’’.
H. R. 1892—233 
SEC. 51005. EXTENSION OF BLENDED SITE NEUTRAL PAYMENT RATE 
FOR 
CERTAIN 
LONG-TERM 
CARE 
HOSPITAL 
DIS-
CHARGES; TEMPORARY ADJUSTMENT TO SITE NEUTRAL 
PAYMENT RATES. 
(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. 51006. RECOGNITION OF ATTENDING PHYSICIAN ASSISTANTS AS 
ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS. 
(a) RECOGNITION
OF ATTENDING PHYSICIAN ASSISTANTS
AS 
ATTENDING PHYSICIANS TO SERVE HOSPICE PATIENTS.— 
(1) IN GENERAL.—Section 1861(dd)(3)(B) of the Social Secu-
rity Act (42 U.S.C. 1395x(dd)(3)(B)) is amended— 
(A) by striking ‘‘or nurse’’ and inserting ‘‘, the nurse’’; 
and 
(B) by inserting ‘‘, or the physician assistant (as defined 
in such subsection)’’ after ‘‘subsection (aa)(5))’’. 
(2) CLARIFICATION OF HOSPICE ROLE OF PHYSICIAN ASSIST-
ANTS.—Section 1814(a)(7)(A)(i)(I) of the Social Security Act (42 
U.S.C. 1395f(a)(7)(A)(i)(I)) is amended by inserting ‘‘or a physi-
cian assistant’’ after ‘‘a nurse practitioner’’. 
(b) EFFECTIVE DATE.—The amendments made by this section 
shall apply to items and services furnished on or after January 
1, 2019. 
SEC. 51007. EXTENSION OF ENFORCEMENT INSTRUCTION ON SUPER-
VISION 
REQUIREMENTS 
FOR 
OUTPATIENT 
THERA-
PEUTIC SERVICES IN CRITICAL ACCESS AND SMALL 
RURAL HOSPITALS THROUGH 2017. 
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), is amended— 
(1) in the section heading, by striking ‘‘2016’’ and inserting 
‘‘2017’’; and 
(2) by striking ‘‘and 2016’’ and inserting ‘‘2016, and 2017’’.
H. R. 1892—234 
SEC. 51008. ALLOWING PHYSICIAN ASSISTANTS, NURSE PRACTI-
TIONERS, AND CLINICAL NURSE SPECIALISTS TO SUPER-
VISE CARDIAC, INTENSIVE CARDIAC, AND PULMONARY 
REHABILITATION PROGRAMS. 
(a) CARDIAC
AND INTENSIVE CARDIAC REHABILITATION PRO-
GRAMS.—Section 1861(eee) of the Social Security Act (42 U.S.C. 
1395x(eee)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘physician-supervised’’; and 
(B) by inserting ‘‘under the supervision of a physician 
(as defined in subsection (r)(1)) or a physician assistant, 
nurse practitioner, or clinical nurse specialist (as those 
terms are defined in subsection (aa)(5))’’ before the period 
at the end; 
(2) in paragraph (2)— 
(A) in subparagraph (A)(iii), by striking the period 
at the end and inserting a semicolon; and 
(B) in subparagraph (B), by striking ‘‘a physician’’ and 
inserting ‘‘a physician (as defined in subsection (r)(1)) or 
a physician assistant, nurse practitioner, or clinical nurse 
specialist (as those terms are defined in subsection (aa)(5))’’; 
and 
(3) in paragraph (4)(A), in the matter preceding clause 
(i)— 
(A) by striking ‘‘physician-supervised’’; and 
(B) by inserting ‘‘under the supervision of a physician 
(as defined in subsection (r)(1)) or a physician assistant, 
nurse practitioner, or clinical nurse specialist (as those 
terms are defined in subsection (aa)(5))’’ after ‘‘paragraph 
(3)’’. 
(b) 
PULMONARY
REHABILITATION
PROGRAMS.—Section 
1861(fff)(1) of the Social Security Act (42 U.S.C. 1395x(fff)(1)) is 
amended— 
(1) by striking ‘‘physician-supervised’’; and 
(2) by inserting ‘‘under the supervision of a physician (as 
defined in subsection (r)(1)) or a physician assistant, nurse 
practitioner, or clinical nurse specialist (as those terms are 
defined in subsection (aa)(5))’’ before the period at the end. 
(c) EFFECTIVE DATE.—The amendments made by this section 
shall apply to items and services furnished on or after January 
1, 2024. 
SEC. 51009. 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)(K)(iv), by striking ‘‘2017 and 2018’’ 
and inserting ‘‘2017, 2018, and 2019’’.
H. R. 1892—235 
TITLE XI—PROTECTING SENIORS’ 
ACCESS TO MEDICARE ACT 
SEC. 52001. REPEAL OF THE INDEPENDENT PAYMENT ADVISORY 
BOARD. 
(a) REPEAL.—Section 1899A of the Social Security Act (42 U.S.C. 
1395kkk) is repealed. 
(b) CONFORMING AMENDMENTS.— 
(1) LOBBYING COOLING-OFF PERIOD.—Paragraph (3) of sec-
tion 207(c) of title 18, United States Code, is repealed. 
(2) GAO STUDY AND REPORT.—Section 3403(b) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 1395kkk–1) is 
repealed. 
(3) MEDPAC REVIEW AND COMMENT.—Section 1805(b) of 
the Social Security Act (42 U.S.C. 1395b–6(b)) is amended— 
(A) by striking paragraph (4); 
(B) by redesignating paragraphs (5) through (8) as 
paragraphs (4) through (7), respectively; and 
(C) by redesignating the paragraph (9) that was 
redesignated by section 3403(c)(1) of the Patient Protection 
and Affordable Care Act (Public Law 111–148) as para-
graph (8). 
(4) NAME CHANGE.—Section 10320(b) of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148) is repealed. 
(5) RULE
OF
CONSTRUCTION.—Section 10320(c) of the 
Patient Protection and Affordable Care Act (Public Law 111– 
148) is repealed. 
TITLE XII—OFFSETS 
SEC. 53101. 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. 53102. THIRD PARTY LIABILITY IN MEDICAID AND CHIP. 
(a) MODIFICATION OF THIRD PARTY LIABILITY RULES RELATED 
TO SPECIAL TREATMENT
OF CERTAIN TYPES
OF CARE
AND PAY-
MENTS.— 
(1) IN GENERAL.—Section 1902(a)(25)(E) of the Social Secu-
rity 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 BIPAR-
TISAN 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
H. R. 1892—236 
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 amend-
ment 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’’.
H. R. 1892—237 
SEC. 53103. 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 addi-
tional 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 pur-
poses 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 cri-
teria 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
H. R. 1892—238 
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 speci-
fied in section 9801(f)(3) of the Internal Rev-
enue 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 assist-
ance 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 indi-
vidual 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 associa-
tion, including amounts awarded as a lump sum pay-
ment. 
‘‘(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 sec-
tion 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
H. R. 1892—239 
income (as defined in subparagraph (K) of such section 
1902(e)(14), as added by subsection (a)(2) of this section). 
SEC. 53104. REBATE OBLIGATION WITH RESPECT TO LINE EXTENSION 
DRUGS. 
(a) IN GENERAL.—Section 1927(c)(2)(C) of the Social Security 
Act (42 U.S.C. 1396r–8(c)(2)(C)) is amended by striking ‘‘(C) TREAT-
MENT OF NEW FORMULATIONS.—In the case’’ and all that follows 
through the period at the end of the first sentence and inserting 
the following: 
‘‘(C) TREATMENT OF NEW FORMULATIONS.— 
‘‘(i) IN GENERAL.—In the case of a drug that is 
a line extension of a single source drug or an innovator 
multiple source drug that is an oral solid dosage form, 
the rebate obligation for a rebate period with respect 
to such drug under this subsection shall be the greater 
of the amount described in clause (ii) for such drug 
or the amount described in clause (iii) for such drug. 
‘‘(ii) AMOUNT 1.—For purposes of clause (i), the 
amount described in this clause with respect to a drug 
described in clause (i) and rebate period is the amount 
computed under paragraph (1) for such drug, increased 
by the amount computed under subparagraph (A) and, 
as applicable, subparagraph (B) for such drug and 
rebate period. 
‘‘(iii) AMOUNT 2.—For purposes of clause (i), the 
amount described in this clause with respect to a drug 
described in clause (i) and rebate period is the amount 
computed under paragraph (1) for such drug, increased 
by the product of— 
‘‘(I) the average manufacturer price for the 
rebate period of the line extension of a single 
source drug or an innovator multiple source drug 
that is an oral solid dosage form; 
‘‘(II) the highest additional rebate (calculated 
as a percentage of average manufacturer price) 
under this paragraph for the rebate period for 
any strength of the original single source drug 
or innovator multiple source drug; and 
‘‘(III) the total number of units of each dosage 
form and strength of the line extension product 
paid for under the State plan in the rebate period 
(as reported by the State).’’. 
(b) EFFECTIVE DATE.—The amendments made subsection (a) 
shall apply with respect to rebate periods beginning on or after 
October 1, 2018. 
SEC. 53105. MEDICAID IMPROVEMENT FUND. 
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), by striking ‘‘$980,000,000’’ and 
inserting ‘‘$0’’.
H. R. 1892—240 
SEC. 53106. PHYSICIAN FEE SCHEDULE UPDATE. 
Section 1848(d)(18) of the Social Security Act (42 U.S.C. 1395w– 
4(d)(18)) is amended by striking ‘‘paragraph (1)(C)’’ and all that 
follows and inserting the following: ‘‘paragraph (1)(C)— 
‘‘(A) for 2016 and each subsequent year through 2018 
shall be 0.5 percent; and 
‘‘(B) for 2019 shall be 0.25 percent.’’. 
SEC. 53107. 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) 
is amended by adding at the end the following new subsection: 
‘‘(v) 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 fur-
nished 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 estab-
lished under subparagraph (A) for each such service. 
‘‘(3) IMPLEMENTATION.—The Secretary shall implement this 
subsection through notice and comment rulemaking.’’. 
SEC. 53108. 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. 53109. HOSPITAL TRANSFER POLICY 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;
H. R. 1892—241 
(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, 2018, 
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 2019, 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 2019 and subsequent fiscal years, (IV)’’. 
(b) MEDPAC EVALUATION AND REPORT.— 
(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 Commis-
sion. 
(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, 2020, 
the Commission shall provide Congress with preliminary 
results on the evaluation being conducted under paragraph 
(1). 
(4) REPORT.—Not later than March 15, 2021, the Commis-
sion shall submit to Congress a report on the evaluation con-
ducted under paragraph (1). 
SEC. 53110. MEDICARE PAYMENT UPDATE FOR HOME HEALTH SERV-
ICES. 
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. 53111. MEDICARE PAYMENT UPDATE FOR SKILLED NURSING 
FACILITIES. 
Section 1888(e)(5)(B) of the Social Security Act (42 U.S.C. 
1395yy(e)(5)(B)) is amended— 
(1) in clause (i), by striking ‘‘and (iii)’’ and inserting ‘‘, 
(iii), and (iv)’’; 
(2) in clause (ii), by striking ‘‘clause (iii)’’ and inserting 
‘‘clauses (iii) and (iv)’’; and
H. R. 1892—242 
(3) by adding at the end the following new clause: 
‘‘(iv) SPECIAL
RULE
FOR
FISCAL
YEAR
2019.—For 
fiscal year 2019 (or other similar annual period speci-
fied in clause (i)), the skilled nursing facility market 
basket percentage, after application of clause (ii), is 
equal to 2.4 percent.’’. 
SEC. 53112. PREVENTING THE ARTIFICIAL INFLATION OF STAR 
RATINGS AFTER THE CONSOLIDATION OF MEDICARE 
ADVANTAGE PLANS OFFERED BY THE SAME ORGANIZA-
TION. 
Section 1853(o)(4) of the Social Security Act (42 U.S.C. 1395w– 
23(o)(4)) is amended by adding at the end the following new 
subparagraph: 
‘‘(D) SPECIAL RULE TO PREVENT THE ARTIFICIAL INFLA-
TION OF STAR RATINGS AFTER THE CONSOLIDATION OF MEDI-
CARE ADVANTAGE PLANS OFFERED BY A SINGLE ORGANIZA-
TION.— 
‘‘(i) IN GENERAL.—If— 
‘‘(I) a Medicare Advantage organization has 
entered into more than one contract with the Sec-
retary with respect to the offering of Medicare 
Advantage plans; and 
‘‘(II) on or after January 1, 2019, the Secretary 
approves a request from the organization to 
consolidate the plans under one or more contract 
(in this subparagraph referred to as a ‘closed con-
tract’) with the plans offered under a separate 
contract (in this subparagraph referred to as the 
‘continuing contract’); 
with respect to the continuing contract, the Secretary 
shall adjust the quality rating under the 5-star rating 
system and any quality increase under this subsection 
and rebate amounts under section 1854 to reflect an 
enrollment-weighted average of scores or ratings for 
the continuing and closed contracts, as determined 
appropriate by the Secretary. 
‘‘(ii) APPLICATION.—An adjustment under clause 
(i) shall apply for any year for which the quality rating 
of the continuing contract is based primarily on a 
measurement period that is prior to the first year 
in which a closed contract is no longer offered.’’. 
SEC. 53113. SUNSETTING EXCLUSION OF BIOSIMILARS FROM MEDI-
CARE 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. 53114. ADJUSTMENTS TO MEDICARE PART B AND PART D PRE-
MIUM SUBSIDIES FOR HIGHER INCOME INDIVIDUALS. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i) of the Social Security 
Act (42 U.S.C. 1395r(i)(3)(C)(i)) is amended— 
(1) in subclause (II), in the matter preceding the table, 
by striking ‘‘years beginning with’’; and 
(2) by adding at the end the following new subclause: 
‘‘(III) Subject to paragraph (5), for years begin-
ning with 2019:
H. R. 1892—243 
‘‘If the modified adjusted gross income 
is: .................................................................
The applicable 
percentage is:
More than $85,000 but not more than 
$107,000 ......................................................
35 percent
More than $107,000 but not more than 
$133,500 ......................................................
50 percent
More than $133,500 but not more than 
$160,000 ......................................................
65 percent
More than $160,000 but less than $500,000 
80 percent
At least $500,000 ...........................................
85 percent.’’. 
(b) JOINT RETURNS.—Section 1839(i)(3)(C)(ii) of the Social Secu-
rity Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by inserting before 
the period the following: ‘‘except, with respect to the dollar amounts 
applied in the last row of the table under subclause (III) of such 
clause (and the second dollar amount specified in the second to 
last row of such table), clause (i) shall be applied by substituting 
dollar amounts which are 150 percent of such dollar amounts for 
the calendar year’’. 
(c) INFLATION ADJUSTMENT.—Section 1839(i)(5) of the Social 
Security Act (42 U.S.C. 1395r(i)(5)) is amended— 
(1) in subparagraph (A), by striking ‘‘In the case’’ and 
inserting ‘‘Subject to subparagraph (C), in the case’’; 
(2) in subparagraph (B), by striking ‘‘subparagraph (A)’’ 
and inserting ‘‘subparagraph (A) or (C)’’; and 
(3) by adding at the end the following new subparagraph: 
‘‘(C) TREATMENT OF ADJUSTMENTS FOR CERTAIN HIGHER 
INCOME INDIVIDUALS.— 
‘‘(i) IN
GENERAL.—Subparagraph (A) shall not 
apply with respect to each dollar amount in paragraph 
(3) of $500,000. 
‘‘(ii) ADJUSTMENT BEGINNING 2028.—In the case of 
any calendar year beginning after 2027, each dollar 
amount in paragraph (3) of $500,000 shall be increased 
by an amount equal to— 
‘‘(I) such dollar amount, multiplied by 
‘‘(II) the percentage (if any) by which the aver-
age of the Consumer Price Index for all urban 
consumers (United States city average) for the 12- 
month period ending with August of the preceding 
calendar year exceeds such average for the 12- 
month period ending with August 2026.’’. 
SEC. 53115. MEDICARE IMPROVEMENT FUND. 
Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
1395iii(b)(1)) is amended by striking ‘‘$220,000,000’’ and inserting 
‘‘$0’’. 
SEC. 53116. CLOSING THE DONUT HOLE FOR SENIORS. 
(a) CLOSING DONUT HOLE SOONER.—Section 1860D–2(b)(2)(D) 
of the Social Security Act (42 U.S.C. 1395w–102(b)(2)(D))— 
(1) in clause (i), by amending subclause (I) to read as 
follows: 
‘‘(I) equal to the difference between—
H. R. 1892—244 
‘‘(aa) the applicable gap percentage (speci-
fied in clause (ii) for the year); and 
‘‘(bb) the discount percentage specified in 
section 1860D–14A(g)(4)(A) for such applicable 
drugs (or, in the case of a year after 2018, 
50 percent); or’’; and 
(2) in clause (ii)— 
(A) in subclause (IV), by adding ‘‘and’’ at the end; 
(B) by striking subclause (V); and 
(C) in subclause (VI)— 
(i) by striking ‘‘2020’’ and inserting ‘‘2019’’; and 
(ii) by redesignating such subclause as subclause 
(V). 
(b) LOWERING DISCOUNTED PRICE.—Section 1860D–14A(g)(4)(A) 
of the Social Security Act (42 U.S.C. 1395w–114a(g)(4)(A)) is 
amended by inserting ‘‘(or, with respect to a plan year after plan 
year 2018, 30 percent)’’ after ‘‘50 percent’’. 
SEC. 53117. 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 amendments 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 (42 U.S.C. 651 et seq.) 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 (42 U.S.C. 
651 et seq.) to meet the requirements imposed by the amend-
ment made by subsection (a), the plan shall not be regarded 
as failing to meet such requirements before the 1st day of 
the 1st calendar quarter beginning after the first regular ses-
sion 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. 
SEC. 53118. INCREASING EFFICIENCY OF PRISON DATA REPORTING. 
(a) IN GENERAL.—Section 1611(e)(1)(I)(i)(II) of the Social Secu-
rity 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 Commis-
sioner of Social Security pursuant to section 1611(e)(1)(I)(i)(II) of 
the Social Security Act (42 U.S.C. 1382(e)(1)(I)(i)(II)) (as amended 
by such subsection) on or after the date that is 6 months after 
the date of enactment of this Act.
H. R. 1892—245 
SEC. 53119. PREVENTION AND PUBLIC HEALTH FUND. 
Section 4002(b) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 300u–11(b)), as amended by section 3103 of Public 
Law 115–96, is amended by striking paragraphs (4) through (9) 
and inserting the following: 
‘‘(4) for fiscal year 2019, $900,000,000; 
‘‘(5) for each of fiscal years 2020 and 2021, $950,000,000; 
‘‘(6) for each of fiscal years 2022 and 2023, $1,000,000,000; 
‘‘(7) for each of fiscal years 2024 and 2025, $1,300,000,000; 
‘‘(8) for each of fiscal years 2026 and 2027, $1,800,000,000; 
and 
‘‘(9) for fiscal year 2028 and each fiscal year thereafter, 
$2,000,000,000.’’. 
DIVISION F—IMPROVEMENTS TO AGRICULTURE 
PROGRAMS 
SEC. 60101. (a) TREATMENT OF SEED COTTON.— 
(1) DESIGNATION
OF
SEED
COTTON
AS
A
COVERED
COM-
MODITY.—Section 1111(6) of the Agricultural Act of 2014 (7 
U.S.C. 9011(6)) is amended— 
(A) by striking ‘‘The term’’ and inserting the following: 
‘‘(A) IN GENERAL.—The term’’; and 
(B) by adding at the end the following: 
‘‘(B) INCLUSION.—Effective beginning with the 2018 
crop year, the term ‘covered commodity’ includes seed 
cotton.’’. 
(2) REFERENCE PRICE FOR SEED COTTON.—Section 1111(18) 
of the Agricultural Act of 2014 (7 U.S.C. 9011(18)) is amended 
by adding at the end the following: 
‘‘(O) For seed cotton, $0.367 per pound.’’. 
(3) DEFINITION OF SEED COTTON.—Section 1111 of the Agri-
cultural Act of 2014 (7 U.S.C. 9011) is amended— 
(A) by redesignating paragraphs (20) through (24) as 
paragraphs (21) through (25), respectively; and 
(B) by inserting after paragraph (19) the following: 
‘‘(20) SEED
COTTON.—The term ‘seed cotton’ means 
unginned upland cotton that includes both lint and seed.’’. 
(4) PAYMENT YIELD.—Section 1113 of the Agricultural Act 
of 2014 (7 U.S.C. 9013) is amended by adding at the end 
the following: 
‘‘(e) PAYMENT YIELD FOR SEED COTTON.— 
‘‘(1) PAYMENT YIELD.—Subject to paragraph (2), the pay-
ment yield for seed cotton for a farm shall be equal to 2.4 
times the payment yield for upland cotton for the farm estab-
lished under section 1104(e)(3) of the Food, Conservation, and 
Energy Act of 2008 (7 U.S.C. 8714(e)(3)) (as in effect on Sep-
tember 30, 2013). 
‘‘(2) UPDATE.—At the sole discretion of the owner of a 
farm with a yield for upland cotton described in paragraph 
(1), the owner of the farm shall have a 1-time opportunity 
to update the payment yield for upland cotton for the farm, 
as provided in subsection (d), for the purpose of calculating 
the payment yield for seed cotton under paragraph (1).’’. 
(5) PAYMENT ACRES.—Section 1114(b) of the Agricultural 
Act of 2014 (7 U.S.C. 9014(b)) is amended by adding at the 
end the following:
H. R. 1892—246 
‘‘(4) SEED COTTON.— 
‘‘(A) IN GENERAL.—Not later than 90 days after the 
date of enactment of this paragraph, the Secretary shall 
require the owner of a farm to allocate all generic base 
acres on the farm under subparagraph (B) or (C), or both. 
‘‘(B) NO RECENT HISTORY OF COVERED COMMODITIES.— 
In the case of a farm on which no covered commodities 
(including seed cotton) were planted or were prevented 
from being planted at any time during the 2009 through 
2016 crop years, the owner of such farm shall allocate 
generic base acres on the farm to unassigned crop base 
for which no payments may be made under section 1116 
or 1117. 
‘‘(C) RECENT HISTORY OF COVERED COMMODITIES.—In 
the case of a farm not described in subparagraph (B), 
the owner of such farm shall allocate generic base acres 
on the farm— 
‘‘(i) subject to subparagraph (D), to seed cotton 
base acres in a quantity equal to the greater of— 
‘‘(I) 80 percent of the generic base acres on 
the farm; or 
‘‘(II) the average number of seed cotton acres 
planted or prevented from being planted on the 
farm during the 2009 through 2012 crop years 
(not to exceed the total generic base acres on the 
farm); or 
‘‘(ii) to base acres for covered commodities 
(including seed cotton), by applying subparagraphs (B), 
(D), (E), and (F) of section 1112(a)(3). 
‘‘(D) TREATMENT OF RESIDUAL GENERIC BASE ACRES.— 
In the case of a farm on which generic base acres are 
allocated under subparagraph (C)(i), the residual generic 
base acres shall be allocated to unassigned crop base for 
which no payments may be made under section 1116 or 
1117. 
‘‘(E) EFFECT OF FAILURE TO ALLOCATE.—In the case 
of a farm not described in subparagraph (B) for which 
the owner of the farm fails to make an election under 
subparagraph (C), the owner of the farm shall be deemed 
to have elected to allocate all generic base acres in accord-
ance with subparagraph (C)(i).’’. 
(6) RECORDKEEPING REGARDING UNASSIGNED CROP BASE.— 
Section 1114 of the Agricultural Act of 2014 (7 U.S.C. 9014) 
is amended by adding at the end the following: 
‘‘(f) UNASSIGNED CROP BASE.—The Secretary shall maintain 
information on generic base acres on a farm allocated as unassigned 
crop base under subsection (b)(4).’’. 
(7) SPECIAL ELECTION PERIOD FOR PRICE LOSS COVERAGE 
OR AGRICULTURE RISK COVERAGE.—Section 1115 of the Agricul-
tural Act of 2014 (7 U.S.C. 9015) is amended— 
(A) in subsection (a), by striking ‘‘For’’ and inserting 
‘‘Except as provided in subsection (g), for’’; and 
(B) by adding at the end the following: 
‘‘(g) SPECIAL ELECTION.— 
‘‘(1) IN GENERAL.—In the case of acres allocated to seed 
cotton on a farm, all of the producers on the farm shall be 
given the opportunity to make a new 1-time election under