I 
115TH CONGRESS 
2D SESSION 
H. R. 4820 
To extend funding for certain public health programs, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 18, 2018 
Mr. MCEACHIN (for himself, Ms. ROYBAL-ALLARD, Mr. CLAY, Mr. SERRANO, 
Mr. ESPAILLAT, Mr. DEUTCH, Mrs. NAPOLITANO, Mr. POCAN, Mr. LAN-
GEVIN, Mr. RICHMOND, Mr. HUFFMAN, Mr. SCHRADER, Ms. ADAMS, Mr. 
MCNERNEY, Mr. GRIJALVA, Mr. BRENDAN F. BOYLE of Pennsylvania, 
Mr. CARSON of Indiana, Mr. SABLAN, Ms. BONAMICI, Mr. LARSON of 
Connecticut, Ms. JUDY CHU of California, Ms. DELBENE, Ms. NORTON, 
Mr. SCOTT of Virginia, Mr. COHEN, Mr. SEAN PATRICK MALONEY of 
New York, Ms. BARRAGA´N, Ms. MATSUI, Ms. SCHAKOWSKY, Mr. VEASEY, 
Mr. SOTO, Ms. JAYAPAL, Mr. KEATING, Mr. AL GREEN of Texas, Mr. 
LOWENTHAL, Ms. WILSON of Florida, Ms. HANABUSA, Ms. CASTOR of 
Florida, Ms. SEWELL of Alabama, Mr. GOMEZ, Mr. LOEBSACK, Ms. 
WASSERMAN SCHULTZ, Mrs. WATSON COLEMAN, Mr. THOMPSON of Cali-
fornia, Mr. COURTNEY, Ms. ROSEN, Mr. TAKANO, Ms. PINGREE, Ms. 
KUSTER of New Hampshire, Mr. KHANNA, Mr. PANETTA, and Mr. 
KIHUEN) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To extend funding for certain public health programs, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Advancing Seniors and 
Kids Act’’ or the ‘‘ASK Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents of this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
TITLE I—CHILDREN’S HEALTH INSURANCE PROGRAM 
Sec. 100. Short title. 
Sec. 101. Permanent extension of the Children’s Health Insurance Program. 
Sec. 102. Extension of certain programs and demonstration projects. 
Sec. 103. Extension of outreach and enrollment program. 
Sec. 104. Extension and reduction of additional Federal financial participation 
for CHIP. 
TITLE II—MEDICARE AND OTHER HEALTH EXTENDERS 
Subtitle A—Medicare Extenders and Related Policies 
Sec. 201. Extension of work GPCI floor. 
Sec. 202. Permanent repeal of the therapy caps. 
Sec. 203. Ground ambulance services cost reporting requirement. 
Sec. 204. Ground ambulance services cost reporting study. 
Sec. 205. Extension of ground ambulance services extenders. 
Sec. 206. Extension of increased inpatient hospital payment adjustment for cer-
tain low-volume hospitals. 
Sec. 207. Extension of the Medicare-Dependent Hospital (MDH) program. 
Sec. 208. Specialized Medicare Advantage plans for special needs individuals. 
Sec. 209. Expanding supplemental benefits to meet the needs of chronically ill 
Medicare Advantage enrollees. 
Sec. 210. Extension of consensus-based entity funding. 
Sec. 211. Extension of certain MIPPA funding provisions. 
Sec. 212. Extension of home health rural add-on. 
Subtitle B—Medicaid and Public Health Extenders 
Sec. 221. Extension for community health centers and the National Health 
Service Corps. 
Sec. 222. Extension for special diabetes programs. 
Sec. 223. Reauthorization of program of payments to teaching health centers 
that operate graduate medical education programs. 
Sec. 224. Extension for family-to-family health information centers. 
Sec. 225. Extension of abstinence education; extension of personal responsi-
bility education program. 
Sec. 226. Extension of health workforce demonstration projects for low-income 
individuals. 
Sec. 227. Delay of reduction to Medicaid DSH allotments. 
Sec. 228. Delay of Bipartisan Budget Act of 2013 third-party liability provi-
sions. 
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Subtitle C—Continuing the Maternal, Infant, and Early Childhood Home 
Visiting Program 
Sec. 231. Continuing evidence-based home visiting program. 
Sec. 232. Continuing to demonstrate results to help families. 
Sec. 233. Reviewing statewide needs to target resources. 
Sec. 234. Improving the likelihood of success in high-risk communities. 
Sec. 235. Option to fund evidence-based home visiting on a pay for outcome 
basis. 
Sec. 236. Data exchange standards for improved interoperability. 
Sec. 237. Allocation of funds. 
TITLE III—STRENGTHENING PROTECTIONS FOR SOCIAL 
SECURITY BENEFICIARIES ACT OF 2018 
Sec. 300. Short title. 
Subtitle A—Strengthening Oversight and Beneficiary Protection 
Sec. 301. Stronger monitoring of representative payees. 
Sec. 302. Reducing the burden on families. 
Sec. 303. Protecting beneficiaries through information sharing. 
Sec. 304. Clarifying overpayment liability for child in child welfare system. 
Sec. 305. Reports. 
Subtitle B—Improving Payee Selection and Quality 
Sec. 311. Advance designation of representative payees. 
Sec. 312. Prohibition on individuals convicted of certain crimes serving as rep-
resentative payees. 
Sec. 313. Prohibition on individuals with representative payees serving as rep-
resentative payees. 
Sec. 314. Reassessment of payee selection and replacement policies. 
TITLE I—CHILDREN’S HEALTH 
INSURANCE PROGRAM 
SEC. 100. SHORT TITLE. 
This title may be cited as the ‘‘Keeping Kids’ Insur-
ance Delivery Stable Act’’ or the ‘‘KIDS Act’’. 
SEC. 101. PERMANENT EXTENSION OF THE CHILDREN’S 
HEALTH INSURANCE PROGRAM. 
(a) FUNDING.— 
(1) IN GENERAL.—Section 2104(a) of the So-
cial Security Act (42 U.S.C. 1397dd(a)), as amend-
ed by section 3201(a) of the CHIP and Public 
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most recently published by the Secretary before 
the beginning of the fiscal year; and 
‘‘(B) 1 plus the percentage increase (if 
any) in the national population of children from 
July 1 in the previous fiscal year to July 1 in 
the fiscal year involved, as determined by the 
Secretary based on the most recent published 
estimates of the Bureau of the Census before 
the beginning of the fiscal year involved, plus 1 
percentage point.’’. 
(2) PREVENTION
OF
DUPLICATE
APPROPRIA-
TIONS FOR FISCAL YEAR 2018.—Notwithstanding any 
other provision of law, insofar as funds have been 
appropriated under subsection (a)(21) of section 
2104 of the Social Security Act (42 U.S.C. 1397dd), 
as such subsection is in effect on the day before the 
date of the enactment of this Act, to provide allot-
ments to States under the State Children’s Health 
Insurance Program established under title XXI of 
the Social Security Act (42 U.S.C. 1397aa et seq.) 
(whether implemented under title XIX, XXI, or 
both, of the Social Security Act) for fiscal year 
2018— 
(A) any amounts that are so appropriated 
that are not so allotted and obligated before the 
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date of the enactment of this Act, are re-
scinded; and 
(B) any amount provided for CHIP allot-
ments to a State under this section (and the 
amendments made by this section) for such fis-
cal year shall be reduced by the amount of such 
appropriations so allotted and obligated before 
such date. 
(b) ALLOTMENTS.—Section 2104(m) of the Social 
Security Act (42 U.S.C. 1397dd(m)), as amended by sec-
tion 3201(b) of the CHIP and Public Health Funding Ex-
tension Act (division C of Public Law 115–96), is amend-
ed— 
(1) in paragraph (2)(B)— 
(A) in the matter preceding clause (i), by 
striking ‘‘(19)’’ and inserting ‘‘(31)’’; and 
(B) in clause (ii)— 
(i) in the matter preceding subclause 
(I), by striking ‘‘and paragraph (10)’’; and 
(ii) in subclause (I), by inserting ‘‘(or, 
in the case of fiscal year 2018, under para-
graph (4))’’ after ‘‘clause (i)’’; 
(2) in paragraph (5), by striking ‘‘, 2017, or 
2018’’ and inserting ‘‘or 2017’’; 
(3) in paragraph (7)— 
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(A) in subparagraph (A), by striking ‘‘and 
ending with fiscal year 2017’’; 
(B) in subparagraph (B), in the matter 
preceding clause (i), by inserting ‘‘(or, in the 
case of fiscal year 2018, by not later than the 
date that is 60 days after the date of the enact-
ment of the KIDS Act)’’ after ‘‘before the Au-
gust 31 preceding the beginning of the fiscal 
year’’; and 
(C) in the matter following subparagraph 
(B), by striking ‘‘or fiscal year 2016’’ and in-
serting ‘‘fiscal year 2016, or any succeeding 
even-numbered fiscal year’’; 
(4) in paragraph (9), by striking ‘‘, 2017, or 
2018’’ and inserting ‘‘or 2017’’; and 
(5) by striking paragraph (10). 
(c) EXTENSION OF THE CHILD ENROLLMENT CON-
TINGENCY FUND.—Section 2104(n) of the Social Security 
Act (42 U.S.C. 1397dd(n)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii), by striking 
‘‘2010, 2011, 2012, 2013, 2014, and 2016’’ 
and inserting ‘‘2010 through 2014, 2016, 2018, 
and each subsequent fiscal year’’; and 
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(B) in subparagraph (B), by striking 
‘‘2010, 2011, 2012, 2013, 2014, and 2016’’ 
and inserting ‘‘2010 through 2014, 2016, 2018, 
and each subsequent fiscal year’’; and 
(2) in paragraph (3)(A), in the matter pre-
ceding clause (i), by striking ‘‘or a semi-annual allot-
ment period for fiscal year 2015 or 2017’’ and in-
serting ‘‘or in fiscal year 2018 or any subsequent 
fiscal year (or a semi-annual allotment period for 
fiscal year 2015, or 2017)’’. 
(d) EXTENSION OF QUALIFYING STATES OPTION.— 
(1) IN GENERAL.—Section 2105(g)(4) of the 
Social Security Act (42 U.S.C. 1397ee(g)(4)) is 
amended— 
(A) in the heading, by striking ‘‘THROUGH 
2017’’ and inserting ‘‘AND SUBSEQUENT FISCAL 
YEARS’’; and 
(B) in subparagraph (A), by striking ‘‘for 
any of fiscal years 2009 through 2017’’ and in-
serting ‘‘for fiscal year 2009 or any subsequent 
fiscal year’’. 
(2) 
TECHNICAL
AMENDMENTS.—Section 
2104(f)(2)(B)(ii) of the Social Security Act (42 
U.S.C. 1397dd(f)(2)(B)(ii)), as amended by section 
3201(c) of the CHIP and Public Health Funding 
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Extension Act (division C of Public Law 115–96), is 
amended— 
(A) in subclause (I), by striking ‘‘for the 
month (as defined in subclause (II))’’ and in-
serting ‘‘(as defined in subclause (II)) for the 
month’’; 
(B) in subclause (II), by inserting ‘‘, as in 
effect on the day before the date of the enact-
ment of the KIDS Act,’’ after ‘‘section 
2105(g)(4)(A)’’; and 
(C) in subclause (VI)— 
(i) by inserting ‘‘, as in effect on the 
day before the date of the enactment of the 
KIDS Act’’ after ‘‘, section 2105(g)(4)’’; 
and 
(ii) by inserting ‘‘, as so in effect’’ 
after ‘‘under section 2105(g)(4)’’. 
(e) EXTENSION OF EXPRESS LANE ELIGIBILITY OP-
TION.—Section 1902(e)(13) of the Social Security Act (42 
U.S.C. 1396a(e)(13)) is amended by striking subpara-
graph (I). 
(f) ASSURANCE OF AFFORDABILITY STANDARD FOR 
CHILDREN AND FAMILIES.— 
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(1) IN GENERAL.—Section 2105(d)(3) of the 
Social Security Act (42 U.S.C. 1397ee(d)(3)) is 
amended— 
(A) in the paragraph heading, by striking 
‘‘UNTIL OCTOBER 1, 2019’’; and 
(B) in subparagraph (A), in the matter 
preceding clause (i)— 
(i) by striking ‘‘During the period 
that begins on’’ and inserting ‘‘Beginning 
on’’; 
(ii) by striking ‘‘and ends on Sep-
tember 30, 2019’’; and 
(iii) by striking ‘‘The preceding sen-
tence shall not be construed as preventing 
a State during such period’’ and inserting 
‘‘Beginning on October 1, 2019, the pre-
ceding sentence shall only apply with re-
spect to children in families whose income 
does not exceed 300 percent of the poverty 
line (as defined in section 2110(c)(5)) ap-
plicable to a family of the size involved. 
The preceding sentences shall not be con-
strued as preventing a State during any 
such periods’’. 
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(2) 
CONFORMING
AMENDMENTS.—Section 
1902(gg)(2) of the Social Security Act (42 U.S.C. 
1396a(gg)(2)) is amended— 
(A) in the paragraph heading, by striking 
‘‘UNTIL OCTOBER 1, 2019’’; and 
(B) by striking ‘‘through September 30, 
2019,’’ and inserting ‘‘(but beginning on Octo-
ber 1, 2019, only with respect to children in 
families whose income does not exceed 300 per-
cent of the poverty line (as defined in section 
2110(c)(5)) applicable to a family of the size in-
volved)’’. 
(g) CHIP LOOK-ALIKE PLANS.— 
(1) BLENDING RISK POOLS.—Section 2107 of 
the Social Security Act (42 U.S.C. 1397gg) is 
amended by adding at the end the following: 
‘‘(g) USE OF BLENDED RISK POOLS.— 
‘‘(1) IN GENERAL.—Nothing in this title (or 
any other provision of Federal law) shall be con-
strued as preventing a State from considering chil-
dren enrolled in a qualified CHIP look-alike pro-
gram and children enrolled in a State child health 
plan under this title (or a waiver of such plan) as 
members of a single risk pool. 
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‘‘(2) QUALIFIED CHIP LOOK-ALIKE PROGRAM.— 
In this subsection, the term ‘qualified CHIP look- 
alike program’ means a State program— 
‘‘(A) under which children who are under 
the age of 19 and are not eligible to receive 
medical assistance under title XIX or child 
health assistance under this title may purchase 
coverage through the State that provides bene-
fits that are at least identical to the benefits 
provided under the State child health plan 
under this title (or a waiver of such plan); and 
‘‘(B) that is funded exclusively through 
non-Federal funds, including funds received by 
the State in the form of premiums for the pur-
chase of such coverage.’’. 
(2) COVERAGE RULE.— 
(A) IN GENERAL.—Section 5000A(f)(1) of 
the Internal Revenue Code of 1986 is amended 
in subparagraph (A)(iii), by inserting ‘‘or under 
a qualified CHIP look-alike program (as de-
fined in section 2107(g) of the Social Security 
Act)’’ before the comma at the end. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
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spect to taxable years beginning after December 
31, 2017. 
(h) AVAILABILITY OF UNUSED FISCAL YEAR 2018 
REDISTRIBUTION AMOUNTS.—Any amounts that have 
been redistributed to States under subsection (f) of section 
2104 of the Social Security Act (42 U.S.C. 1397dd) for 
fiscal year 2018 that are not, or will not be, expended by 
the end of that fiscal year shall be— 
(1) adjusted by the Secretary before the end of 
fiscal year 2018 to reflect an updated estimate of 
shortfalls under subsection (f)(2)(A) of such section; 
and 
(2) available for redistribution under subsection 
(f) of such section for subsequent fiscal years. 
SEC. 102. EXTENSION OF CERTAIN PROGRAMS AND DEM-
ONSTRATION PROJECTS. 
(a) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.—Section 1139A(e)(8) of the Social Security 
Act (42 U.S.C. 1320b–9a(e)(8)) is amended— 
(1) by striking ‘‘and $10,000,000’’ and insert-
ing ‘‘, $10,000,000’’; and 
(2) by inserting after ‘‘2017’’ the following: ‘‘, 
and $5,000,000 for fiscal year 2018 and each subse-
quent fiscal year’’. 
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(b) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i) of the Social Security Act (42 U.S.C. 
1320b–9a(i)) is amended— 
(1) by striking ‘‘Out of any’’ and inserting the 
following: 
‘‘(1) IN GENERAL.—Out of any’’; 
(2) by striking ‘‘there is appropriated for each’’ 
and inserting ‘‘there is appropriated— 
‘‘(A) for each’’; 
(3) by striking ‘‘, and there is appropriated for 
the period’’ and inserting ‘‘; 
‘‘(B) for the period’’; 
(4) by striking ‘‘. Funds appropriated under 
this subsection shall remain available until ex-
pended.’’ and inserting ‘‘; and’’; and 
(5) by adding at the end the following: 
‘‘(C) for fiscal year 2018 and each subse-
quent fiscal year, $15,000,000 for the purpose 
of carrying out this section (other than sub-
sections (e), (f), and (g)). 
‘‘(2) 
AVAILABILITY.—Funds 
appropriated 
under this subsection shall remain available until ex-
pended.’’. 
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SEC. 103. EXTENSION OF OUTREACH AND ENROLLMENT 
PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Secu-
rity Act (42 U.S.C. 1397mm) is amended— 
(1) in subsection (a)(1), by striking ‘‘during the 
period of fiscal years 2009 through 2017’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $40,000,000’’ and in-
serting ‘‘, $40,000,000’’; and 
(B) by inserting after ‘‘2017’’ the fol-
lowing: ‘‘, and $20,000,000 for fiscal year 2018 
and each subsequent fiscal year’’. 
(b) MAKING ORGANIZATIONS THAT USE PARENT 
MENTORS
ELIGIBLE
TO
RECEIVE
GRANTS.—Section 
2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) 
is amended— 
(1) in paragraph (1)(E), by striking ‘‘or com-
munity-based doula programs’’ and inserting ‘‘, com-
munity-based doula programs, or parent mentors’’; 
and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) PARENT
MENTOR.—The term ‘parent 
mentor’ means an individual who— 
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‘‘(A) is a parent or guardian of at least 
one child who is an eligible child under this title 
or title XIX; and 
‘‘(B) is trained to assist families with chil-
dren who have no health insurance coverage 
with respect to improving the social deter-
minants of the health of such children, includ-
ing by providing— 
‘‘(i) education about health insurance 
coverage, including, with respect to obtain-
ing such coverage, eligibility criteria and 
application and renewal processes; 
‘‘(ii) assistance with completing and 
submitting applications for health insur-
ance coverage; 
‘‘(iii) a liaison between families and 
representatives of State plans under title 
XIX or State child health plans under this 
title; 
‘‘(iv) guidance on identifying medical 
and dental homes and community phar-
macies for children; and 
‘‘(v) assistance and referrals to suc-
cessfully address social determinants of 
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children’s health, including poverty, food 
insufficiency, and housing.’’. 
(c) EXCLUSION FROM MODIFIED ADJUSTED GROSS 
INCOME.—Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended— 
(1) in the first paragraph (14), relating to in-
come determined using modified adjusted gross in-
come, by adding at the end the following new sub-
paragraph: 
‘‘(J) EXCLUSION
OF
PARENT
MENTOR 
COMPENSATION
FROM
INCOME
DETERMINA-
TION.—Any nominal amount received by an in-
dividual as compensation, including a stipend, 
for participation as a parent mentor (as defined 
in paragraph (5) of section 2113(f)) in an activ-
ity or program funded through a grant under 
such section shall be disregarded for purposes 
of determining the income eligibility of such in-
dividual for medical assistance under the State 
plan or any waiver of such plan.’’; and 
(2) by striking ‘‘(14) EXCLUSION’’ and insert-
ing ‘‘(15) EXCLUSION’’. 
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SEC. 104. EXTENSION AND REDUCTION OF ADDITIONAL 
FEDERAL FINANCIAL PARTICIPATION FOR 
CHIP. 
Section 2105(b) of the Social Security Act (42 U.S.C. 
1397ee(b)) is amended in the second sentence by inserting 
‘‘and during the period that begins on October 1, 2019, 
and ends on September 30, 2020, the enhanced FMAP 
determined for a State for a fiscal year (or for any portion 
of a fiscal year occurring during such period) shall be in-
creased by 11.5 percentage points’’ after ‘‘23 percentage 
points,’’. 
TITLE II—MEDICARE AND 
OTHER HEALTH EXTENDERS 
Subtitle A—Medicare Extenders 
and Related Policies 
SEC. 201. 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 ‘‘Janu-
ary 1, 2018’’ and inserting ‘‘January 1, 2020’’. 
SEC. 202. PERMANENT REPEAL OF THE THERAPY CAPS. 
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 para-
graphs (4) and (5)’’; 
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(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 serv-
ices of the type described in section 1861(p), speech-lan-
guage pathology services of the type described in such sec-
tion 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 ex-
penses 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)— 
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(A) by striking ‘‘Subject to paragraphs (4) 
and (5)’’ and inserting ‘‘(A) Subject to para-
graphs (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 physi-
cians’ 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 consid-
ered as incurred expenses for purposes of subsections (a) 
and (b) unless the applicable requirements of paragraph 
(7) are met.’’; 
(3) in paragraph (5)— 
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(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 para-
graph (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 para-
graph (5)(B)) indicating that such services are medi-
cally necessary as justified by appropriate docu-
mentation in the medical record involved. 
‘‘(B) TARGETED MEDICAL REVIEW FOR CER-
TAIN SERVICES ABOVE THRESHOLD.— 
‘‘(i) IN GENERAL.—In the case where ex-
penses that would be incurred for such services 
would exceed the threshold described in clause 
(ii) for the year, such services shall be subject 
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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 pre-
ceding year increased by the percentage in-
crease 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 serv-
ices. 
‘‘(iv) FUNDING.—For purposes of carrying 
out this subparagraph, the Secretary shall pro-
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vide for the transfer, from the Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841 to the Centers for Medicare & 
Medicaid Services Program Management Ac-
count, of $5,000,000 for each fiscal year begin-
ning 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.’’. 
SEC. 203. GROUND AMBULANCE SERVICES COST REPORT-
ING REQUIREMENT. 
(a) IN GENERAL.—Section 1121 of the Social Secu-
rity 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 am-
bulance services,’’ after ‘‘health maintenance or-
ganizations,’’; 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 system for 
providers of services with respect to ambulance 
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services to ensure that such system contains in-
formation similar (as determined by the Sec-
retary) to information required under the uni-
form reporting system for suppliers of ground 
ambulance services.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(d) In the case of a supplier of ground ambulance 
services that furnishes such services for fewer than 20 in-
dividuals entitled to benefits under part A of title XVIII 
and enrolled under part B of such title in a cost reporting 
period (as defined by the Secretary), the Secretary may 
modify the requirements for inclusion of any information 
specified in subsection (a) in reports made in accordance 
with the uniform reporting systems established under this 
section with respect to such services.’’. 
(b) SUSPENSION OF PAYMENT FOR GROUND AMBU-
LANCE SERVICES; DEEMING CERTAIN PAYMENTS OVER-
PAYMENTS.—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.— 
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‘‘(A) 
IN
GENERAL.—With 
respect 
to 
ground ambulance services furnished by a sup-
plier of such services during cost reporting peri-
ods (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 infor-
mation described in subparagraph (B). 
‘‘(B) 
ADDITIONAL
INFORMATION.—The 
Secretary may, with respect to a supplier of 
ground ambulance services, require the fol-
lowing information (to be reported to the extent 
practicable under the uniform reporting system 
established under section 1121(a) for such sup-
pliers): 
‘‘(i) Whether the supplier is part of 
an emergency services department, a gov-
ernmental 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. 
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‘‘(iii) The average number of volun-
teer hours a week used by the supplier. 
‘‘(C) SUSPENSION OF PAYMENT.—Subject 
to subparagraph (E), in the case that the Sec-
retary determines that a supplier of ground am-
bulance services has not made to the Secretary 
a timely report described in subparagraph (A) 
with respect to a cost reporting period begin-
ning 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 
finds that such supplier has made such a re-
port. 
‘‘(D) DEEMING CERTAIN PAYMENTS OVER-
PAYMENTS.—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, accu-
rate, and timely report described in subpara-
graph (A) with respect to a cost reporting pe-
riod beginning on or after January 1, 2022, the 
Secretary may deem payments made under this 
subsection to such supplier for such period to 
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be overpayments and recoup such overpay-
ments. 
‘‘(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
RE-
PORTING ELEMENTS AND ENFORCEMENT.—Not 
earlier than January 1, 2024, the Secretary 
may provide that subparagraph (D) no longer 
applies to ground ambulance services suppliers 
or a category of such suppliers after— 
‘‘(i) taking into account the rec-
ommendation of the Medicare Payment 
Advisory Commission in the most recent 
report available to the Secretary submitted 
under section 204 of the Advancing Sen-
iors and Kids Act regarding whether cost 
reports made by suppliers or a category of 
suppliers (as specified for purposes of the 
report submitted under such section) 
should be required or modified; and 
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‘‘(ii) undertaking notice and comment 
rulemaking. 
‘‘(G) AUDIT OF COST REPORTS.—The Sec-
retary shall audit reports described in subpara-
graph (A) made with respect to cost reporting 
periods beginning on or after January 1, 2021. 
‘‘(H) APPEALS.—The Secretary shall es-
tablish 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 REDUC-
TION ACT.—Chapter 35 of title 44, United States 
Code, shall not apply with respect to— 
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(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 ambu-
lance services and reports required to be made 
under section 1834(l)(17) of such Act (42 
U.S.C. 1395m(l)(17)), as added by subsection 
(b) of this section; and 
(B) the modification of the uniform report-
ing 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.— 
(1) IN
GENERAL.—There are hereby appro-
priated to the Secretary from the Federal Hospital 
Insurance Trust Fund under section 1817 of the So-
cial 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) $92,000,000 (of which not less than 
$10,000,000 shall be used to fulfill the auditing re-
quirement under section 1834(l)(17)(G) of such Act, 
as added by subsection (b) of this section) to carry 
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