184 
ambulance services furnished during such a period by 
the supplier; and 
(2) the Secretary should take into account only 
the timeliness of such a report made with respect to 
such a period when determining whether to suspend 
payments to a supplier under section 1834(l) of the 
Social Security Act (42 U.S.C. 1395m(l)). 
(g) GROUND AMBULANCE SERVICES COST REPORTING 
STUDY.— 
(1) IN
GENERAL.—Not later than March 15, 
2023, and as determined necessary by the Medicare 
Payment Advisory Commission thereafter, such Com-
mission shall assess and submit to Congress a report 
on cost reports of suppliers and providers of ground 
ambulance services carried out in accordance with 
sections 1121(a) and 1834(l) of the Social Security 
Act (42 U.S.C. 1320a(a), 1395m(l)), the adequacy of 
payments for such services made under section 
1834(l) of such Act, and geographic variations in the 
cost of providing such services. 
(2) CONTENTS.—The report described in para-
graph (1) shall contain the following: 
(A) An analysis of cost report data sub-
mitted in accordance with such sections.
185 
(B) An analysis of any burden on providers 
and suppliers of such services associated with re-
porting such data. 
(C) A recommendation on whether or not 
cost reports of ground ambulance services made 
by suppliers or a category of suppliers (as speci-
fied by the Secretary) of such services, or the 
ground ambulance portion of cost reports made 
by providers of such services, should be required 
or modified, taking into account the analyses de-
scribed in subparagraphs (A) and (B). 
SEC. 2112. EXTENSION OF WORK GPCI FLOOR. 
Section 1848(e)(1)(E) of the Social Security Act (42 
U.S.C. 1395w–4(e)(1)(E)) is amended by striking ‘‘Janu-
ary 1, 2018’’ and inserting ‘‘January 1, 2020’’. 
SEC. 2113. REPEAL OF MEDICARE PAYMENT CAP FOR THER-
APY SERVICES; REPLACEMENT WITH LIMITA-
TION TO ENSURE APPROPRIATE THERAPY. 
Section 1833(g) of the Social Security Act (42 U.S.C. 
1395l(g)) is amended— 
(1) in paragraph (1)— 
(A) by striking ‘‘Subject to paragraphs (4) 
and (5)’’ and inserting ‘‘(A) Subject to para-
graphs (4) and (5)’’;
186 
(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 serv-
ices 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 pur-
poses of subsections (a) and (b) unless the applicable re-
quirements of paragraph (7) are met.’’; 
(2) in paragraph (3)— 
(A) by striking ‘‘Subject to paragraphs (4) 
and (5)’’ and inserting ‘‘(A) Subject to para-
graphs (4) and (5)’’;
187 
(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 serv-
ices 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)— 
(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
188 
(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 para-
graph: 
‘‘(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 CERTAIN 
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 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;
189 
‘‘(II) 2028, is the amount specified in 
subclause (I) increased by the percentage in-
crease in the MEI (as defined in section 
1842(i)(3)) for 2028; and 
‘‘(III) a subsequent year, is the amount 
specified in this clause for the preceding 
year increased by the percentage increase in 
the MEI (as defined in section 1842(i)(3)) 
for such subsequent year; 
except that if an increase under subclause (II) or 
(III) for a year is not a multiple of $10, it shall 
be rounded to the nearest multiple of $10. 
‘‘(iii) APPLICATION.—The threshold under 
clause (ii) shall be applied separately— 
‘‘(I) for physical therapy services and 
speech-language pathology services; and 
‘‘(II) for occupational therapy services. 
‘‘(iv) FUNDING.—For purposes of carrying 
out this subparagraph, the Secretary shall pro-
vide for the transfer, from the Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841 to the Centers for Medicare & Med-
icaid Services Program Management Account, of 
$5,000,000 for each fiscal year beginning with 
fiscal year 2018, to remain available until ex-
190 
pended. Such funds may not be used by a con-
tractor under section 1893(h) for medical reviews 
under this subparagraph.’’. 
Subtitle C—Miscellaneous 
SEC. 2121. PROVIDING CONTINUED ACCESS TO MEDICARE 
ADVANTAGE SPECIAL NEEDS PLANS FOR VUL-
NERABLE POPULATIONS. 
(a) EXTENSION.—Section 1859(f)(1) of the Social Se-
curity Act (42 U.S.C. 1395w–28(f)(1)) is amended by strik-
ing ‘‘and for periods before January 1, 2019’’. 
(b) INCREASED INTEGRATION OF DUAL SNPS.— 
(1) IN GENERAL.—Section 1859(f) of the Social 
Security Act (42 U.S.C. 1395w–28(f)) is amended— 
(A) in paragraph (3), by adding at the end 
the following new subparagraph: 
‘‘(F) The plan meets the requirements ap-
plicable under paragraph (8).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(8) INCREASED INTEGRATION OF DUAL SNPS.— 
‘‘(A) DESIGNATED
CONTACT.—The Sec-
retary, acting through the Federal Coordinated 
Health Care Office established under section 
2602 of Public Law 111–148, shall serve as a 
dedicated point of contact for States to address
191 
misalignments that arise with the integration of 
specialized MA plans for special needs individ-
uals described in subsection (b)(6)(B)(ii) under 
this paragraph and, consistent with such role, 
shall establish— 
‘‘(i) a uniform process for dissemi-
nating to State Medicaid agencies informa-
tion under this title impacting contracts be-
tween such agencies and such plans under 
this subsection; and 
‘‘(ii) basic resources for States inter-
ested in exploring such plans as a platform 
for integration, such as a model contract or 
other tools to achieve those goals. 
‘‘(B) UNIFIED
GRIEVANCES
AND
APPEALS 
PROCESS.— 
‘‘(i) IN
GENERAL.—Not later than 
April 1, 2020, the Secretary shall establish 
procedures, to the extent feasible as deter-
mined by the Secretary, unifying grievances 
and appeals procedures under sections 
1852(f), 1852(g), 1902(a)(3), 1902(a)(5), 
and 1932(b)(4) for items and services pro-
vided by specialized MA plans for special 
needs individuals described in subsection
192 
(b)(6)(B)(ii) under this title and title XIX. 
With respect to items and services described 
in the preceding sentence, procedures estab-
lished under this clause shall apply in place 
of otherwise applicable grievances and ap-
peals procedures. The Secretary shall solicit 
comment in developing such procedures 
from States, plans, beneficiaries and their 
representatives, and other relevant stake-
holders. 
‘‘(ii) PROCEDURES.—The procedures 
established under clause (i) shall be in-
cluded in the plan contract under para-
graph (3)(D) and shall— 
‘‘(I) adopt the provisions for the 
enrollee that are most protective for the 
enrollee and, to the extent feasible as 
determined by the Secretary, are com-
patible with unified timeframes and 
consolidated access to external review 
under an integrated process; 
‘‘(II) take into account differences 
in State plans under title XIX to the 
extent necessary;
193 
‘‘(III) be easily navigable by an 
enrollee; and 
‘‘(IV) include the elements de-
scribed in clause (iii), as applicable. 
‘‘(iii) ELEMENTS
DESCRIBED.—Both 
unified appeals and unified grievance pro-
cedures shall include, as applicable, the fol-
lowing elements described in this clause: 
‘‘(I) Single written notification of 
all applicable grievances and appeal 
rights under this title and title XIX. 
For purposes of this subparagraph, the 
Secretary may waive the requirements 
under section 1852(g)(1)(B) when the 
specialized MA plan covers items or 
services under this part or under title 
XIX. 
‘‘(II) Single pathways for resolu-
tion of any grievance or appeal related 
to a particular item or service pro-
vided by specialized MA plans for spe-
cial needs individuals described in sub-
section (b)(6)(B)(ii) under this title 
and title XIX.
194 
‘‘(III) Notices written in plain 
language and available in a language 
and format that is accessible to the en-
rollee, including in non-English lan-
guages that are prevalent in the service 
area of the specialized MA plan. 
‘‘(IV) 
Unified 
timeframes 
for 
grievances and appeals processes, such 
as an individual’s filing of a grievance 
or appeal, a plan’s acknowledgment 
and resolution of a grievance or ap-
peal, and notification of decisions with 
respect to a grievance or appeal. 
‘‘(V) Requirements for how the 
plan must process, track, and resolve 
grievances and appeals, to ensure bene-
ficiaries are notified on a timely basis 
of decisions that are made throughout 
the grievance or appeals process and 
are able to easily determine the status 
of a grievance or appeal. 
‘‘(iv) CONTINUATION
OF
BENEFITS 
PENDING APPEAL.—The unified procedures 
under clause (i) shall, with respect to all 
benefits under parts A and B and title XIX
195 
subject to appeal under such procedures, in-
corporate provisions under current law and 
implementing regulations that provide con-
tinuation of benefits pending appeal under 
this title and title XIX. 
‘‘(C) REQUIREMENT
FOR
UNIFIED
GRIEV-
ANCES AND APPEALS.—For 2021 and subsequent 
years, the contract of a specialized MA plan for 
special needs individuals described in subsection 
(b)(6)(B)(ii) with a State Medicaid agency 
under paragraph (3)(D) shall require the use of 
unified grievances and appeals procedures as de-
scribed in subparagraph (B). 
‘‘(D) REQUIREMENTS FOR INTEGRATION.— 
‘‘(i) IN GENERAL.—For 2021 and sub-
sequent years, a specialized MA plan for 
special needs individuals described in sub-
section (b)(6)(B)(ii) shall meet one or more 
of the following requirements, to the extent 
permitted under State law, for integration 
of benefits under this title and title XIX: 
‘‘(I) The specialized MA plan 
must meet the requirements of con-
tracting with the State Medicaid agen-
cy described in paragraph (3)(D) in
196 
addition to coordinating long-term 
services and supports or behavioral 
health services, or both, by meeting an 
additional minimum set of require-
ments determined by the Secretary 
through 
the 
Federal 
Coordinated 
Health Care Office established under 
section 2602 of the Patient Protection 
and Affordable Care Act based on 
input from stakeholders, such as noti-
fying the State in a timely manner of 
hospitalizations, emergency room vis-
its, and hospital or nursing home dis-
charges of enrollees, assigning one pri-
mary care provider for each enrollee, 
or sharing data that would benefit the 
coordination of items and services 
under this title and the State plan 
under title XIX. Such minimum set of 
requirements must be included in the 
contract of the specialized MA plan 
with the State Medicaid agency under 
such paragraph. 
‘‘(II) The specialized MA plan 
must meet the requirements of a fully
197 
integrated plan described in section 
1853(a)(1)(B)(iv)(II) (other than the 
requirement that the plan have similar 
average levels of frailty, as determined 
by the Secretary, as the PACE pro-
gram), or enter into a capitated con-
tract with the State Medicaid agency 
to provide long-term services and sup-
ports or behavioral health services, or 
both. 
‘‘(III) In the case of a specialized 
MA plan that is offered by a parent or-
ganization that is also the parent orga-
nization of a Medicaid managed care 
organization providing long term serv-
ices and supports or behavioral services 
under 
a 
contract 
under 
section 
1903(m), the parent organization must 
assume clinical and financial responsi-
bility for benefits provided under this 
title and title XIX with respect to any 
individual who is enrolled in both the 
specialized MA plan and the Medicaid 
managed care organization.
198 
‘‘(ii) SUSPENSION
OF
ENROLLMENT 
FOR
FAILURE
TO
MEET
REQUIREMENTS 
DURING INITIAL PERIOD.—During the pe-
riod of plan years 2021 through 2025, if the 
Secretary determines that a specialized MA 
plan for special needs individuals described 
in subsection (b)(6)(B)(ii) has failed to 
comply with clause (i), the Secretary may 
provide for the application against the 
Medicare Advantage organization offering 
the plan of the remedy described in section 
1857(g)(2)(B) in the same manner as the 
Secretary may apply such remedy, and in 
accordance with the same procedures as 
would apply, in the case of an MA organi-
zation determined by the Secretary to have 
engaged in conduct described in section 
1857(g)(1). If the Secretary applies such 
remedy to a Medicare Advantage organiza-
tion under the preceding sentence, the orga-
nization shall submit to the Secretary (at a 
time, and in a form and manner, specified 
by the Secretary) information describing 
how the plan will come into compliance 
with clause (i).
199 
‘‘(E) STUDY AND REPORT TO CONGRESS.— 
‘‘(i) IN GENERAL.—Not later than Jan-
uary 1, 2022, and, subject to clause (iii), bi-
ennially thereafter through 2032, the Medi-
care Payment Advisory Commission estab-
lished under section 1805, in consultation 
with the Medicaid and CHIP Payment and 
Access Commission established under section 
1900, shall conduct (and submit to the Sec-
retary and the Committees on Ways and 
Means and Energy and Commerce of the 
House of Representatives and the Committee 
on Finance of the Senate a report on) a 
study to determine how specialized MA 
plans for special needs individuals described 
in subsection (b)(6)(B)(ii) perform among 
each other based on data from Healthcare 
Effectiveness Data and Information Set 
(HEDIS) quality measures, reported on the 
plan level, as required under section 
1852(e)(3) (or such other measures or data 
sources that are available and appropriate, 
such as encounter data and Consumer As-
sessment of Healthcare Providers and Sys-
tems data, as specified by such Commissions
200 
as enabling an accurate evaluation under 
this subparagraph). Such study shall in-
clude, as feasible, the following comparison 
groups of specialized MA plans for special 
needs individuals described in subsection 
(b)(6)(B)(ii): 
‘‘(I) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(I). 
‘‘(II) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(II). 
‘‘(III) A comparison group of 
such plans operating within the Fi-
nancial Alignment Initiative dem-
onstration for the period for which 
such plan is so operating and the dem-
onstration is in effect, and, in the case 
that an integration option that is not 
with respect to specialized MA plans 
for special needs individuals is estab-
lished after the conclusion of the dem-
onstration involved.
201 
‘‘(IV) A comparison group of such 
plans that are described in subpara-
graph (D)(i)(III). 
‘‘(V) A comparison group of MA 
plans, as feasible, not described in a 
previous subclause of this clause, with 
respect to the performance of such 
plans for enrollees who are special 
needs individuals described in sub-
section (b)(6)(B)(ii). 
‘‘(ii) DISCRETIONARY ADDITIONAL RE-
PORTS.—Beginning with 2033 and every 
five years thereafter, the Medicare Payment 
Advisory Commission, in consultation with 
the Medicaid and CHIP Payment and Ac-
cess Commission shall, at the discretion of 
the Secretary, conduct a study described in 
clause (i).’’. 
(2) CONFORMING AMENDMENT TO RESPONSIBIL-
ITIES OF FEDERAL COORDINATED HEALTH CARE OF-
FICE.—Section 2602(d) of Public Law 111–148 (42 
U.S.C. 1315b(d)) is amended by adding at the end the 
following new paragraphs: 
‘‘(6) To act as a designated contact for States 
under subsection (f)(8)(A) of section 1859 of the So-
202 
cial Security Act (42 U.S.C. 1395w–28) with respect 
to the integration of specialized MA plans for special 
needs individuals described in subsection (b)(6)(B)(ii) 
of such section. 
‘‘(7) To be responsible, subject to the final ap-
proval of the Secretary, for developing regulations 
and guidance related to the implementation of a uni-
fied grievance and appeals process as described in 
subparagraphs (B) and (C) of section 1859(f)(8) of 
the Social Security Act (42 U.S.C. 1395w–28(f)(8)). 
‘‘(8) To be responsible, subject to the final ap-
proval of the Secretary, for developing regulations 
and guidance related to the integration or alignment 
of policy and oversight under the Medicare program 
under title XVIII of such Act and the Medicaid pro-
gram under title XIX of such Act regarding special-
ized MA plans for special needs individuals described 
in subsection (b)(6)(B)(ii) of such section 1859.’’. 
(c) IMPROVEMENTS TO SEVERE OR DISABLING CHRON-
IC CONDITION SNPS.— 
(1) CARE
MANAGEMENT
REQUIREMENTS.—Sec-
tion 1859(f)(5) of the Social Security Act (42 U.S.C. 
1395w–28(f)(5)) is amended— 
(A) by striking ‘‘ALL SNPS.—The require-
ments’’ and inserting ‘‘ALL SNPS.—
203 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the requirements’’; 
(B) by redesignating subparagraphs (A) 
and (B) as clauses (i) and (ii), respectively, and 
indenting appropriately; and 
(C) in clause (ii), as redesignated by sub-
paragraph (B), by redesignating clauses (i) 
through (iii) as subclauses (I) through (III), re-
spectively, and indenting appropriately; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(B) IMPROVEMENTS
TO
CARE
MANAGE-
MENT
REQUIREMENTS
FOR
SEVERE
OR
DIS-
ABLING
CHRONIC
CONDITION
SNPS.—For 2020 
and subsequent years, in the case of a specialized 
MA plan for special needs individuals described 
in subsection (b)(6)(B)(iii), the requirements de-
scribed in this paragraph include the following: 
‘‘(i) The interdisciplinary team under 
subparagraph (A)(ii)(III) includes a team 
of providers with demonstrated expertise, 
including training in an applicable spe-
cialty, in treating individuals similar to the 
targeted population of the plan.
204 
‘‘(ii) Requirements developed by the 
Secretary to provide face-to-face encounters 
with individuals enrolled in the plan not 
less frequently than on an annual basis. 
‘‘(iii) As part of the model of care 
under clause (i) of subparagraph (A), the 
results of the initial assessment and annual 
reassessment under clause (ii)(I) of such 
subparagraph of each individual enrolled in 
the plan are addressed in the individual’s 
individualized care plan under clause 
(ii)(II) of such subparagraph. 
‘‘(iv) As part of the annual evaluation 
and approval of such model of care, the Sec-
retary shall take into account whether the 
plan fulfilled the previous year’s goals (as 
required under the model of care). 
‘‘(v) The Secretary shall establish a 
minimum benchmark for each element of the 
model of care of a plan. The Secretary shall 
only approve a plan’s model of care under 
this paragraph if each element of the model 
of care meets the minimum benchmark ap-
plicable under the preceding sentence.’’.
205 
(2) REVISIONS TO THE DEFINITION OF A SEVERE 
OR
DISABLING
CHRONIC
CONDITIONS
SPECIALIZED 
NEEDS INDIVIDUAL.— 
(A) 
IN
GENERAL.—Section 
1859(b)(6)(B)(iii) of the Social Security Act (42 
U.S.C. 1395w–28(b)(6)(B)(iii)) is amended— 
(i) by striking ‘‘who have’’ and insert-
ing ‘‘who— 
‘‘(I) before January 1, 2022, 
have’’; 
(ii) in subclause (I), as added by 
clause (i), by striking the period at the end 
and inserting ‘‘; and’’; and 
(iii) by adding at the end the following 
new subclause: 
‘‘(II) on or after January 1, 2022, 
have one or more comorbid and medi-
cally complex chronic conditions that 
is life threatening or significantly lim-
its overall health or function, have a 
high risk of hospitalization or other 
adverse health outcomes, and require 
intensive care coordination and that is 
listed under subsection (f)(9)(A).’’.
206 
(B) PANEL OF CLINICAL ADVISORS.—Sec-
tion 1859(f) of the Social Security Act (42 
U.S.C. 1395w–28(f)), as amended by subsection 
(b), is amended by adding at the end the fol-
lowing new paragraph: 
‘‘(9) LIST OF CONDITIONS FOR CLARIFICATION OF 
THE DEFINITION OF A SEVERE OR DISABLING CHRON-
IC CONDITIONS SPECIALIZED NEEDS INDIVIDUAL.— 
‘‘(A) IN GENERAL.—Not later than Decem-
ber 31, 2020, and every 5 years thereafter, sub-
ject to subparagraphs (B) and (C), the Secretary 
shall convene a panel of clinical advisors to es-
tablish and update a list of conditions that meet 
each of the following criteria: 
‘‘(i) Conditions that meet the defini-
tion of a severe or disabling chronic condi-
tion under subsection (b)(6)(B)(iii) on or 
after January 1, 2022. 
‘‘(ii) Conditions that require prescrip-
tion drugs, providers, and models of care 
that are unique to the specific population of 
enrollees in a specialized MA plan for spe-
cial needs individuals described in such sub-
section on or after such date and—
207 
‘‘(I) as a result of access to, and 
enrollment in, such a specialized MA 
plan for special needs individuals, in-
dividuals with such condition would 
have a reasonable expectation of slow-
ing or halting the progression of the 
disease, improving health outcomes and 
decreasing overall costs for individuals 
diagnosed with such condition com-
pared to available options of care other 
than through such a specialized MA 
plan for special needs individuals; or 
‘‘(II) have a low prevalence in the 
general population of beneficiaries 
under this title or a disproportionally 
high per-beneficiary cost under this 
title. 
‘‘(B) INCLUSION OF CERTAIN CONDITIONS.— 
The conditions listed under subparagraph (A) 
shall include HIV/AIDS, end stage renal disease, 
and chronic and disabling mental illness. 
‘‘(C) REQUIREMENT.—In establishing and 
updating the list under subparagraph (A), the 
panel shall take into account the availability of 
varied benefits, cost-sharing, and supplemental
208 
benefits under the model described in paragraph 
(2) of section 1859(h), including the expansion 
under paragraph (1) of such section.’’. 
(d) QUALITY MEASUREMENT AT THE PLAN LEVEL FOR 
SNPS AND DETERMINATION OF FEASABILITY OF QUALITY 
MEASUREMENT
AT
THE
PLAN
LEVEL
FOR
ALL
MA 
PLANS.—Section 1853(o) of the Social Security Act (42 
U.S.C. 1395w–23(o)) is amended by adding at the end the 
following new paragraphs: 
‘‘(6) QUALITY
MEASUREMENT
AT
THE
PLAN 
LEVEL FOR SNPS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the Secretary may require reporting 
of data under section 1852(e) for, and apply 
under this subsection, quality measures at the 
plan level for specialized MA plans for special 
needs individuals instead of at the contract level. 
‘‘(B) CONSIDERATIONS.—Prior to applying 
quality measurement at the plan level under this 
paragraph, the Secretary shall— 
‘‘(i) take into consideration the min-
imum number of enrollees in a specialized 
MA plan for special needs individuals in 
order to determine if a statistically signifi-
209 
cant or valid measurement of quality at the 
plan level is possible under this paragraph; 
‘‘(ii) take into consideration the im-
pact of such application on plans that serve 
a disproportionate number of individuals 
dually eligible for benefits under this title 
and under title XIX; 
‘‘(iii) if quality measures are reported 
at the plan level, ensure that MA plans are 
not required to provide duplicative informa-
tion; and 
‘‘(iv) ensure that such reporting does 
not interfere with the collection of encounter 
data submitted by MA organizations or the 
administration of any changes to the pro-
gram under this part as a result of the col-
lection of such data. 
‘‘(C) APPLICATION.—If the Secretary ap-
plies quality measurement at the plan level 
under this paragraph— 
‘‘(i) such quality measurement may in-
clude Medicare Health Outcomes Survey 
(HOS), Healthcare Effectiveness Data and 
Information Set (HEDIS), Consumer As-
sessment of Healthcare Providers and Sys-
210 
tems (CAHPS) measures and quality meas-
ures under part D; and 
‘‘(ii) the Secretary shall consider ap-
plying administrative actions, such as rem-
edies described in section 1857(g)(2), at the 
plan level. 
‘‘(7) DETERMINATION OF FEASIBILITY OF QUAL-
ITY MEASUREMENT AT THE PLAN LEVEL FOR ALL MA 
PLANS.— 
‘‘(A) DETERMINATION
OF
FEASIBILITY.— 
The Secretary shall determine the feasibility of 
requiring reporting of data under section 1852(e) 
for, and applying under this subsection, quality 
measures at the plan level for all MA plans 
under this part. 
‘‘(B) CONSIDERATION
OF
CHANGE.—After 
making a determination under subparagraph 
(A), the Secretary shall consider requiring such 
reporting and applying such quality measures at 
the plan level as described in such subpara-
graph’’. 
(e) GAO STUDY AND REPORT ON STATE-LEVEL INTE-
GRATION BETWEEN DUAL SNPS AND MEDICAID.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the
211 
‘‘Comptroller General’’) shall conduct a study on 
State-level integration between specialized MA plans 
for special needs individuals described in subsection 
(b)(6) (B)(ii) of section 1859 of the Social Security 
Act (42 U.S.C. 1395w–28) and the Medicaid program 
under title XIX of such Act (42 U.S.C. 1396 et seq.). 
Such study shall include an analysis of the following: 
(A) The characteristics of States in which 
the State agency responsible for administering 
the State plan under such title XIX has a con-
tract with such a specialized MA plan and that 
delivers long-term services and supports under 
the State plan under such title XIX through a 
managed care program, including the require-
ments under such State plan with respect to 
long-term services and supports. 
(B) The types of such specialized MA plans, 
which may include the following: 
(i) 
A 
plan 
described 
in 
section 
1853(a)(1)(B)(iv)(II) of such Act (42 U.S.C. 
1395w–23(a)(1)(B)(iv)(II)). 
(ii) A plan that meets the requirements 
described in subsection (f)(3)(D) of such sec-
tion 1859.
212 
(iii) A plan described in clause (ii) 
that also meets additional requirements es-
tablished by the State. 
(C) The characteristics of individuals en-
rolled in such specialized MA plans. 
(D) As practicable, the following with re-
spect to State programs for the delivery of long- 
term services and supports under such title XIX 
through a managed care program: 
(i) Which populations of individuals 
are eligible to receive such services and sup-
ports. 
(ii) Whether all such services and sup-
ports are provided on a capitated basis or 
if any of such services and supports are 
carved out and provided through fee- 
forservice. 
(E) As practicable, how the availability and 
variation of integration arrangements of such 
specialized MA plans offered in States affects 
spending, service delivery options, access to com-
munity-based care, and utilization of care. 
(F) The efforts of State Medicaid programs 
to transition dually-eligible beneficiaries receiv-
ing long-term services and supports (LTSS)
213 
from institutional settings to home and commu-
nity-based settings and related financial impacts 
of such transitions. 
(G) Barriers and opportunities for making 
further progress on dual integration, as well as 
recommendations for legislation or administra-
tive action to expedite or refine pathways toward 
fully integrated care. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
SEC. 2122. EXTENSION OF CERTAIN MIPPA FUNDING PROVI-
SIONS; STATE HEALTH INSURANCE ASSIST-
ANCE PROGRAM REPORTING REQUIREMENTS. 
(a) FUNDING EXTENSIONS.—Section 119 of the Medi-
care Improvements for Patients and Providers Act of 2008 
(42 U.S.C. 1395b–3 note) is amended— 
(1) in subsection (a)(1)(B)— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end;
214 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clause: 
‘‘(viii) for each of fiscal years 2018 
and 2019, of $13,000,000.’’; 
(2) in subsection (b)(1)(B)— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clause: 
‘‘(viii) for each of fiscal years 2018 
and 2019, of $7,500,000.’’; 
(3) in subsection (c)(1)(B)— 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clause: 
‘‘(viii) for each of fiscal years 2018 
and 2019, of $5,000,000.’’; and 
(4) in subsection (d)(2)—
215 
(A) in clause (vi), by striking ‘‘and’’ at the 
end; 
(B) in clause (vii), by striking the period at 
the end and inserting ‘‘; and’’; and 
(C) by inserting after clause (vii) the fol-
lowing new clause: 
‘‘(viii) for each of fiscal years 2018 
and 2019, of $12,000,000.’’. 
(b) STATE HEALTH INSURANCE ASSISTANCE PRO-
GRAM REPORTING REQUIREMENTS.—Beginning not later 
than April 1, 2019, and biennially thereafter, the Agency 
for Community Living shall electronically post on its 
website the following information, with respect to grants to 
States for State health insurance assistance programs, (such 
information to be presented by State and by entity receiv-
ing funds from the State to carry out such a program fund-
ed by such grant): 
(1) The amount of Federal funding provided to 
each such State for such program for the period in-
volved and the amount of Federal funding provided 
by each such State for such program to each such en-
tity for the period involved. 
(2) Information as the Secretary may specify, 
with respect to such programs carried out through
216 
such grants, consistent with the terms and conditions 
for receipt of such grants. 
SEC. 2123. EXTENSION OF FUNDING FOR QUALITY MEAS-
URE ENDORSEMENT, INPUT, AND SELECTION; 
REPORTING REQUIREMENTS. 
(a) IN GENERAL.—Section 1890(d) of the Social Secu-
rity Act (42 U.S.C. 1395aaa(d)) is amended— 
(1) in paragraph (2), by adding at the end the 
following new sentence: ‘‘Any of such amounts re-
maining available as of the date of the enactment of 
the SUSTAIN Care Act of 2018 shall be used only for 
purposes under this section that are purposes other 
than funding a contract entered into under subsection 
(a).’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(3) For purposes of carrying out this section, 
the Secretary shall provide for the transfer, from the 
Federal Hospital Insurance Trust Fund under section 
1817 and the Federal Supplemental Medical Insur-
ance Trust Fund under 1841, in such proportion as 
Secretary deems appropriate, to the Centers for Medi-
care & Medicaid Services Program Management Ac-
count of $7,500,000 for each of fiscal years 2018 and 
2019. Of the amount transferred under the previous
217 
sentence for a fiscal year, there shall be used for the 
purpose of funding a contract entered into under sub-
section (a) with respect to carrying out section 1890A 
(other than subsections (e) and (f)) for such fiscal 
year an amount that is not less than the amount used 
for such purpose for fiscal year 2017.’’. 
(b) ANNUAL REPORT BY SECRETARY TO CONGRESS.— 
Section 1890 of the Social Security Act (42 U.S.C. 
1395aaa) is amended by adding at the end the following 
new subsection: 
‘‘(e) ANNUAL
REPORT
BY
SECRETARY
TO
CON-
GRESS.—By not later than March 1 of each year (beginning 
with 2018), the Secretary shall submit to Congress a report 
containing the following: 
‘‘(1) A comprehensive plan that identifies the 
quality measurement needs of programs and initia-
tives of the Secretary and provides a strategy for 
using the work performed by the entity with a con-
tract under subsection (a) and the work of any other 
entity the Secretary has contracted with to perform 
work associated with this section or section 1890A to 
help meet those needs, specifically with respect to the 
programs under this title and title XIX. 
‘‘(2) The amount of mandatory funding provided 
under subsection (d) for purposes of carrying out this
218 
section and section 1890A that has been obligated by 
the Secretary, the amount of funding provided that 
has been expended, and the amount of funding pro-
vided that remains unobligated. 
‘‘(3) A description of how the funds provided 
that are obligated have been allocated, including how 
much of that funding has been allocated for work per-
formed by the Secretary, the entity with a contract 
under subsection (a), and any other entity the Sec-
retary has contracted with to perform work related to 
this section or section 1890A, respectively. 
‘‘(4) A description of the activities for which the 
obligated funds have been or will be used, including 
any activities performed by the Secretary, task orders, 
specific projects, and activities assigned to the entity 
with a contract under subsection (a), and task orders, 
specific projects, and activities assigned to any other 
entity the Secretary has contracted with to perform 
work related to carrying out this section or section 
1890A. 
‘‘(5) The amount of funding allocated to each of 
the activities described in paragraph (4). 
‘‘(6) Estimates for, and descriptions of, obliga-
tions and expenditures that the Secretary anticipates 
will be needed in the succeeding two year period to
219 
carry out each of the quality measurement activities 
required under this section and section 1890A, includ-
ing any obligations that will require funds to be ex-
pended in a future year.’’. 
(c) REVISIONS
TO ANNUAL REPORT FROM CON-
SENSUS-BASED ENTITY
TO CONGRESS
AND
THE SEC-
RETARY.— 
(1) IN GENERAL.—Section 1890(b)(5)(A) of the 
Social Security Act (42 U.S.C. 1395aaa(b)(5)(A)) is 
amended— 
(A) by redesignating clauses (i) through (vi) 
as subclauses (I) through (VI), respectively, and 
moving the margins accordingly; 
(B) in the matter preceding subclause (I), 
as redesignated by clause (i), by striking ‘‘con-
taining a description of—’’ and inserting ‘‘con-
taining the following: 
‘‘(i) A description of—’’; and 
(C) by adding at the end the following new 
clauses: 
‘‘(ii) An itemization of financial infor-
mation for the fiscal year ending September 
30 of the preceding year, including— 
‘‘(I) annual revenues of the entity 
(including any government funding,
220 
private sector contributions, grants, 
membership revenues, and investment 
revenue); 
‘‘(II) annual expenses of the enti-
ty (including grants paid, benefits 
paid, salaries or other compensation, 
fundraising expenses, and overhead 
costs); and 
‘‘(III) a breakdown of the amount 
awarded per contracted task order and 
the specific projects funded in each task 
order assigned to the entity. 
‘‘(iii) Any updates or modifications of 
internal policies and procedures of the enti-
ty as they relate to the duties of the entity 
under this section, including— 
‘‘(I) specifically identifying any 
modifications to the disclosure of inter-
ests and conflicts of interests for com-
mittees, work groups, task forces, and 
advisory panels of the entity; and 
‘‘(II) information on external 
stakeholder participation in the duties 
of the entity under this section (includ-
ing complete rosters for all committees,
221 
work groups, task forces, and advisory 
panels funded through government con-
tracts, descriptions of relevant interests 
and any conflicts of interest for mem-
bers of all committees, work groups, 
task forces, and advisory panels, and 
the total percentage by health care sec-
tor of all convened committees, work 
groups, task forces, and advisory pan-
els.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to reports submitted for 
years beginning with 2018. 
(d) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States shall conduct a study on health care 
quality measurement efforts funded under sections 
1890 and 1890A of the Social Security Act (42 
U.S.C. 1395aaa; 1395aaa–1). Such study shall in-
clude an examination of the following: 
(A) The extent to which the Secretary of 
Health and Human Services (in this subsection 
referred to as the ‘‘Secretary’’) has set and 
prioritized objectives to be achieved for each of
222 
the quality measurement activities required 
under such sections 1890 and 1890A. 
(B) The efforts that the Secretary has un-
dertaken to meet quality measurement objectives 
associated with such sections 1890 and 1890A, 
including division of responsibilities for those ef-
forts within the Department of Health and 
Human Services and through contracts with a 
consensus-based entity under subsection (a) of 
such section 1890 (in this subsection referred to 
as the ‘‘consensus-based entity’’) and other enti-
ties, and the extent of any overlap among the 
work performed by the Secretary, the consensus- 
based entity, the Measure Application Partner-
ship (MAP) convened by such entity to provide 
input to the Secretary on the selection of quality 
and efficiency measures, and any other entities 
the Secretary has contracted with to perform 
work related to carrying out such sections 1890 
and 1890A. 
(C) The total amount of mandatory funding 
provided to the Secretary for purposes of car-
rying out such sections 1890 and 1890A, the 
amount of such funding that has been obligated
223 
by the Secretary, and the amount of such fund-
ing that remains unobligated. 
(D) How the obligated funds have been allo-
cated, including how much of the obligated fund-
ing has been allocated for work performed by the 
Secretary, the consensus-based entity, and any 
other entity the Secretary has contracted with to 
perform work related to carrying out such sec-
tions 1890 and 1890A, respectively, and descrip-
tions of such work. 
(E) The extent to which the Secretary has 
developed a comprehensive and long-term plan to 
ensure that it can achieve quality measurement 
objectives related to carrying out such sections 
1890 and 1890A in a timely manner and with 
efficient use of available resources, including the 
roles of the consensus-based entity, the Measure 
Application Partnership (MAP), and any other 
entity the Secretary has contracted with to per-
form work related to such sections 1890 and 
1890A in helping the Secretary achieve those ob-
jectives. 
(2) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
of the United States shall submit to Congress a report
224 
containing the results of the study conducted under 
paragraph (1), together with recommendations for 
such legislation and administrative action as the 
Comptroller General determines appropriate. 
TITLE 
II—ADDITIONAL 
MEDI-
CARE POLICIES RELATING TO 
EXTENDERS 
SEC. 2201. HOME HEALTH PAYMENT REFORM. 
(a) BUDGET NEUTRAL TRANSITION TO A 30-DAY UNIT 
OF PAYMENT
FOR HOME HEALTH SERVICES.—Section 
1895(b) of the Social Security Act (42 U.S.C. 1395fff(b)) 
is amended— 
(1) in paragraph (2)— 
(A) by striking ‘‘PAYMENT.—In defining’’ 
and inserting ‘‘PAYMENT.— 
‘‘(A) IN GENERAL.—In defining’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(B) 30-DAY UNIT OF SERVICE.—For pur-
poses of implementing the prospective payment 
system with respect to home health units of serv-
ice furnished during a year beginning with 
2020, the Secretary shall apply a 30-day unit of 
service as the unit of service applied under this 
paragraph.’’;
225 
(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 stand-
ard 
prospective 
payment 
amount 
(or 
amounts) for 30-day units of service (as de-
scribed in paragraph (2)(B)) for the pro-
spective payment system under this sub-
section. Such standard prospective payment 
amount (or amounts) shall be calculated in 
a manner such that the estimated aggregate 
amount of expenditures under the system 
during such period with application of 
paragraph (2)(B) is equal to the estimated 
aggregate amount of expenditures that oth-
erwise would have been made under the sys-
tem 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 Sec-
226 
retary shall make assumptions about behav-
ior changes that could occur as a result of 
the implementation of paragraph (2)(B) 
and the case-mix adjustment factors estab-
lished under paragraph (4)(B) and shall 
provide a description of such assumptions 
in the notice and comment rulemaking used 
to implement this clause.’’; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(D) BEHAVIOR ASSUMPTIONS AND ADJUST-
MENTS.— 
‘‘(i) IN GENERAL.—The Secretary shall 
annually determine the impact of dif-
ferences between assumed behavior changes 
(as described in paragraph (3)(A)(iv)) and 
actual behavior changes on estimated aggre-
gate expenditures under this subsection with 
respect to years beginning with 2020 and 
ending with 2026. 
‘‘(ii) PERMANENT ADJUSTMENTS.—The 
Secretary shall, at a time and in a manner 
determined appropriate, through notice and 
comment rulemaking, provide for one or 
more permanent increases or decreases to
227 
the standard prospective payment amount 
(or amounts) for applicable years, on a pro-
spective basis, to offset for such increases or 
decreases in estimated aggregate expendi-
tures (as determined under clause (i)). 
‘‘(iii) TEMPORARY ADJUSTMENTS FOR 
RETROSPECTIVE BEHAVIOR.—The Secretary 
shall, at a time and in a manner deter-
mined appropriate, through notice and 
comment rulemaking, provide for one or 
more temporary increases or decreases to 
the payment amount for a unit of home 
health services (as determined under para-
graph (4)) for applicable years, on a pro-
spective basis, to offset for such increases or 
decreases in estimated aggregate expendi-
tures (as determined under clause (i)). Such 
a temporary increase or decrease shall 
apply only with respect to the year for 
which such temporary increase or decrease 
is made, and the Secretary shall not take 
into account such a temporary increase or 
decrease in computing such amount under 
this subsection for a subsequent year.’’; and 
(3) in paragraph (4)(B)—
228 
(A) by striking ‘‘FACTORS.—The Secretary’’ 
and inserting ‘‘FACTORS.— 
‘‘(i) IN
GENERAL.—The Secretary’’; 
and 
(B) by adding at the end the following new 
clause: 
‘‘(ii) 
TREATMENT
OF
THERAPY 
THRESHOLDS.—For 2020 and subsequent 
years, the Secretary shall eliminate the use 
of therapy thresholds (established by the 
Secretary) in case mix adjustment factors 
established under clause (i) for calculating 
payments under the prospective payment 
system under this subsection.’’. 
(b) TECHNICAL EXPERT PANEL.— 
(1) IN GENERAL.—During the period beginning 
on January 1, 2018, and ending on December 31, 
2018, the Secretary of Health and Human Services 
shall hold at least one session of a technical expert 
panel, the participants of which shall include home 
health providers, patient representatives, and other 
relevant stakeholders. The technical expert panel shall 
identify and prioritize recommendations with respect 
to the prospective payment system for home health
229 
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 Pro-
spective Payment System Rate Update and Pro-
posed CY 2019 Case-Mix Adjustment Method-
ology Refinements; Home Health Value-Based 
Purchasing Model; and Home Health Quality 
Reporting Requirements’’ (82 Fed. Reg. 35294 
through 35332 (July 28, 2017)). 
(B) Alternative case-mix models to the 
Home Health Groupings Model that were sub-
mitted during 2017 as comments in response to 
proposed rule making, including patient-focused 
factors that consider the risks of hospitalization 
and readmission to a hospital, improvement or 
maintenance of functionality of individuals to 
increase the capacity for self-care, quality of 
care, and resource utilization. 
(2) INAPPLICABILITY OF FACA.—The provisions 
of the Federal Advisory Committee Act (5 U.S.C. 
App.) shall not apply to the technical expert panel 
under paragraph (1).
231 
and any unintended consequences, including with re-
spect to behavioral changes and quality. 
(2) FINAL REPORT.—Not later than March 15, 
2026, such Commission shall submit to Congress a 
final report on such application and any such con-
sequences. 
SEC. 2202. INFORMATION TO SATISFY DOCUMENTATION OF 
MEDICARE ELIGIBILITY FOR HOME HEALTH 
SERVICES. 
(a) PART A.—Section 1814(a) of the Social Security 
Act (42 U.S.C. 1395f(a)) is amended by inserting before 
‘‘For purposes of paragraph (2)(C),’’ the following new sen-
tence: ‘‘For purposes of documentation for physician certifi-
cation and recertification made under paragraph (2) on or 
after January 1, 2019, and made with respect to home 
health services furnished by a home health agency, in addi-
tion to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute 
or post-acute care facility (in the case that home health 
services were furnished to an individual who was directly 
admitted to the home health agency from such a facility), 
the Secretary may use documentation in the medical record 
of the home health agency as supporting material, as appro-
priate to the case involved.’’.
232 
(b) PART B.—Section 1835(a) of the Social Security 
Act (42 U.S.C. 1395n(a)) is amended by inserting before 
‘‘For purposes of paragraph (2)(A),’’ the following new sen-
tence: ‘‘For purposes of documentation for physician certifi-
cation and recertification made under paragraph (2) on or 
after January 1, 2019, and made with respect to home 
health services furnished by a home health agency, in addi-
tion to using documentation in the medical record of the 
physician who so certifies or the medical record of the acute 
or post-acute care facility (in the case that home health 
services were furnished to an individual who was directly 
admitted to the home health agency from such a facility), 
the Secretary may use documentation in the medical record 
of the home health agency as supporting material, as appro-
priate to the case involved.’’. 
SEC. 2203. VOLUNTARY SETTLEMENT OF HOME HEALTH 
CLAIMS. 
(a) SETTLEMENT
PROCESS
FOR
HOME
HEALTH 
CLAIMS.— 
(1) IN GENERAL.—Not later than one year after 
the date of enactment of this Act, the Secretary of 
Health and Human Services shall establish a settle-
ment process under which a home health agency enti-
tled to an eligible administrative appeal has the op-
tion to enter into a settlement with the Secretary that
233 
is reached in a manner consistent with the succeeding 
paragraphs of this subsection. 
(2) PROCESS
AND
CONSIDERATION
OF
HOME 
HEALTH CLAIMS.—A settlement under paragraph (1) 
with a home health agency that is with respect to an 
eligible administrative appeal may only be reached in 
accordance with the following process: 
(A) A settlement under such paragraph 
with the home health agency shall be with respect 
to all claims by such agency, subject to para-
graph (4), that, as of the date of such settlement, 
are under an eligible administrative appeal. 
(B) For the duration of the settlement proc-
ess with such agency, an eligible administrative 
appeal that is with respect to any such claim by 
such agency shall be suspended. 
(C) Under the settlement process, the Sec-
retary shall determine an aggregate amount to 
be paid to the home health agency with respect 
to all claims by such agency that are under an 
eligible administrative appeal in the following 
manner: 
(i) The Secretary shall, for purposes of 
applying clause (ii) with respect to all set-
tlements under paragraph (1), select a per-
234 
centage. In selecting such percentage, the 
Secretary shall consider the percentage used 
under the Centers for Medicare & Medicaid 
Services hospital appeals settlement that 
began on August 29, 2014. 
(ii) The Secretary shall, with respect to 
each denied claim for such agency that is 
under an eligible administrative appeal, 
calculate an amount (referred to in this 
subparagraph as an ‘‘individual claim 
amount’’) by multiplying the net payable 
amount for such claim by the percentage se-
lected under clause (i). 
(iii) Such aggregate amount with re-
spect to such agency shall be determined by 
calculating the total sum of all the indi-
vidual claim amounts calculated under 
clause (ii) with respect to such agency. 
(3) EFFECT OF PROCESS.— 
(A) EFFECT OF SETTLEMENT.— 
(i) FURTHER APPEAL.—As part of any 
settlement under paragraph (1) between a 
home health agency and the Secretary, such 
home health agency shall be required to 
forego the right to an administrative appeal
235 
under section 1869 of the Social Security 
Act (42 U.S.C. 1395ff) or section 1878 of 
such Act (42 U.S.C. 1395oo) (including any 
redetermination, reconsideration, hearing, 
or review) with respect to any claims for 
home health services that are subject to the 
settlement. 
(ii) JUDICIAL REVIEW.—There shall be 
no administrative or judicial review under 
such section 1869 or otherwise of a settle-
ment under paragraph (1) and the claims 
covered by the settlement. 
(B) EFFECT OF NO SETTLEMENT.—In the 
event that the process described in paragraph (2) 
does not, with respect to a home health agency, 
result in a settlement under paragraph (1) with 
such agency, any appeal under such section 1869 
that is with respect to a claim by such agency 
that was suspended pursuant to paragraph 
(2)(B) shall resume under such section. 
(4) COORDINATION WITH LAW ENFORCEMENT.— 
The Secretary of Health and Human Services shall 
establish a process to coordinate with appropriate law 
enforcement agencies in order to avoid the inadvertent
236 
settlement of cases that involve fraud or other crimi-
nal activity. 
(b) NO ENTITLEMENT TO SETTLEMENT PROCESS.— 
Nothing in this section shall be construed as creating an 
entitlement to enter into a settlement process established 
pursuant to subsection (a). 
(c) ELIGIBLE ADMINISTRATIVE APPEAL DEFINED.— 
For purposes of this section, the term ‘‘eligible administra-
tive appeal’’ means an appeal under section 1869 of the 
Social Security Act (42 U.S.C. 1395ff) (including any rede-
termination, reconsideration, hearing, or review)— 
(1) that is with respect to one or more claims 
that— 
(A) are for home health services that were 
furnished on or after January 1, 2011, and be-
fore January 1, 2015; and 
(B) were timely filed consistent with section 
1814(a)(1) of such Act (42 U.S.C. 1395f(a)(1)) 
or sections 1835(a)(1) and 1842(b)(3) of such Act 
(42 U.S.C. 1395n(a)(1), 1395u(b)(3)); and 
(2) either— 
(A) was timely filed consistent with section 
1869 of such Act (42 U.S.C. 1395ff) and is pend-
ing; or
237 
(B) for which the applicable time frame to 
file an appeal has not expired. 
(d) CONFORMING AMENDMENT.—Section 1869 of the 
Social Security Act (42 U.S.C. 1395ff) is amended by add-
ing at the end the following new subsection: 
‘‘(j) APPLICATION WITH RESPECT TO CERTAIN HOME 
HEALTH CLAIMS.—For the application of the provisions of 
this section with respect to certain claims for home health 
services that were furnished on or after January 1, 2011, 
and before January 1, 2015, see section 106 of the 
Healthcare Extension, Reauthorization, and Opportunities 
Act of 2017.’’. 
SEC. 2204. EXTENSION OF ENFORCEMENT INSTRUCTION ON 
MEDICARE 
SUPERVISION 
REQUIREMENTS 
FOR OUTPATIENT THERAPEUTIC SERVICES IN 
CRITICAL ACCESS AND SMALL RURAL HOS-
PITALS. 
Section 1834 of the Social Security Act (42 U.S.C. 
1395m) is amended by adding at the end the following new 
subsection: 
‘‘(v) EXTENSION OF ENFORCEMENT INSTRUCTION ON 
SUPERVISION REQUIREMENTS FOR OUTPATIENT THERA-
PEUTIC SERVICES IN CRITICAL ACCESS AND SMALL RURAL 
HOSPITALS.—For calendar year 2017, the Secretary shall 
continue to apply the enforcement instruction described in
238 
the notice of the Centers for Medicare & Medicaid Services 
entitled ‘Enforcement Instruction on Supervision Require-
ments for Outpatient Therapeutic Services in Critical Ac-
cess and Small Rural Hospitals for CY 2013’, dated Novem-
ber 1, 2012 (providing for an exception to the restatement 
and clarification under the final rulemaking changes to the 
Medicare hospital outpatient prospective payment system 
and calendar year 2009 payment rates (published in the 
Federal Register on November 18, 2008, 73 Fed. Reg. 68702 
through 68704) with respect to requirements for direct su-
pervision by physicians for therapeutic hospital outpatient 
services), as previously extended under section 1 of Public 
Law 113-198, as amended by section 1 of Public Law 114- 
112 and section 16004(a) of the 21st Century Cures Act 
(Public Law 114-255).’’. 
SEC. 2205. TECHNICAL AMENDMENTS TO PUBLIC LAW 114– 
10. 
(a) MIPS TRANSITION.—Section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4) is amended— 
(1) in subsection (q)— 
(A) in paragraph (1)— 
(i) in subparagraph (B), by striking 
‘‘items and services’’ and inserting ‘‘covered 
professional services (as defined in sub-
section (k)(3)(A))’’; and
239 
(ii) in subparagraph (C)(iv)— 
(I) by amending subclause (I) to 
read as follows: 
‘‘(I) The minimum number (as 
determined by the Secretary) of— 
‘‘(aa) for performance peri-
ods beginning before January 1, 
2018, individuals enrolled under 
this part who are treated by the 
eligible professional for the per-
formance period involved; and 
‘‘(bb) for performance periods 
beginning on or after January 1, 
2018, individuals enrolled under 
this part who are furnished cov-
ered professional services (as de-
fined in subsection (k)(3)(A)) by 
the eligible professional for the 
performance period involved.’’; 
(II) in subclause (II), by striking 
‘‘items and services’’ and inserting 
‘‘covered professional services (as de-
fined in subsection (k)(3)(A))’’; and 
(III) by amending subclause (III) 
to read as follows:
240 
‘‘(III) The minimum amount (as 
determined by the Secretary) of— 
‘‘(aa) for performance peri-
ods beginning before January 1, 
2018, allowed charges billed by 
such professional under this part 
for such performance period; and 
‘‘(bb) for performance periods 
beginning on or after January 1, 
2018, allowed charges for covered 
professional services (as defined in 
subsection (k)(3)(A)) billed by 
such professional for such per-
formance period.’’; 
(B) in paragraph (5)(D)— 
(i) in clause (i)(I), by inserting ‘‘sub-
ject to clause (iii),’’ after ‘‘clauses (i) and 
(ii) of paragraph (2)(A),’’; and 
(ii) by adding at the end the following 
new clause: 
‘‘(iii) TRANSITION YEARS.—For each of 
the second, third, fourth, and fifth years for 
which the MIPS applies to payments, the 
performance score for the performance cat-
egory described in paragraph (2)(A)(ii)
241 
shall not take into account the improvement 
of the professional involved.’’; 
(C) in paragraph (5)(E)— 
(i) in clause (i)(I)(bb)— 
(I) in the heading by striking 
‘‘FIRST
YEARS’’ 
and 
inserting 
‘‘FIRST 5 YEARS’’; and 
(II) by striking ‘‘the first and sec-
ond years’’ and inserting ‘‘each of the 
first through fifth years’’; 
(ii) in clause (i)(II)(bb)— 
(I) in the heading, by striking ‘‘2 
YEARS’’ and inserting ‘‘5 YEARS’’; and 
(II) by striking the second sen-
tence and inserting the following new 
sentences: ‘‘For each of the second, 
third, fourth, and fifth years for which 
the MIPS applies to payments, not less 
than 10 percent and not more than 30 
percent of such score shall be based on 
performance with respect to the cat-
egory described in clause (ii) of para-
graph (2)(A). Nothing in the previous 
sentence shall be construed, with re-
spect to a performance period for a
242 
year described in the previous sentence, 
as preventing the Secretary from bas-
ing 30 percent of such score for such 
year with respect to the category de-
scribed in such clause (ii), if the Sec-
retary determines, based on informa-
tion posted under subsection (r)(2)(I) 
that sufficient resource use measures 
are ready for adoption for use under 
the performance category under para-
graph (2)(A)(ii) for such performance 
period.’’; 
(D) in paragraph (6)(D)— 
(i) in clause (i), in the second sentence, 
by striking ‘‘Such performance threshold’’ 
and inserting ‘‘Subject to clauses (iii) and 
(iv), such performance threshold’’; 
(ii) in clause (ii)— 
(I) in the first sentence, by insert-
ing ‘‘(beginning with 2019 and ending 
with 2024)’’ after ‘‘for each year of the 
MIPS’’; and 
(II) in the second sentence, by in-
serting ‘‘subject to clause (iii),’’ after 
‘‘For each such year,’’;
243 
(iii) in clause (iii)— 
(I) in the heading, by striking ‘‘2’’ 
and inserting ‘‘5’’; and 
(II) in the first sentence, by strik-
ing ‘‘two years’’ and inserting ‘‘five 
years’’; and 
(iv) by adding at the end the following 
new clause: 
‘‘(iv) ADDITIONAL SPECIAL RULE FOR 
THIRD, FOURTH
AND
FIFTH
YEARS
OF 
MIPS.—For purposes of determining MIPS 
adjustment factors under subparagraph (A), 
in addition to the requirements specified in 
clause (iii), the Secretary shall increase the 
performance threshold with respect to each 
of the third, fourth, and fifth years to which 
the MIPS applies to ensure a gradual and 
incremental transition to the performance 
threshold described in clause (i) (as esti-
mated by the Secretary) with respect to the 
sixth year to which the MIPS applies.’’; 
(E) in paragraph (6)(E)— 
(i) by striking ‘‘In the case of items 
and services’’ and inserting ‘‘In the case of
244 
covered professional services (as defined in 
subsection (k)(3)(A))’’; and 
(ii) by striking ‘‘under this part with 
respect to such items and services’’ and in-
serting ‘‘under this part with respect to 
such covered professional services’’; and 
(F) in paragraph (7), in the first sentence, 
by striking ‘‘items and services’’ and inserting 
‘‘covered professional services (as defined in sub-
section (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 (begin-
ning with 2018), post on the Internet website of 
the Centers for Medicare & Medicaid Services in-
formation on resource use measures in use under 
subsection (q), resource use measures under de-
velopment and the time-frame for such develop-
ment, potential future resource use measure top-
ics, a description of stakeholder engagement, and 
the percent of expenditures under part A and 
this part that are covered by resource use meas-
ures.’’; and
245 
(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 fol-
lows: 
‘‘(C) COMMITTEE REVIEW OF MODELS SUB-
MITTED.—The Committee, on a periodic basis— 
‘‘(i) shall review models submitted 
under subparagraph (B); 
‘‘(ii) may provide individuals and 
stakeholder entities who submitted such 
models with— 
‘‘(I) initial feedback on such mod-
els regarding the extent to which such 
models meet the criteria described in 
subparagraph (A); and 
‘‘(II) an explanation of the basis 
for the feedback provided under sub-
clause (I); and 
‘‘(iii) shall prepare comments and rec-
ommendations regarding whether such mod-
els meet the criteria described in subpara-
246 
graph (A) and submit such comments and 
recommendations to the Secretary.’’. 
SEC. 2206. REVISED REQUIREMENTS FOR MEDICARE INTEN-
SIVE CARDIAC REHABILITATION PROGRAMS. 
(a) IN GENERAL.—Section 1861(eee)(4)(B) of the So-
cial Security Act (42 U.S.C. 1395x(eee)(4)(B)) is amend-
ed— 
(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 Asso-
ciation (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 re-
habilitation program shall be covered, unless the 
Secretary determines, using the same process 
used to determine that the condition is covered 
for a cardiac rehabilitation program, that such
247 
coverage is not supported by the clinical evi-
dence.’’. 
(b) ENSURING FUTURE SUPERVISION LEVEL PARITY 
WITH
CARDIAC
REHABILITATION
PROGRAMS.—Section 
1861(eee)(4)(A) of the Social Security Act (42 U.S.C. 
1395x(eee)(4)(A)) is amended, in the matter preceding 
clause (i), by striking ‘‘physician-supervised program (as 
described in paragraph (2))’’ and inserting ‘‘program (su-
pervised as described in paragraph (2))’’. 
TITLE 
III—CREATING 
HIGH- 
QUALITY RESULTS AND OUT-
COMES NECESSARY TO IM-
PROVE CHRONIC (CHRONIC) 
CARE 
Subtitle A—Receiving High Quality 
Care in the Home 
SEC. 2301. EXTENDING THE INDEPENDENCE AT HOME DEM-
ONSTRATION PROGRAM. 
(a) IN GENERAL.—Section 1866E of the Social Secu-
rity Act (42 U.S.C. 1395cc–5) is amended— 
(1) in subsection (e)— 
(A) in paragraph (1)— 
(i) by striking ‘‘An agreement’’ and in-
serting ‘‘Agreements’’; and
248 
(ii) by striking ‘‘5-year’’ and inserting 
‘‘7-year’’; and 
(B) in paragraph (5)— 
(i) by striking ‘‘10,000’’ and inserting 
‘‘15,000’’; and 
(ii) by adding at the end the following 
new sentence: ‘‘An applicable beneficiary 
that participates in the demonstration pro-
gram by reason of the increase from 10,000 
to 15,000 in the preceding sentence pursu-
ant to the amendment made by section 
2301(a)(1)(B) of the SUSTAIN Care Act of 
2018 shall be considered in the spending 
target estimates under paragraph (1) of 
subsection (c) and the incentive payment 
calculations under paragraph (2) of such 
subsection for the sixth and seventh years of 
such program.’’; 
(2) in subsection (g), in the first sentence, by in-
serting ‘‘, including, to the extent practicable, with re-
spect to the use of electronic health information sys-
tems, as described in subsection (b)(1)(A)(vi)’’ after 
‘‘under the demonstration program’’; and
249 
(3) in subsection (i)(1)(A), by striking ‘‘will not 
receive an incentive payment for the second of 2’’ and 
inserting ‘‘did not achieve savings for the third of 3’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a)(3) shall take effect as if included in the enact-
ment of Public Law 111–148. 
SEC. 2302. EXPANDING ACCESS TO HOME DIALYSIS THER-
APY. 
(a) IN GENERAL.—Section 1881(b)(3) of the Social Se-
curity Act (42 U.S.C. 1395rr(b)(3)) is amended— 
(1) by redesignating subparagraphs (A) and (B) 
as clauses (i) and (ii), respectively; 
(2) in clause (ii), as redesignated by paragraph 
(1), by striking ‘‘on a comprehensive’’ and insert 
‘‘subject to subparagraph (B), on a comprehensive’’; 
(3) by striking ‘‘With respect to’’ and inserting 
‘‘(A) With respect to’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(B)(i) For purposes of subparagraph (A)(ii), subject 
to clause (ii), an individual determined to have end stage 
renal disease receiving home dialysis may choose to receive 
monthly end stage renal disease-related clinical assessments 
furnished on or after January 1, 2019, via telehealth.
250 
‘‘(ii) Clause (i) shall apply to an individual only if 
the individual receives a face-to-face clinical assessment, 
without the use of telehealth— 
‘‘(I) in the case of the initial 3 months of home 
dialysis of such individual, at least monthly; and 
‘‘(II) after such initial 3 months, at least once 
every 3 consecutive months.’’. 
(b) ORIGINATING SITE REQUIREMENTS.— 
(1) IN GENERAL.—Section 1834(m) of the Social 
Security Act (42 U.S.C. 1395m(m)) is amended— 
(A) in paragraph (4)(C)(ii), by adding at 
the end the following new subclauses: 
‘‘(IX) A renal dialysis facility, 
but only for purposes of section 
1881(b)(3)(B). 
‘‘(X) The home of an individual, 
but only for purposes of section 
1881(b)(3)(B).’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(5) TREATMENT OF HOME DIALYSIS MONTHLY 
ESRD-RELATED VISIT.—The geographic requirements 
described in paragraph (4)(C)(i) shall not apply with 
respect to telehealth services furnished on or after 
January 
1, 
2019, 
for 
purposes 
of 
section
251 
1881(b)(3)(B), at an originating site described in 
subclause (VI), (IX), or (X) of paragraph (4)(C)(ii).’’. 
(2) NO FACILITY FEE IF ORIGINATING SITE FOR 
HOME
DIALYSIS
THERAPY
IS
THE
HOME.—Section 
1834(m)(2)(B) of the Social Security (42 U.S.C. 
1395m(m)(2)(B)) is amended— 
(A) by redesignating clauses (i) and (ii) as 
subclauses (I) and (II), and indenting appro-
priately; 
(B) in subclause (II), as redesignated by 
subparagraph (A), by striking ‘‘clause (i) or this 
clause’’ and inserting ‘‘subclause (I) or this sub-
clause’’; 
(C) by striking ‘‘SITE.—With respect to’’ 
and inserting ‘‘SITE.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii), with respect to’’; and 
(D) by adding at the end the following new 
clause: 
‘‘(ii) NO FACILITY FEE IF ORIGINATING 
SITE FOR HOME DIALYSIS THERAPY IS THE 
HOME.—No facility fee shall be paid under 
this subparagraph to an originating site de-
scribed in paragraph (4)(C)(ii)(X).’’.
252 
(c) CLARIFICATION REGARDING TELEHEALTH PRO-
VIDED TO BENEFICIARIES.—Section 1128A(i)(6) of the So-
cial Security Act (42 U.S.C. 1320a–7a(i)(6)) is amended— 
(1) in subparagraph (H), by striking ‘‘or’’ at the 
end; 
(2) in subparagraph (I), by striking the period 
at the end and inserting ‘‘; or’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(J) the provision of telehealth technologies 
(as defined by the Secretary) on or after Janu-
ary 1, 2019, by a provider of services or a renal 
dialysis facility (as such terms are defined for 
purposes of title XVIII) to an individual with 
end stage renal disease who is receiving home di-
alysis for which payment is being made under 
part B of such title, if— 
‘‘(i) the telehealth technologies are not 
offered as part of any advertisement or so-
licitation; 
‘‘(ii) the telehealth technologies are pro-
vided for the purpose of furnishing tele-
health services related to the individual’s 
end stage renal disease; and
253 
‘‘(iii) the provision of the telehealth 
technologies meets any other requirements 
set forth in regulations promulgated by the 
Secretary.’’. 
(d) CONFORMING AMENDMENT.—Section 1881(b)(1) of 
the Social Security Act (42 U.S.C. 1395rr(b)(1)) is amend-
ed by striking ‘‘paragraph (3)(A)’’ and inserting ‘‘para-
graph (3)(A)(i)’’. 
Subtitle B—Expanding Innovation 
and Technology 
SEC. 2311. ADAPTING BENEFITS TO MEET THE NEEDS OF 
CHRONICALLY ILL MEDICARE ADVANTAGE 
ENROLLEES. 
Section 1859 of the Social Security Act (42 U.S.C. 
1395w–28) is amended by adding at the end the following 
new subsection: 
‘‘(h) NATIONAL TESTING OF MEDICARE ADVANTAGE 
VALUE-BASED INSURANCE DESIGN MODEL.— 
‘‘(1) IN GENERAL.—In implementing the Medi-
care Advantage Value-Based Insurance Design model 
that is being tested under section 1115A(b), the Sec-
retary shall revise the testing of the model under such 
section to cover, effective not later than January 1, 
2020, all States.
254 
‘‘(2) TERMINATION
AND
MODIFICATION
PROVI-
SION NOT APPLICABLE UNTIL JANUARY 1, 2022.—The 
provisions of section 1115A(b)(3)(B) shall apply to 
the Medicare Advantage Value-Based Insurance De-
sign model, including such model as revised under 
paragraph (1), beginning January 1, 2022, but shall 
not apply to such model, as so revised, prior to such 
date. 
‘‘(3) FUNDING.—The Secretary shall allocate 
funds made available under section 1115A(f)(1) to de-
sign, implement, and evaluate the Medicare Advan-
tage Value-Based Insurance Design model, as revised 
under paragraph (1).’’. 
SEC. 2312. EXPANDING SUPPLEMENTAL BENEFITS TO MEET 
THE NEEDS OF CHRONICALLY ILL MEDICARE 
ADVANTAGE ENROLLEES. 
(a) IN GENERAL.—Section 1852(a)(3) of the Social Se-
curity Act (42 U.S.C. 1395w–22(a)(3)) is amended— 
(1) in subparagraph (A), by striking ‘‘Each’’ 
and inserting ‘‘Subject to subparagraph (D), each’’; 
and 
(2) by adding at the end the following new sub-
paragraph:
255 
‘‘(D) EXPANDING SUPPLEMENTAL BENEFITS 
TO MEET THE NEEDS OF CHRONICALLY ILL EN-
ROLLEES.— 
‘‘(i) IN GENERAL.—For plan year 2020 
and subsequent plan years, in addition to 
any supplemental health care benefits other-
wise provided under this paragraph, an MA 
plan, including a specialized MA plan for 
special needs individuals (as defined in sec-
tion 1859(b)(6)), may provide supplemental 
benefits described in clause (ii) to a chron-
ically ill enrollee (as defined in clause (iii)). 
‘‘(ii) SUPPLEMENTAL
BENEFITS
DE-
SCRIBED.— 
‘‘(I) IN GENERAL.—Supplemental 
benefits described in this clause are 
supplemental benefits that, with respect 
to a chronically ill enrollee, have a rea-
sonable expectation of improving or 
maintaining the health or overall func-
tion of the chronically ill enrollee and 
may not be limited to being primarily 
health related benefits. 
‘‘(II) AUTHORITY TO WAIVE UNI-
FORMITY
REQUIREMENTS.—The Sec-
256 
retary may, only with respect to sup-
plemental benefits provided to a chron-
ically ill enrollee under this subpara-
graph, waive the uniformity require-
ments under this part, as determined 
appropriate by the Secretary. 
‘‘(iii) CHRONICALLY
ILL
ENROLLEE 
DEFINED.—In this subparagraph, the term 
‘chronically ill enrollee’ means an enrollee 
in an MA plan that the Secretary deter-
mines— 
‘‘(I) has one or more comorbid 
and medically complex chronic condi-
tions that is life threatening or signifi-
cantly limits the overall health or func-
tion of the enrollee; 
‘‘(II) has a high risk of hos-
pitalization or other adverse health 
outcomes; and 
‘‘(III) requires intensive care co-
ordination.’’. 
(b) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on sup-
257 
plemental benefits provided to enrollees in Medicare 
Advantage plans under part C of title XVIII of the 
Social Security Act, including specialized MA plans 
for special needs individuals (as defined in section 
1859(b)(6) of such Act (42 U.S.C. 1395w–28(b)(6))). 
To the extend data are available, such study shall in-
clude an analysis of the following: 
(A) The type of supplemental benefits pro-
vided to such enrollees, the total number of en-
rollees receiving each supplemental benefit, and 
whether the supplemental benefit is covered by 
the standard benchmark cost of the benefit or 
with an additional premium. 
(B) The frequency in which supplemental 
benefits are utilized by such enrollees. 
(C) The impact supplemental benefits have 
on— 
(i) indicators of the quality of care re-
ceived by such enrollees, including overall 
health and function of the enrollees; 
(ii) the utilization of items and serv-
ices for which benefits are available under 
the original Medicare fee-for-service pro-
gram option under parts A and B of such 
title XVIII by such enrollees; and
258 
(iii) the amount of the bids submitted 
by Medicare Advantage Organizations for 
Medicare Advantage plans under such part 
C. 
(2) CONSULTATION.—In conducting the study 
under paragraph (1), the Comptroller General shall, 
as necessary, consult with the Centers for Medicare & 
Medicaid Services and Medicare Advantage organiza-
tions offering Medicare Advantage plans. 
(3) REPORT.—Not later than 5 years after the 
date of the enactment of this Act, the Comptroller 
General shall submit to Congress a report containing 
the results of the study conducted under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Comptroller 
General determines appropriate. 
SEC. 2313. INCREASING CONVENIENCE FOR MEDICARE AD-
VANTAGE 
ENROLLEES 
THROUGH 
TELE-
HEALTH. 
(a) IN GENERAL.—Section 1852 of the Social Security 
Act (42 U.S.C. 1395w–22) is amended— 
(1) in subsection (a)(1)(B)(i), by inserting ‘‘, 
subject to subsection (m),’’ after ‘‘means’’; and 
(2) by adding at the end the following new sub-
section:
259 
‘‘(m) PROVISION OF ADDITIONAL TELEHEALTH BENE-
FITS.— 
‘‘(1) MA PLAN
OPTION.—For plan year 2020 
and subsequent plan years, subject to the requirements 
of paragraph (3), an MA plan may provide addi-
tional telehealth benefits (as defined in paragraph 
(2)) to individuals enrolled under this part. 
‘‘(2) ADDITIONAL
TELEHEALTH
BENEFITS
DE-
FINED.— 
‘‘(A) IN
GENERAL.—For purposes of this 
subsection and section 1854: 
‘‘(i) DEFINITION.—The term ‘addi-
tional telehealth benefits’ means services— 
‘‘(I) for which benefits are avail-
able under part B, including services 
for which payment is not made under 
section 1834(m) due to the conditions 
for payment under such section; and 
‘‘(II) that are identified for the 
year involved by the Secretary as clini-
cally appropriate to furnish using elec-
tronic information and telecommuni-
cations technology when a physician 
(as defined in section 1861(r)) or prac-
titioner 
(described 
in 
section
260 
1842(b)(18)(C)) providing the service 
is not at the same location as the plan 
enrollee. 
‘‘(ii) EXCLUSION OF CAPITAL AND IN-
FRASTRUCTURE
COSTS
AND
INVEST-
MENTS.—The term ‘additional telehealth 
benefits’ does not include capital and infra-
structure costs and investments relating to 
such benefits. 
‘‘(B) PUBLIC
COMMENT.—Not later than 
November 30, 2018, the Secretary shall solicit 
comments on— 
‘‘(i) what types of items and services 
(including those provided through supple-
mental health care benefits, such as remote 
patient monitoring, secure messaging, store 
and forward technologies, and other non- 
face-to-face communication) should be con-
sidered to be additional telehealth benefits; 
and 
‘‘(ii) the requirements for the provision 
or furnishing of such benefits (such as licen-
sure, training, and coordination require-
ments).
261 
‘‘(3) REQUIREMENTS
FOR
ADDITIONAL
TELE-
HEALTH BENEFITS.—The Secretary shall specify re-
quirements for the provision or furnishing of addi-
tional telehealth benefits, including with respect to the 
following: 
‘‘(A) Physician or practitioner qualifica-
tions (other than licensure) and other require-
ments such as specific training. 
‘‘(B) Factors necessary for the coordination 
of such benefits with other items and services, in-
cluding those furnished in-person. 
‘‘(C) Such other areas as determined by the 
Secretary. 
‘‘(4) ENROLLEE CHOICE.—If an MA plan pro-
vides a service as an additional telehealth benefit (as 
defined in paragraph (2))— 
‘‘(A) the MA plan shall also provide access 
to such benefit through an in-person visit (and 
not only as an additional telehealth benefit); and 
‘‘(B) an individual enrollee shall have dis-
cretion as to whether to receive such service 
through the in-person visit or as an additional 
telehealth benefit. 
‘‘(5) TREATMENT UNDER MA.—For purposes of 
this subsection and section 1854, if a plan provides
262 
additional telehealth benefits, such additional tele-
health benefits shall be treated as if they were benefits 
under the original Medicare fee-for-service program 
option. 
‘‘(6) CONSTRUCTION.—Nothing in this subsection 
shall be construed as affecting the requirement under 
subsection (a)(1) that MA plans provide enrollees 
with items and services (other than hospice care) for 
which benefits are available under parts A and B, in-
cluding benefits available under section 1834(m).’’. 
(b) CLARIFICATION REGARDING INCLUSION
IN BID 
AMOUNT.—Section 1854(a)(6)(A)(ii)(I) of the Social Secu-
rity Act (42 U.S.C. 1395w–24(a)(6)(A)(ii)(I)) is amended 
by inserting ‘‘, including, for plan year 2020 and subse-
quent plan years, the provision of additional telehealth ben-
efits as described in section 1852(m)’’ before the semicolon 
at the end. 
SEC. 2314. PROVIDING ACCOUNTABLE CARE ORGANIZA-
TIONS THE ABILITY TO EXPAND THE USE OF 
TELEHEALTH. 
(a) IN GENERAL.—Section 1899 of the Social Security 
Act (42 U.S.C. 1395jjj) is amended by adding at the end 
the following new subsection: 
‘‘(l) PROVIDING ACOS THE ABILITY TO EXPAND THE 
USE OF TELEHEALTH SERVICES.—
263 
‘‘(1) IN GENERAL.—In the case of telehealth serv-
ices for which payment would otherwise be made 
under this title furnished on or after January 1, 
2020, for purposes of this subsection only, the fol-
lowing shall apply with respect to such services fur-
nished by a physician or practitioner participating 
in an applicable ACO (as defined in paragraph (2)) 
to a Medicare fee-for-service beneficiary assigned to 
the applicable ACO: 
‘‘(A) INCLUSION OF HOME AS ORIGINATING 
SITE.—Subject to paragraph (3), the home of a 
beneficiary shall be treated as an originating site 
described in section 1834(m)(4)(C)(ii). 
‘‘(B) NO APPLICATION OF GEOGRAPHIC LIM-
ITATION.—The geographic limitation under sec-
tion 1834(m)(4)(C)(i) shall not apply with re-
spect to an originating site described in section 
1834(m)(4)(C)(ii) (including the home of a bene-
ficiary under subparagraph (A)), subject to State 
licensing requirements. 
‘‘(2) DEFINITIONS.—In this subsection: 
‘‘(A) APPLICABLE ACO.—The term ‘applica-
ble ACO’ means an ACO participating in a 
model tested or expanded under section 1115A or 
under this section—
264 
‘‘(i) that operates under a two-sided 
model— 
‘‘(I) 
described 
in 
section 
425.600(a) of title 42, Code of Federal 
Regulations; or 
‘‘(II) tested or expanded under 
section 1115A; and 
‘‘(ii) for which Medicare fee-for-service 
beneficiaries are assigned to the ACO using 
a prospective assignment method, as deter-
mined appropriate by the Secretary. 
‘‘(B) HOME.—The term ‘home’ means, with 
respect to a Medicare fee-for-service beneficiary, 
the place of residence used as the home of the 
beneficiary. 
‘‘(3) TELEHEALTH SERVICES RECEIVED IN THE 
HOME.—In the case of telehealth services described in 
paragraph (1) where the home of a Medicare fee-for- 
service beneficiary is the originating site, the fol-
lowing shall apply: 
‘‘(A) NO FACILITY FEE.—There shall be no 
facility fee paid to the originating site under sec-
tion 1834(m)(2)(B). 
‘‘(B) EXCLUSION OF CERTAIN SERVICES.— 
No payment may be made for such services that
265 
are inappropriate to furnish in the home setting 
such as services that are typically furnished in 
inpatient settings such as a hospital.’’. 
(b) STUDY AND REPORT.— 
(1) STUDY.— 
(A) IN GENERAL.—The Secretary of Health 
and Human Services (in this subsection referred 
to as the ‘‘Secretary’’) shall conduct a study on 
the implementation of section 1899(l) of the So-
cial Security Act, as added by subsection (a). 
Such study shall include an analysis of the utili-
zation of, and expenditures for, telehealth serv-
ices under such section. 
(B) COLLECTION OF DATA.—The Secretary 
may collect such data as the Secretary deter-
mines necessary to carry out the study under 
this paragraph. 
(2) REPORT.—Not later than January 1, 2026, 
the Secretary shall submit to Congress a report con-
taining the results of the study conducted under para-
graph (1), together with recommendations for such 
legislation and administrative action as the Secretary 
determines appropriate.
266 
SEC. 2315. EXPANDING THE USE OF TELEHEALTH FOR INDI-
VIDUALS WITH STROKE. 
Section 1834(m) of the Social Security Act (42 U.S.C. 
1395m(m)), as amended by section 2302(b), is amended— 
(1) in paragraph (4)(C)(i), in the matter pre-
ceding subclause (I), by striking ‘‘The term’’ and in-
serting ‘‘Except as provided in paragraph (6), the 
term’’; and 
(2) by adding at the end the following new para-
graph: 
‘‘(6) TREATMENT
OF
STROKE
TELEHEALTH 
SERVICES.— 
‘‘(A) NON-APPLICATION
OF
ORIGINATING 
SITE
REQUIREMENTS.—The requirements de-
scribed in paragraph (4)(C) shall not apply with 
respect to telehealth services furnished on or after 
January 1, 2021, for purposes of diagnosis, eval-
uation, or treatment of symptoms of an acute 
stroke, as determined by the Secretary. 
‘‘(B) INCLUSION OF CERTAIN SITES.—With 
respect to telehealth services described in sub-
paragraph (A), the term ‘originating site’ shall 
include any hospital (as defined in section 
1861(e)) or critical access hospital (as defined in 
section 1861(mm)(1)), any mobile stroke unit (as 
defined by the Secretary), or any other site deter-
267 
mined appropriate by the Secretary, at which 
the eligible telehealth individual is located at the 
time the service is furnished via a telecommuni-
cations system. 
‘‘(C) NO ORIGINATING SITE FACILITY FEE 
FOR NEW SITES.—No facility fee shall be paid 
under paragraph (2)(B) to an originating site 
with respect to a telehealth service described in 
subparagraph (A) if the originating site does not 
otherwise meet the requirements for an origi-
nating site under paragraph (4)(C).’’. 
Subtitle C—Identifying the 
Chronically Ill Population 
SEC. 2321. PROVIDING FLEXIBILITY FOR BENEFICIARIES TO 
BE PART OF AN ACCOUNTABLE CARE ORGANI-
ZATION. 
Section 1899(c) of the Social Security Act (42 U.S.C. 
1395jjj(c)) is amended— 
(1) by redesignating paragraphs (1) and (2) as 
subparagraphs (A) and (B), respectively, and indent-
ing appropriately; 
(2) by striking ‘‘ACOS.—The Secretary’’ and in-
serting ‘‘ACOS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), the 
Secretary’’; and
268 
(3) by adding at the end the following new para-
graph: 
‘‘(2) PROVIDING FLEXIBILITY.— 
‘‘(A) CHOICE
OF
PROSPECTIVE
ASSIGN-
MENT.—For each agreement period (effective for 
agreements entered into or renewed on or after 
January 1, 2020), in the case where an ACO es-
tablished under the program is in a Track that 
provides for the retrospective assignment of 
Medicare fee-for-service beneficiaries to the ACO, 
the Secretary shall permit the ACO to choose to 
have Medicare fee-for-service beneficiaries as-
signed prospectively, rather than retrospectively, 
to the ACO for an agreement period. 
‘‘(B) ASSIGNMENT
BASED
ON
VOLUNTARY 
IDENTIFICATION BY MEDICARE FEE-FOR-SERVICE 
BENEFICIARIES.— 
‘‘(i) IN
GENERAL.—For performance 
year 2018 and each subsequent performance 
year, if a system is available for electronic 
designation, the Secretary shall permit a 
Medicare fee-for-service beneficiary to volun-
tarily identify an ACO professional as the 
primary care provider of the beneficiary for
269 
purposes of assigning such beneficiary to an 
ACO, as determined by the Secretary. 
‘‘(ii) 
NOTIFICATION
PROCESS.—The 
Secretary shall establish a process under 
which a Medicare fee-for-service beneficiary 
is— 
‘‘(I) notified of their ability to 
make an identification described in 
clause (i); and 
‘‘(II) informed of the process by 
which they may make and change such 
identification. 
‘‘(iii) SUPERSEDING CLAIMS-BASED AS-
SIGNMENT.—A voluntary identification by 
a Medicare fee-for-service beneficiary under 
this subparagraph shall supersede any 
claims-based assignment otherwise deter-
mined by the Secretary.’’.
270 
Subtitle D—Empowering Individ-
uals and Caregivers in Care De-
livery 
SEC. 2331. ELIMINATING BARRIERS TO CARE COORDINA-
TION UNDER ACCOUNTABLE CARE ORGANIZA-
TIONS. 
(a) IN GENERAL.—Section 1899 of the Social Security 
Act (42 U.S.C. 1395jjj), as amended by section 2314(a), is 
amended— 
(1) in subsection (b)(2), by adding at the end the 
following new subparagraph: 
‘‘(I) An ACO that seeks to operate an ACO 
Beneficiary Incentive Program pursuant to sub-
section (m) shall apply to the Secretary at such 
time, in such manner, and with such informa-
tion as the Secretary may require.’’; 
(2) by adding at the end the following new sub-
section: 
‘‘(m) AUTHORITY TO PROVIDE INCENTIVE PAYMENTS 
TO BENEFICIARIES WITH RESPECT TO QUALIFYING PRI-
MARY CARE SERVICES.— 
‘‘(1) PROGRAM.— 
‘‘(A) IN GENERAL.—In order to encourage 
Medicare fee-for-service beneficiaries to obtain 
medically necessary primary care services, an
273 
definition of primary care physician under 
section 425.20 of title 42, Code of Federal 
Regulations (or any successor regulation); 
‘‘(ii) an ACO professional described in 
subsection (h)(1)(B); or 
‘‘(iii) a Federally qualified health cen-
ter or rural health clinic (as such terms are 
defined in section 1861(aa)). 
‘‘(D) INCENTIVE PAYMENTS.—An incentive 
payment made by an ACO pursuant to an ACO 
Beneficiary Incentive Program established under 
this subsection shall be— 
‘‘(i) in an amount up to $20, with 
such maximum amount updated annually 
by the percentage increase in the consumer 
price index for all urban consumers (United 
States city average) for the 12-month period 
ending with June of the previous year; 
‘‘(ii) in the same amount for each 
Medicare fee-for-service beneficiary described 
in clause (i) or (ii) of subparagraph (B) 
without regard to enrollment of such a bene-
ficiary in a medicare supplemental policy 
(described in section 1882(g)(1)), in a State 
Medicaid plan under title XIX or a waiver
274 
of such a plan, or in any other health in-
surance policy or health benefit plan; 
‘‘(iii) made for each qualifying service 
furnished to such a beneficiary described in 
clause (i) or (ii) of subparagraph (B) dur-
ing a period specified by the Secretary; and 
‘‘(iv) made no later than 30 days after 
a qualifying service is furnished to such a 
beneficiary described in clause (i) or (ii) of 
subparagraph (B). 
‘‘(E) NO SEPARATE PAYMENTS FROM THE 
SECRETARY.—The Secretary shall not make any 
separate payment to an ACO for the costs, in-
cluding incentive payments, of carrying out an 
ACO Beneficiary Incentive Program established 
under this subsection. Nothing in this subpara-
graph shall be construed as prohibiting an ACO 
from using shared savings received under this 
section to carry out an ACO Beneficiary Incen-
tive Program. 
‘‘(F) NO APPLICATION TO SHARED SAVINGS 
CALCULATION.—Incentive payments made by an 
ACO under this subsection shall be disregarded 
for purposes of calculating benchmarks, esti-
275 
mated average per capita Medicare expenditures, 
and shared savings under this section. 
‘‘(G) 
REPORTING
REQUIREMENTS.—An 
ACO conducting an ACO Beneficiary Incentive 
Program under this subsection shall, at such 
times and in such format as the Secretary may 
require, report to the Secretary such information 
and retain such documentation as the Secretary 
may require, including the amount and fre-
quency of incentive payments made and the 
number of Medicare fee-for-service beneficiaries 
receiving such payments. 
‘‘(H) TERMINATION.—The Secretary may 
terminate an ACO Beneficiary Incentive Pro-
gram established under this subsection at any 
time for reasons determined appropriate by the 
Secretary. 
‘‘(3) EXCLUSION OF INCENTIVE PAYMENTS.—Any 
payment made under an ACO Beneficiary Incentive 
Program established under this subsection shall not be 
considered income or resources or otherwise taken into 
account for purposes of— 
‘‘(A) determining eligibility for benefits or 
assistance (or the amount or extent of benefits or 
assistance) under any Federal program or under
276 
any State or local program financed in whole or 
in part with Federal funds; or 
‘‘(B) any Federal or State laws relating to 
taxation.’’; 
(3) in subsection (e), by inserting ‘‘, including 
an ACO Beneficiary Incentive Program under sub-
sections (b)(2)(I) and (m)’’ after ‘‘the program’’; and 
(4) in subsection (g)(6), by inserting ‘‘or of an 
ACO Beneficiary Incentive Program under sub-
sections (b)(2)(I) and (m)’’ after ‘‘under subsection 
(d)(4)’’. 
(b) 
AMENDMENT
TO
SECTION
1128B.—Section 
1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a– 
7b(b)(3)) is amended— 
(1) by striking ‘‘and’’ at the end of subpara-
graph (I); 
(2) by striking the period at the end of subpara-
graph (J) and inserting ‘‘; and’’; and 
(3) by adding at the end the following new sub-
paragraph: 
‘‘(K) an incentive payment made to a Medi-
care fee-for-service beneficiary by an ACO under 
an ACO Beneficiary Incentive Program estab-
lished under subsection (m) of section 1899, if 
the payment is made in accordance with the re-
277 
quirements of such subsection and meets such 
other conditions as the Secretary may estab-
lish.’’. 
(c) EVALUATION AND REPORT.— 
(1) EVALUATION.—The Secretary of Health and 
Human Services (in this subsection referred to as the 
‘‘Secretary’’) shall conduct an evaluation of the ACO 
Beneficiary Incentive Program established under sub-
sections (b)(2)(I) and (m) of section 1899 of the So-
cial Security Act (42 U.S.C. 1395jjj), as added by 
subsection (a). The evaluation shall include an anal-
ysis of the impact of the implementation of the Pro-
gram on expenditures and beneficiary health outcomes 
under title XVIII of the Social Security Act (42 
U.S.C. 1395 et seq.). 
(2) REPORT.—Not later than October 1, 2023, 
the Secretary shall submit to Congress a report con-
taining the results of the evaluation under paragraph 
(1), together with recommendations for such legisla-
tion and administrative action as the Secretary deter-
mines appropriate.
278 
SEC. 2332. GAO STUDY AND REPORT ON LONGITUDINAL 
COMPREHENSIVE CARE PLANNING SERVICES 
UNDER MEDICARE PART B. 
(a) STUDY.—The Comptroller General shall conduct a 
study on the establishment under part B of the Medicare 
program under title XVIII of the Social Security Act of 
a payment code for a visit for longitudinal comprehensive 
care planning services. Such study shall include an anal-
ysis of the following to the extent such information is avail-
able: 
(1) The frequency with which services similar to 
longitudinal comprehensive care planning services are 
furnished to Medicare beneficiaries, which providers 
of services and suppliers are furnishing those services, 
whether Medicare reimbursement is being received for 
those services, and, if so, through which codes those 
services are being reimbursed. 
(2) Whether, and the extent to which, longitu-
dinal comprehensive care planning services would 
overlap, and could therefore result in duplicative pay-
ment, with services covered under the hospice benefit 
as well as the chronic care management code, evalua-
tion and management codes, or other codes that al-
ready exist under part B of the Medicare program. 
(3) Any barriers to hospitals, skilled nursing fa-
cilities, hospice programs, home health agencies, and
280 
(B) 
the 
effectiveness 
and 
patient- 
centeredness of the care plan in organizing deliv-
ery of services consistent with the plan; 
(C) the availability of the care plan and as-
sociated documentation to other providers that 
care for the beneficiary; and 
(D) the extent to which the beneficiary re-
ceived services and support that is free from dis-
crimination based on advanced age, disability 
status, or advanced illness. 
(7) Stakeholder’s views on how such quality 
metrics would provide information on— 
(A) the goals, values, and preferences of the 
beneficiary; 
(B) the documentation of the care plan; 
(C) services furnished to the beneficiary; 
and 
(D) outcomes of treatment. 
(8) Stakeholder’s views on— 
(A) the type of training and education 
needed for applicable providers, individuals, and 
caregivers in order to facilitate longitudinal 
comprehensive care planning services;
281 
(B) the types of providers of services and 
suppliers that should be included in the inter-
disciplinary team of an applicable provider; and 
(C) the characteristics of Medicare bene-
ficiaries that would be most appropriate to re-
ceive longitudinal comprehensive care planning 
services, such as individuals with advanced dis-
ease and individuals who need assistance with 
multiple activities of daily living. 
(9) Stakeholder’s views on the frequency with 
which longitudinal comprehensive care planning serv-
ices should be furnished. 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the 
study conducted under subsection (a), together with rec-
ommendations for such legislation and administrative ac-
tion as the Comptroller General determines appropriate. 
(c) DEFINITIONS.—In this section: 
(1) APPLICABLE PROVIDER.—The term ‘‘applica-
ble provider’’ means a hospice program (as defined in 
subsection (dd)(2) of section 1861 of the Social Secu-
rity Act (42 U.S.C. 1395ww)) or other provider of 
services (as defined in subsection (u) of such section)
282 
or supplier (as defined in subsection (d) of such sec-
tion) that— 
(A) furnishes longitudinal comprehensive 
care planning services through an interdiscipli-
nary team; and 
(B) meets such other requirements as the 
Secretary may determine to be appropriate. 
(2) COMPTROLLER GENERAL.—The term ‘‘Comp-
troller General’’ means the Comptroller General of the 
United States. 
(3) 
INTERDISCIPLINARY
TEAM.—The 
term 
‘‘interdisciplinary team’’ means a group that— 
(A) includes the personnel described in sub-
section (dd)(2)(B)(i) of such section 1861; 
(B) may include a chaplain, minister, or 
other clergy; and 
(C) may include other direct care personnel. 
(4) LONGITUDINAL COMPREHENSIVE CARE PLAN-
NING SERVICES.—The term ‘‘longitudinal comprehen-
sive care planning services’’ means a voluntary 
shared decisionmaking process that is furnished by an 
applicable provider through an interdisciplinary 
team and includes a conversation with Medicare bene-
ficiaries who have received a diagnosis of a serious or 
life-threatening illness. The purpose of such services is
283 
to discuss a longitudinal care plan that addresses the 
progression of the disease, treatment options, the 
goals, values, and preferences of the beneficiary, and 
the availability of other resources and social supports 
that may reduce the beneficiary’s health risks and 
promote self-management and shared decisionmaking. 
(5) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
Subtitle E—Other Policies to Im-
prove Care for the Chronically 
Ill 
SEC. 2341. GAO STUDY AND REPORT ON IMPROVING MEDI-
CATION SYNCHRONIZATION. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall conduct a study on the extent to which Medicare 
prescription drug plans (MA–PD plans and stand alone 
prescription drug plans) under part D of title XVIII of the 
Social Security Act and private payors use programs that 
synchronize pharmacy dispensing so that individuals may 
receive multiple prescriptions on the same day to facilitate 
comprehensive counseling and promote medication adher-
ence. The study shall include a analysis of the following: 
(1) The extent to which pharmacies have adopted 
such programs.
284 
(2) The common characteristics of such pro-
grams, including how pharmacies structure coun-
seling sessions under such programs and the types of 
payment and other arrangements that Medicare pre-
scription drug plans and private payors employ 
under such programs to support the efforts of phar-
macies. 
(3) How such programs compare for Medicare 
prescription drug plans and private payors. 
(4) What is known about how such programs af-
fect patient medication adherence and overall patient 
health outcomes, including if adherence and outcomes 
vary by patient subpopulations, such as disease state 
and socioeconomic status. 
(5) What is known about overall patient satisfac-
tion with such programs and satisfaction with such 
programs, including within patient subpopulations, 
such as disease state and socioeconomic status. 
(6) The extent to which laws and regulations of 
the Medicare program support such programs. 
(7) Barriers to the use of medication synchroni-
zation programs by Medicare prescription drug plans. 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the
285 
study under subsection (a), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 2342. GAO STUDY AND REPORT ON IMPACT OF OBE-
SITY 
DRUGS 
ON 
PATIENT 
HEALTH 
AND 
SPENDING. 
(a) STUDY.—The Comptroller General of the United 
States (in this section referred to as the ‘‘Comptroller Gen-
eral’’) shall, to the extent data are available, conduct a 
study on the use of prescription drugs to manage the weight 
of obese patients and the impact of coverage of such drugs 
on patient health and on health care spending. Such study 
shall examine the use and impact of these obesity drugs in 
the non-Medicare population and for Medicare beneficiaries 
who have such drugs covered through an MA–PD plan (as 
defined in section 1860D–1(a)(3)(C) of the Social Security 
Act (42 U.S.C. 1395w–101(a)(3)(C))) as a supplemental 
health care benefit. The study shall include an analysis of 
the following: 
(1) The prevalence of obesity in the Medicare 
and non-Medicare population. 
(2) The utilization of obesity drugs. 
(3) The distribution of Body Mass Index by in-
dividuals taking obesity drugs, to the extent prac-
ticable.
286 
(4) What is known about the use of obesity drugs 
in conjunction with the receipt of other items or serv-
ices, such as behavioral counseling, and how these 
compare to items and services received by obese indi-
viduals who do not take obesity drugs. 
(5) Physician considerations and attitudes re-
lated to prescribing obesity drugs. 
(6) The extent to which coverage policies cease or 
limit coverage for individuals who fail to receive clin-
ical benefit. 
(7) What is known about the extent to which in-
dividuals who take obesity drugs adhere to the pre-
scribed regimen. 
(8) What is known about the extent to which in-
dividuals who take obesity drugs maintain weight loss 
over time. 
(9) What is known about the subsequent impact 
such drugs have on medical services that are directly 
related to obesity, including with respect to sub-
populations determined based on the extent of obesity. 
(10) What is known about the spending associ-
ated with the care of individuals who take obesity 
drugs, compared to the spending associated with the 
care of individuals who do not take such drugs.
287 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Comptroller General shall 
submit to Congress a report containing the results of the 
study under subsection (a), together with recommendations 
for such legislation and administrative action as the Comp-
troller General determines appropriate. 
SEC. 2343. HHS STUDY AND REPORT ON LONG-TERM RISK 
FACTORS FOR CHRONIC CONDITIONS AMONG 
MEDICARE BENEFICIARIES. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) shall 
conduct a study on long-term cost drivers to the Medicare 
program, including obesity, tobacco use, mental health con-
ditions, and other factors that may contribute to the deterio-
ration of health conditions among individuals with chronic 
conditions in the Medicare population. The study shall in-
clude an analysis of any barriers to collecting and ana-
lyzing such information and how to remove any such bar-
riers (including through legislation and administrative ac-
tions). 
(b) REPORT.—Not later than 18 months after the date 
of the enactment of this Act, the Secretary shall submit to 
Congress a report containing the results of the study under 
subsection (a), together with recommendations for such leg-
islation and administrative action as the Secretary deter-
288 
mines appropriate. The Secretary shall also post such re-
port on the Internet website of the Department of Health 
and Human Services. 
TITLE IV—MEDICARE PART B 
MISCELLANEOUS POLICIES 
Subtitle A—Medicare Part B 
Improvement Act 
SEC. 2401. HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT. 
(a) IN GENERAL.—Section 1834(u) of the Social Secu-
rity Act (42 U.S.C. 1395m(u)) is amended by adding at 
the end the following new paragraph: 
‘‘(7) HOME INFUSION THERAPY SERVICES TEM-
PORARY TRANSITIONAL PAYMENT.— 
‘‘(A) 
TEMPORARY
TRANSITIONAL
PAY-
MENT.— 
‘‘(i) 
IN
GENERAL.—The 
Secretary 
shall, in accordance with the payment 
methodology described in subparagraph (B) 
and subject to the provisions of this para-
graph, provide a home infusion therapy 
services temporary transitional payment 
under this part to an eligible home infusion 
supplier (as defined in subparagraph (F)) 
for items and services described in subpara-
289 
graphs (A) and (B) of section 1861(iii)(2)) 
furnished during the period specified in 
clause (ii) by such supplier in coordination 
with the furnishing of transitional home in-
fusion drugs (as defined in clause (iii)). 
‘‘(ii) PERIOD
SPECIFIED.—For pur-
poses of clause (i), the period specified in 
this clause is the period beginning on Janu-
ary 1, 2019, and ending on the day before 
the date of the implementation of the pay-
ment system under paragraph (1)(A). 
‘‘(iii) TRANSITIONAL HOME INFUSION 
DRUG DEFINED.—For purposes of this para-
graph, the term ‘transitional home infusion 
drug’ has the meaning given to the term 
‘home 
infusion 
drug’ 
under 
section 
1861(iii)(3)(C)), except that clause (ii) of 
such section shall not apply if a drug de-
scribed in such clause is identified in 
clauses (i), (ii), (iii) or (iv) of subpara-
graph (C) as of the date of the enactment of 
this paragraph. 
‘‘(B) PAYMENT
METHODOLOGY.—For pur-
poses of this paragraph, the Secretary shall es-
tablish a payment methodology, with respect to
290 
items and services described in subparagraph 
(A)(i). Under such payment methodology the 
Secretary shall— 
‘‘(i) create the three payment categories 
described in clauses (i), (ii), and (iii) of 
subparagraph (C); 
‘‘(ii) assign drugs to such categories, in 
accordance with such clauses; 
‘‘(iii) assign appropriate Healthcare 
Common 
Procedure 
Coding 
System 
(HCPCS) codes to each payment category; 
and 
‘‘(iv) 
establish 
a 
single 
payment 
amount for each such payment category, in 
accordance with subparagraph (D), for each 
infusion drug administration calendar day 
in the individual’s home for drugs assigned 
to such category. 
‘‘(C) PAYMENT CATEGORIES.— 
‘‘(i) PAYMENT CATEGORY 1.—The Sec-
retary shall create a payment category 1 
and assign to such category drugs which are 
covered under the Local Coverage Deter-
mination on External Infusion Pumps 
(LCD number L33794) and billed with the
291 
following HCPCS codes (as identified as of 
January 1, 2018, and as subsequently 
modified by the Secretary): J0133, J0285, 
J0287, J0288, J0289, J0895, J1170, J1250, 
J1265, J1325, J1455, J1457, J1570, J2175, 
J2260, J2270, J2274, J2278, J3010, or 
J3285. 
‘‘(ii) PAYMENT CATEGORY 2.—The Sec-
retary shall create a payment category 2 
and assign to such category drugs which are 
covered under such local coverage deter-
mination and billed with the following 
HCPCS codes (as identified as of January 
1, 2018, and as subsequently modified by 
the Secretary): J1555 JB, J1559 JB, J1561 
JB, J1562 JB, J1569 JB, or J1575 JB. 
‘‘(iii) PAYMENT
CATEGORY
3.—The 
Secretary shall create a payment category 3 
and assign to such category drugs which are 
covered under such local coverage deter-
mination and billed with the following 
HCPCS codes (as identified as of January 
1, 2018, and as subsequently modified by 
the 
Secretary): 
J9000, 
J9039, 
J9040,
292 
J9065, J9100, J9190, J9200, J9360, or 
J9370. 
‘‘(iv) INFUSION
DRUGS
NOT
OTHER-
WISE
INCLUDED.—With respect to drugs 
that are not included in payment category 
1, 2, or 3 under clause (i), (ii), or (iii), re-
spectively, the Secretary shall assign to the 
most appropriate of such categories, as de-
termined by the Secretary, drugs which 
are— 
‘‘(I) covered under such local cov-
erage determination and billed under 
HCPCS codes J7799 or J7999 (as 
identified as of July 1, 2017, and as 
subsequently modified by the Sec-
retary); or 
‘‘(II) billed under any code that is 
implemented after the date of the en-
actment of this paragraph and in-
cluded in such local coverage deter-
mination or included in subregulatory 
guidance as a home infusion drug de-
scribed in subparagraph (A)(i). 
‘‘(D) PAYMENT AMOUNTS.—
293 
‘‘(i) IN GENERAL.—Under the payment 
methodology, the Secretary shall pay eligible 
home infusion suppliers, with respect to 
items and services described in subpara-
graph (A)(i) furnished during the period 
described in subparagraph (A)(ii) by such 
supplier to an individual, at amounts equal 
to the amounts determined under the physi-
cian fee schedule established under section 
1848 for services furnished during the year 
for codes and units of such codes described 
in clauses (ii), (iii), and (iv) with respect 
to drugs included in the payment category 
under subparagraph (C) specified in the re-
spective clause, determined without applica-
tion of the geographic adjustment under 
subsection (e) of such section. 
‘‘(ii) PAYMENT AMOUNT FOR CATEGORY 
1.—For purposes of clause (i), the codes and 
units described in this clause, with respect 
to drugs included in payment category 1 
described in subparagraph (C)(i), are one 
unit of HCPCS code 96365 plus three units 
of HCPCS code 96366 (as identified as of
294 
January 1, 2018, and as subsequently 
modified by the Secretary). 
‘‘(iii) PAYMENT
AMOUNT
FOR
CAT-
EGORY 2.—For purposes of clause (i), the 
codes and units described in this clause, 
with respect to drugs included in payment 
category 2 described in subparagraph 
(C)(i), are one unit of HCPCS code 96369 
plus three units of HCPCS code 96370 (as 
identified as of January 1, 2018, and as 
subsequently modified by the Secretary). 
‘‘(iv) PAYMENT
AMOUNT
FOR
CAT-
EGORY 3.—For purposes of clause (i), the 
codes and units described in this clause, 
with respect to drugs included in payment 
category 3 described in subparagraph 
(C)(i), are one unit of HCPCS code 96413 
plus three units of HCPCS code 96415 (as 
identified as of January 1, 2018, and as 
subsequently modified by the Secretary). 
‘‘(E) CLARIFICATIONS.— 
‘‘(i) INFUSION DRUG ADMINISTRATION 
DAY.—For purposes of this subsection, with 
respect to the furnishing of transitional 
home infusion drugs or home infusion drugs
295 
to an individual by an eligible home infu-
sion supplier or a qualified home infusion 
therapy supplier, a reference to payment to 
such supplier for an infusion drug adminis-
tration calendar day in the individual’s 
home shall refer to payment only for the 
date on which professional services (as de-
scribed in section 1861(iii)(2)(A)) were fur-
nished to administer such drugs to such in-
dividual. For purposes of the previous sen-
tence, an infusion drug administration cal-
endar day shall include all such drugs ad-
ministered to such individual on such day. 
‘‘(ii) TREATMENT OF MULTIPLE DRUGS 
ADMINISTERED
ON
SAME
INFUSION
DRUG 
ADMINISTRATION DAY.—In the case that an 
eligible home infusion supplier, with respect 
to an infusion drug administration cal-
endar day in an individual’s home, fur-
nishes to such individual transitional home 
infusion drugs which are not all assigned to 
the same payment category under subpara-
graph (C), payment to such supplier for 
such infusion drug administration calendar 
day in the individual’s home shall be a sin-
296 
gle payment equal to the amount of pay-
ment under this paragraph for the drug, 
among all such drugs so furnished to such 
individual during such calendar day, for 
which the highest payment would be made 
under this paragraph. 
‘‘(F) 
ELIGIBLE
HOME
INFUSION
SUP-
PLIERS.—In this paragraph, the term ‘eligible 
home infusion supplier’ means a supplier that is 
enrolled under this part as a pharmacy that pro-
vides external infusion pumps and external infu-
sion pump supplies and that maintains all 
pharmacy licensure requirements in the State in 
which the applicable infusion drugs are adminis-
tered. 
‘‘(G) 
IMPLEMENTATION.—Notwithstanding 
any other provision of law, the Secretary may 
implement this paragraph by program instruc-
tion or otherwise.’’. 
(b) CONFORMING AMENDMENT.— 
(1) Section 1842(b)(6)(I) of the Social Security 
Act (42 U.S.C. 1395u(b)(6)(I)) is amended by insert-
ing ‘‘or, in the case of items and services described in 
clause (i) of section 1834(u)(7)(A) furnished to an in-
dividual during the period described in clause (ii) of
297 
such section, payment shall be made to the eligible 
home infusion therapy supplier’’ after ‘‘payment shall 
be made to the qualified home infusion therapy sup-
plier’’. 
(2) Section 5012(d) of the 21st Century Cures 
Act is amended by inserting the following before the 
period at the end the following: ‘‘, except that the 
amendments made by paragraphs (1) and (2) of sub-
section (c) shall apply to items and services furnished 
on or after January 1, 2019’’. 
SEC. 2402. ORTHOTIST’S AND PROSTHETIST’S CLINICAL 
NOTES AS PART OF THE PATIENT’S MEDICAL 
RECORD. 
Section 1834(h) of the Social Security Act (42 U.S.C. 
1395m(h)) is amended by adding at the end the following 
new paragraph: 
‘‘(5) DOCUMENTATION CREATED BY ORTHOTISTS 
AND
PROSTHETISTS.—For purposes of determining 
the reasonableness and medical necessity of orthotics 
and 
prosthetics, 
documentation 
created 
by 
an 
orthotist or prosthetist shall be considered part of the 
individual’s medical record to support documentation 
created by eligible professionals described in section 
1848(k)(3)(B).’’.
298 
SEC. 2403. INDEPENDENT ACCREDITATION FOR DIALYSIS 
FACILITIES AND ASSURANCE OF HIGH QUAL-
ITY SURVEYS. 
(a) ACCREDITATION AND SURVEYS.— 
(1) IN GENERAL.—Section 1865 of the Social Se-
curity Act (42 U.S.C. 1395bb) is amended— 
(A) in subsection (a)— 
(i) in paragraph (1), in the matter 
preceding subparagraph (A), by striking ‘‘or 
the conditions and requirements under sec-
tion 1881(b)’’; and 
(ii) in paragraph (4), by inserting 
‘‘(including a renal dialysis facility)’’ after 
‘‘facility’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(e) With respect to an accreditation body that has re-
ceived approval from the Secretary under subsection 
(a)(3)(A) for accreditation of provider entities that are re-
quired to meet the conditions and requirements under sec-
tion 1881(b), in addition to review and oversight authori-
ties otherwise applicable under this title, the Secretary shall 
(as the Secretary determines appropriate) conduct, with re-
spect to such accreditation body and provider entities, any 
or all of the following as frequently as is otherwise required
299 
to be conducted under this title with respect to other accredi-
tation bodies or other provider entities: 
‘‘(1) Validation surveys referred to in subsection 
(d). 
‘‘(2) Accreditation program reviews (as defined 
in section 488.8(c) of title 42 of the Code of Federal 
Regulations, or a successor regulation). 
‘‘(3) Performance reviews (as defined in section 
488.8(a) of title 42 of the Code of Federal Regula-
tions, or a successor regulation).’’. 
(2) TIMING
FOR
ACCEPTANCE
OF
REQUESTS 
FROM
ACCREDITATION
ORGANIZATIONS.—Not later 
than 90 days after the date of enactment of this Act, 
the Secretary of Health and Human Services shall 
begin accepting requests from national accreditation 
bodies 
for 
a 
finding 
described 
in 
section 
1865(a)(3)(A) of the Social Security Act (42 U.S.C. 
1395bb(a)(3)(A)) for purposes of accrediting provider 
entities that are required to meet the conditions and 
requirements under section 1881(b) of such Act (42 
U.S.C. 1395rr(b)). 
(b) REQUIREMENT FOR TIMING OF SURVEYS OF NEW 
DIALYSIS FACILITIES.—Section 1881(b)(1) of the Social Se-
curity Act (42 U.S.C. 1395rr(b)(1)) is amended by adding 
at the end the following new sentence: ‘‘Beginning 180 days
300 
after the date of the enactment of this sentence, an initial 
survey of a provider of services or a renal dialysis facility 
to determine if the conditions and requirements under this 
paragraph are met shall be initiated not later than 90 days 
after such date on which both the provider enrollment form 
(without regard to whether such form is submitted prior 
to or after such date of enactment) has been determined by 
the Secretary to be complete and the provider’s enrollment 
status indicates approval is pending the results of such sur-
vey.’’. 
SEC. 2404. MODERNIZING THE APPLICATION OF THE STARK 
RULE UNDER MEDICARE. 
(a) CLARIFICATION OF THE WRITING REQUIREMENT 
AND SIGNATURE REQUIREMENT FOR ARRANGEMENTS PUR-
SUANT TO THE STARK RULE.— 
(1) 
WRITING
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)) is amended by adding at the end the 
following new subparagraph: 
‘‘(D) WRITTEN
REQUIREMENT
CLARIFIED.—In 
the case of any requirement pursuant to this section 
for a compensation arrangement to be in writing, 
such requirement shall be satisfied by such means as 
determined by the Secretary, including by a collection 
of documents, including contemporaneous documents
301 
evidencing the course of conduct between the parties 
involved.’’. 
(2) 
SIGNATURE
REQUIREMENT.—Section 
1877(h)(1) of the Social Security Act (42 U.S.C. 
1395nn(h)(1)), as amended by paragraph (1), is fur-
ther amended by adding at the end the following new 
subparagraph: 
‘‘(E) SPECIAL RULE FOR SIGNATURE RE-
QUIREMENTS.—In the case of any requirement 
pursuant to this section for a compensation ar-
rangement to be in writing and signed by the 
parties, such signature requirement shall be met 
if— 
‘‘(i) not later than 90 consecutive cal-
endar days immediately following the date 
on which the compensation arrangement be-
came noncompliant, the parties obtain the 
required signatures; and 
‘‘(ii) the compensation arrangement 
otherwise complies with all criteria of the 
applicable exception.’’. 
(b) INDEFINITE HOLDOVER
FOR LEASE ARRANGE-
MENTS AND PERSONAL SERVICES ARRANGEMENTS PURSU-
ANT TO THE STARK RULE.—Section 1877(e) of the Social 
Security Act (42 U.S.C. 1395nn(e)) is amended—
302 
(1) in paragraph (1), by adding at the end the 
following new subparagraph: 
‘‘(C) HOLDOVER LEASE ARRANGEMENTS.— 
In the case of a holdover lease arrangement for 
the lease of office space or equipment, which im-
mediately follows a lease arrangement described 
in subparagraph (A) for the use of such office 
space or subparagraph (B) for the use of such 
equipment and that expired after a term of at 
least 1 year, payments made by the lessee to the 
lessor pursuant to such holdover lease arrange-
ment, if— 
‘‘(i) the lease arrangement met the con-
ditions of subparagraph (A) for the lease of 
office space or subparagraph (B) for the use 
of equipment when the arrangement ex-
pired; 
‘‘(ii) the holdover lease arrangement is 
on the same terms and conditions as the 
immediately preceding arrangement; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A) for the lease of office space or 
subparagraph (B) for the use of equip-
ment.’’; and
303 
(2) in paragraph (3), by adding at the end the 
following new subparagraph: 
‘‘(C) HOLDOVER
PERSONAL
SERVICE
AR-
RANGEMENT.—In the case of a holdover personal 
service arrangement, which immediately follows 
an arrangement described in subparagraph (A) 
that expired after a term of at least 1 year, re-
muneration from an entity pursuant to such 
holdover personal service arrangement, if— 
‘‘(i) the personal service arrangement 
met the conditions of subparagraph (A) 
when the arrangement expired; 
‘‘(ii) the holdover personal service ar-
rangement is on the same terms and condi-
tions as the immediately preceding arrange-
ment; and 
‘‘(iii) the holdover arrangement con-
tinues to satisfy the conditions of subpara-
graph (A).’’.
304 
Subtitle B—Additional Provisions 
SEC. 2411. MAKING PERMANENT THE REMOVAL OF THE 
RENTAL CAP FOR DURABLE MEDICAL EQUIP-
MENT UNDER MEDICARE WITH RESPECT TO 
SPEECH GENERATING DEVICES. 
Section 1834(a)(2)(A)(iv) of the Social Security Act 
(42 U.S.C. 1395m(a)(2)(A)(iv)) is amended by striking 
‘‘and before October 1, 2018,’’. 
SEC. 2412. INCREASED CIVIL AND CRIMINAL PENALTIES 
AND INCREASED SENTENCES FOR FEDERAL 
HEALTH CARE PROGRAM FRAUD AND ABUSE. 
(a) INCREASED CIVIL MONEY PENALTIES AND CRIMI-
NAL FINES.— 
(1) INCREASED CIVIL MONEY PENALTIES.—Sec-
tion 1128A of the Social Security Act (42 U.S.C. 
1320a–7a) is amended— 
(A) in subsection (a), in the matter fol-
lowing paragraph (10)— 
(i) by striking ‘‘$10,000’’ and inserting 
‘‘$20,000’’ each place it appears; 
(ii) by striking ‘‘$15,000’’ and insert-
ing ‘‘$30,000’’; and 
(iii) by striking ‘‘$50,000’’ and insert-
ing ‘‘$100,000’’ each place it appears; and 
(B) in subsection (b)—
305 
(i) in paragraph (1), in the flush text 
following subparagraph (B), by striking 
‘‘$2,000’’ and inserting ‘‘$5,000’’; 
(ii) in paragraph (2), by striking 
‘‘$2,000’’ and inserting ‘‘$5,000’’; and 
(iii) in paragraph (3)(A)(i), by strik-
ing ‘‘$5,000’’ and inserting ‘‘$10,000’’. 
(2) 
INCREASED
CRIMINAL
FINES.—Section 
1128B of such Act (42 U.S.C. 1320a–7b) is amend-
ed— 
(A) in subsection (a), in the matter fol-
lowing paragraph (6)— 
(i) by striking ‘‘$25,000’’ and inserting 
‘‘$100,000’’; and 
(ii) by striking ‘‘$10,000’’ and insert-
ing ‘‘$20,000’’; 
(B) in subsection (b)— 
(i) in paragraph (1), in the flush text 
following subparagraph (B), by striking 
‘‘$25,000’’ and inserting ‘‘$100,000’’; and 
(ii) in paragraph (2), in the flush text 
following subparagraph (B), by striking 
‘‘$25,000’’ and inserting ‘‘$100,000’’; 
(C) in subsection (c), by striking ‘‘$25,000’’ 
and inserting ‘‘$100,000’’;
306 
(D) in subsection (d), in the flush text fol-
lowing paragraph (2), by striking ‘‘$25,000’’ and 
inserting ‘‘$100,000’’; and 
(E) in subsection (e), by striking ‘‘$2,000’’ 
and inserting ‘‘$4,000’’. 
(b) INCREASED SENTENCES FOR FELONIES INVOLVING 
FEDERAL HEALTH CARE PROGRAM FRAUD AND ABUSE.— 
(1) FALSE
STATEMENTS
AND
REPRESENTA-
TIONS.—Section 1128B(a) of the Social Security Act 
(42 U.S.C. 1320a–7b(a)) is amended, in the matter 
following paragraph (6), by striking ‘‘not more than 
five years or both, or (ii)’’ and inserting ‘‘not more 
than 10 years or both, or (ii)’’. 
(2) ANTIKICKBACK.—Section 1128B(b) of such 
Act (42 U.S.C. 1320a–7b(b)) is amended— 
(A) in paragraph (1), in the flush text fol-
lowing subparagraph (B), by striking ‘‘not more 
than five years’’ and inserting ‘‘not more than 
10 years’’; and 
(B) in paragraph (2), in the flush text fol-
lowing subparagraph (B), by striking ‘‘not more 
than five years’’ and inserting ‘‘not more than 
10 years’’. 
(3) FALSE
STATEMENT
OR
REPRESENTATION 
WITH RESPECT TO CONDITIONS OR OPERATIONS OF
307 
FACILITIES.—Section 1128B(c) of such Act (42 U.S.C. 
1320a–7b(c)) is amended by striking ‘‘not more than 
five years’’ and inserting ‘‘not more than 10 years’’. 
(4) EXCESS
CHARGES.—Section 1128B(d) of 
such Act (42 U.S.C. 1320a–7b(d)) is amended, in the 
flush text following paragraph (2), by striking ‘‘not 
more than five years’’ and inserting ‘‘not more than 
10 years’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall apply to acts committed after the date of the 
enactment of this Act. 
SEC. 2413. REDUCING THE VOLUME OF FUTURE EHR-RE-
LATED SIGNIFICANT HARDSHIP REQUESTS. 
Section 1848(o)(2)(A) of the Social Security Act (42 
U.S.C. 1395w–4(o)(2)(A)) and section 1886(n)(3)(A) of 
such Act (42 U.S.C. 1395ww(n)(3)(A)) are each amended 
in the last sentence by striking ‘‘by requiring’’ and all that 
follows through ‘‘this paragraph’’. 
SEC. 2414. COVERAGE OF CERTAIN DNA SPECIMEN PROVE-
NANCE ASSAY TESTS UNDER MEDICARE. 
(a) BENEFIT.— 
(1) COVERAGE.—Section 1861 of the Social Se-
curity Act (42 U.S.C. 1395x) is amended— 
(A) in subsection (s)(2)—
308 
(i) in subparagraph (FF), by striking 
‘‘and’’ at the end; 
(ii) in subparagraph (GG), by insert-
ing ‘‘and’’ at the end; and 
(iii) by adding at the end the following 
new subparagraph: 
‘‘(HH) a prostate cancer DNA Specimen Prove-
nance Assay test (DSPA test) (as defined in sub-
section (jjj)); and’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(jjj) PROSTATE CANCER DNA SPECIMENT PROVE-
NANCE ASSAY TEST.—The term ‘prostate cancer DNA Spec-
imen Provenance Assay Test’ (DSPA test) means a test 
that, after a determination of cancer in one or more pros-
tate biopsy specimens obtained from an individual, assesses 
the identity of the DNA in such specimens by comparing 
such DNA with the DNA that was separately taken from 
such individual at the time of the biopsy.’’. 
(2) 
EXCLUSION
FROM
COVERAGE.—Section 
1862(a)(1) of the Social Security Act (42 U.S.C. 
1395y(a)(1)) is amended— 
(A) in subparagraph (O), by striking ‘‘and’’ 
at the end;
309 
(B) in subparagraph (P), by striking the 
semicolon at the end and inserting ‘‘, and’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(Q) in the case of a prostate cancer DNA Speci-
men Provenance Assay test (DSPA test) (as defined 
in section 1861(jjj)), unless such test is furnished on 
or after January 1, 2019, and before January 1, 
2024, and such test is ordered by the physician who 
furnished the prostate cancer biopsy that obtained the 
specimen tested;’’. 
(b) PAYMENT
AMOUNT
AND
RELATED
REQUIRE-
MENTS.—Section 1834 of the Social Security Act (42 
U.S.C. 1395m), as amended by section 2204, is further 
amended by adding at the end the following new subsection: 
‘‘(w) PROSTATE CANCER DNA SPECIMEN PROVE-
NANCE ASSAY TESTS.— 
‘‘(1) PAYMENT FOR COVERED TESTS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the payment amount for a prostate 
cancer DNA Specimen Provenance Assay test 
(DSPA test) (as defined in section 1861(jjj)) 
shall be $200. Such payment shall be payment 
for all of the specimens obtained from the biopsy 
furnished to an individual that are tested.
310 
‘‘(B) LIMITATION.—Payment for a DSPA 
test under subparagraph (A) may only be made 
on an assignment-related basis. 
‘‘(C) PROHIBITION
ON
SEPARATE
PAY-
MENT.—No separate payment shall be made for 
obtaining DNA that was separately taken from 
an individual at the time of a biopsy described 
in subparagraph (A). 
‘‘(2) HCPCS CODE
AND
MODIFIER
ASSIGN-
MENT.— 
‘‘(A) IN GENERAL.—The Secretary shall as-
sign one or more HCPCS codes to a prostate 
cancer DNA Specimen Provenance Assay test 
and may use a modifier to facilitate making 
payment under this section for such test. 
‘‘(B) IDENTIFICATION
OF
DNA
MATCH
ON 
CLAIM.—The Secretary shall require an indica-
tion on a claim for a prostate cancer DNA Spec-
imen Provenance Assay test of whether the DNA 
of the prostate biopsy specimens match the DNA 
of the individual diagnosed with prostate cancer. 
Such indication may be made through use of a 
HCPCS code, a modifier, or other means, as de-
termined appropriate by the Secretary. 
‘‘(3) DNA MATCH REVIEW.—
311 
‘‘(A) IN GENERAL.—The Secretary shall re-
view at least three years of claims under part B 
for prostate cancer DNA Specimen Provenance 
Assay tests to identify whether the DNA of the 
prostate biopsy specimens match the DNA of the 
individuals diagnosed with prostate cancer. 
‘‘(B) POSTING ON INTERNET WEBSITE.—Not 
later than July 1, 2022, the Secretary shall post 
on the Internet website of the Centers for Medi-
care & Medicaid Services the findings of the re-
view conducted under subparagraph (A).’’. 
(c) COST-SHARING.—Section 1833(a)(1) of the Social 
Security Act (42 U.S.C. 1395l(a)(1)) is amended— 
(1) by striking ‘‘and (BB)’’ and inserting 
‘‘(BB)’’; and 
(2) by inserting before the semicolon at the end 
the following: ‘‘, and (CC) with respect to a prostate 
cancer DNA Specimen Provenance Assay test (DSPA 
test) (as defined in section 1861(jjj)), the amount 
paid shall be an amount equal to 80 percent of the 
lesser of the actual charge for the test or the amount 
specified under section 1834(w)’’.
312 
SEC. 2415. STRENGTHENING RULES IN CASE OF COMPETI-
TION FOR DIABETIC TESTING STRIPS. 
(a) SPECIAL RULE IN CASE OF COMPETITION FOR DI-
ABETIC TESTING STRIPS.— 
(1) IN
GENERAL.—Paragraph (10) of section 
1847(b) of the Social Security Act (42 U.S.C. 1395w– 
3(b)) is amended— 
(A) in subparagraph (A), by striking the 
second sentence and inserting the following new 
sentence: ‘‘With respect to bids to furnish such 
types of products on or after January 1, 2019, 
the volume for such types of products shall be de-
termined by the Secretary through the use of 
multiple sources of data (from mail order and 
non-mail order Medicare markets), including 
market-based data measuring sales of diabetic 
testing strip products that are not exclusively 
sold by a single retailer from such markets.’’; 
and 
(B) by adding at the end the following new 
subparagraphs: 
‘‘(C) DEMONSTRATION OF ABILITY TO FUR-
NISH TYPES OF DIABETIC TESTING STRIP PROD-
UCTS.—With respect to bids to furnish diabetic 
testing strip products on or after January 1, 
2019, an entity shall attest to the Secretary that
313 
the entity has the ability to obtain an inventory 
of the types and quantities of diabetic testing 
strip products that will allow the entity to fur-
nish such products in a manner consistent with 
its bid and— 
‘‘(i) demonstrate to the Secretary, 
through letters of intent with manufactur-
ers, wholesalers, or other suppliers, or other 
evidence as the Secretary may specify, such 
ability; or 
‘‘(ii) demonstrate to the Secretary that 
it made a good faith attempt to obtain such 
a letter of intent or such other evidence. 
‘‘(D) USE OF UNLISTED TYPES IN CALCULA-
TION OF PERCENTAGE.—With respect to bids to 
furnish diabetic testing strip products on or after 
January 1, 2019, in determining under subpara-
graph (A) whether a bid submitted by an entity 
under such subparagraph covers 50 percent (or 
such higher percentage as the Secretary may 
specify) of all types of diabetic testing strip 
products, the Secretary may not attribute a per-
centage to types of diabetic testing strip products 
that the Secretary does not identify by brand, 
model, and market share volume.
314 
‘‘(E) ADHERENCE TO DEMONSTRATION.— 
‘‘(i) IN GENERAL.—In the case of an 
entity that is furnishing diabetic testing 
strip products on or after January 1, 2019, 
under a contract entered into under the 
competition conducted pursuant to para-
graph (1), the Secretary shall establish a 
process to monitor, on an ongoing basis, the 
extent to which such entity continues to 
cover the product types included in the enti-
ty’s bid. 
‘‘(ii) TERMINATION.—If the Secretary 
determines that an entity described in 
clause (i) fails to maintain in inventory, or 
otherwise maintain ready access to (through 
requirements, contracts, or otherwise) a type 
of product included in the entity’s bid, the 
Secretary may terminate such contract un-
less the Secretary finds that the failure of 
the entity to maintain inventory of, or 
ready access to, the product is the result of 
the discontinuation of the product by the 
product manufacturer, a market-wide short-
age of the product, or the introduction of a
315 
newer model or version of the product in the 
market involved.’’. 
(b) CODIFYING
AND
EXPANDING
ANTI-SWITCHING 
RULE.—Section 1847(b) of the Social Security Act (42 
U.S.C. 1395w–3(b)), as amended by subsection (a)(1), is 
further amended— 
(1) by redesignating paragraph (11) as para-
graph (12); and 
(2) by inserting after paragraph (10) the fol-
lowing new paragraph: 
‘‘(11) ADDITIONAL SPECIAL RULES IN CASE OF 
COMPETITION FOR DIABETIC TESTING STRIPS.— 
‘‘(A) IN GENERAL.—With respect to an enti-
ty that is furnishing diabetic testing strip prod-
ucts to individuals under a contract entered into 
under the competitive acquisition program estab-
lished under this section, the entity shall furnish 
to each individual a brand of such products that 
is compatible with the home blood glucose mon-
itor selected by the individual. 
‘‘(B) PROHIBITION
ON
INFLUENCING
AND 
INCENTIVIZING.—An entity described in sub-
paragraph (A) may not attempt to influence or 
incentivize an individual to switch the brand of
316 
glucose monitor or diabetic testing strip product 
selected by the individual, including by— 
‘‘(i) persuading, pressuring, or advis-
ing the individual to switch; or 
‘‘(ii) furnishing information about al-
ternative brands to the individual where the 
individual has not requested such informa-
tion. 
‘‘(C) PROVISION OF INFORMATION.— 
‘‘(i) STANDARDIZED
INFORMATION.— 
Not later than January 1, 2019, the Sec-
retary shall develop and make available to 
entities described in subparagraph (A) 
standardized information that describes the 
rights of an individual with respect to such 
an entity. The information described in the 
preceding sentence shall include information 
regarding— 
‘‘(I) the requirements established 
under subparagraphs (A) and (B); 
‘‘(II) the right of the individual to 
purchase diabetic testing strip products 
from another mail order supplier of 
such products or a retail pharmacy if 
the entity is not able to furnish the
317 
brand of such product that is compat-
ible with the home blood glucose mon-
itor selected by the individual; and 
‘‘(III) the right of the individual 
to return diabetic testing strip prod-
ucts furnished to the individual by the 
entity. 
‘‘(ii) REQUIREMENT.—With respect to 
diabetic testing strip products furnished on 
or after the date on which the Secretary de-
velops the standardized information under 
clause (i), an entity described in subpara-
graph (A) may not communicate directly to 
an individual until the entity has verbally 
provided the individual with such standard-
ized information. 
‘‘(D) ORDER REFILLS.—With respect to di-
abetic testing strip products furnished on or 
after January 1, 2019, the Secretary shall re-
quire an entity furnishing diabetic testing strip 
products to an individual to contact and receive 
a request from the individual for such products 
not more than 14 days prior to dispensing a re-
fill of such products to the individual.’’.
318 
(c) IMPLEMENTATION; NON-APPLICATION OF THE PA-
PERWORK REDUCTION ACT.— 
(1) 
IMPLEMENTATION.—Notwithstanding 
any 
other provision of law, the Secretary of Health and 
Human Services may implement the provisions of, 
and amendments made by, this section by program 
instruction or otherwise. 
(2) NON-APPLICATION OF THE PAPERWORK RE-
DUCTION ACT.—Chapter 35 of title 44, United States 
Code (commonly referred to as the ‘‘Paperwork Re-
duction Act of 1995’’), shall not apply to this section 
or the amendments made by this section. 
TITLE V—OTHER HEALTH 
EXTENDERS 
SEC. 2501. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
THE NATIONAL HEALTH SERVICE CORPS, AND 
TEACHING HEALTH CENTERS THAT OPERATE 
GME PROGRAMS. 
(a) COMMUNITY HEALTH CENTERS FUNDING.—Sec-
tion 10503(b)(1) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(1)), as amended by section 
3101 of Public Law 115–96, is amended by amending sub-
paragraph (F) to read as follows: 
‘‘(F) $3,600,000,000 for each of fiscal years 
2018 and 2019.’’.
319 
(b) OTHER COMMUNITY HEALTH CENTERS PROVI-
SIONS.—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 subpara-
graphs (B) through (D); 
(B) by striking ‘‘(1) IN GENERAL’’ and all 
that follows through ‘‘The Secretary’’ and insert-
ing the following: 
‘‘(1) CENTERS.—The Secretary’’; and 
(C) in paragraph (1), as amended, by redes-
ignating clauses (i) through (v) as subpara-
graphs (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 cen-
ters funded under this section to implement evidence-
320 
based models for increasing access to high-quality pri-
mary care services, which may include models related 
to— 
‘‘(A) improving the delivery of care for in-
dividuals 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 ca-
pacity building models; 
‘‘(F) care integration, including integration 
of behavioral health, mental health, or substance 
use disorder services; and 
‘‘(G) addressing emerging public health or 
substance use disorder issues to meet the health 
needs of the population served by the health cen-
ter. 
‘‘(2) SUSTAINABILITY.—In making supplemental 
awards under this subsection, the Secretary may con-
sider whether the health center involved has submitted 
a plan for continuing the activities funded under this 
subsection after supplemental funding is expended. 
‘‘(3) SPECIAL
CONSIDERATION.—The Secretary 
may give special consideration to applications for
321 
supplemental funding under this subsection that seek 
to address significant barriers to access to care in 
areas with a greater shortage of health care providers 
and health services relative to the national average.’’; 
(5) in subsection (e)(1)— 
(A) in subparagraph (B)— 
(i) by striking ‘‘2 years’’ and inserting 
‘‘1 year’’; and 
(ii) by adding at the end the following: 
‘‘The Secretary shall not make a grant 
under this paragraph unless the applicant 
provides assurances to the Secretary that 
within 120 days of receiving grant funding 
for the operation of the health center, the 
applicant will submit, for approval by the 
Secretary, an implementation plan to meet 
the requirements of subsection (k)(3). The 
Secretary may extend such 120-day period 
for achieving compliance upon a demonstra-
tion of good cause by the health center.’’; 
and 
(B) in subparagraph (C)— 
(i) in the subparagraph heading, by 
striking ‘‘AND PLANS’’;
322 
(ii) by striking ‘‘or plan (as described 
in subparagraphs (B) and (C) of subsection 
(c)(1))’’; 
(iii) by striking ‘‘or plan, including 
the purchase’’ and inserting the following: 
‘‘including— 
‘‘(i) the purchase’’; 
(iv) by inserting ‘‘, which may include 
data and information systems’’ after ‘‘of 
equipment’’; 
(v) by striking the period at the end 
and inserting a semicolon; and 
(vi) by adding at the end the following: 
‘‘(ii) the provision of training and 
technical assistance; and 
‘‘(iii) other activities that— 
‘‘(I) reduce costs associated with 
the provision of health services; 
‘‘(II) improve access to, and 
availability of, health services provided 
to individuals served by the centers; 
‘‘(III) enhance the quality and co-
ordination of health services; or 
‘‘(IV) improve the health status of 
communities.’’;
323 
(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 SERV-
ICES.— 
‘‘(A) APPROVAL OF NEW ACCESS POINTS.— 
‘‘(i) IN GENERAL.—The Secretary may 
approve applications for grants under sub-
paragraph (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
APPLICA-
TIONS.—In carrying out clause (i), the Sec-
324 
retary 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 serv-
ices provided by the applicants involved to 
the medically underserved populations in 
urban areas which may be expected to use 
the services provided by the applicants is 
not less than two to three or greater than 
three to two. 
‘‘(iv) SERVICE AREA OVERLAP.—If in 
carrying out clause (i) the applicant pro-
poses to serve an area that is currently 
served by another health center funded 
under this section, the Secretary may con-
sider whether the award of funding to an 
additional health center in the area can be 
justified based on the unmet need for addi-
tional services within the catchment area. 
‘‘(B) APPROVAL OF EXPANDED SERVICE AP-
PLICATIONS.— 
‘‘(i) IN GENERAL.—The Secretary may 
approve applications for grants under sub-
paragraph (A) or (B) of paragraph (1) to 
expand the capacity of the applicant to pro-
325 
vide required primary health services de-
scribed in subsection (b)(1) or additional 
health services described in subsection 
(b)(2). 
‘‘(ii) 
PRIORITY
EXPANSION 
PROJECTS.—In carrying out clause (i), the 
Secretary may give special consideration to 
expanded service applications that seek to 
address emerging public health or behav-
ioral health, mental health, or substance 
abuse issues through increasing the avail-
ability of additional health services de-
scribed in subsection (b)(2) in an area in 
which there are significant barriers to ac-
cessing care. 
‘‘(iii) CONSIDERATION
OF
APPLICA-
TIONS.—In carrying out clause (i), the Sec-
retary 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 serv-
ices provided by the applicants involved to 
the medically underserved populations in 
urban areas which may be expected to use 
the services provided by such applicants is
326 
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 home-
lessness, homeless veterans, and veterans at risk 
of homelessness’’; and 
(B) in paragraph (5)— 
(i) by striking subparagraph (B); 
(ii) by redesignating subparagraph (C) 
as subparagraph (B); and 
(iii) in subparagraph (B) (as so redes-
ignated)— 
(I) in the subparagraph heading, 
by striking ‘‘ABUSE’’ and inserting 
‘‘USE DISORDER’’; and 
(II) by striking ‘‘abuse’’ and in-
serting ‘‘use disorder’’; 
(9) in subsection (k)— 
(A) in paragraph (2)— 
(i) in the paragraph heading, by in-
serting ‘‘UNMET’’ before ‘‘NEED’’;
327 
(ii) in the matter preceding subpara-
graph (A), by inserting ‘‘or subsection 
(e)(6)’’ after ‘‘subsection (e)(1)’’; 
(iii) in subparagraph (A), by inserting 
‘‘unmet’’ before ‘‘need for health services’’; 
(iv) in subparagraph (B), by striking 
‘‘and’’ at the end; 
(v) in subparagraph (C), by striking 
the period at the end and inserting ‘‘; and’’; 
and 
(vi) by adding after subparagraph (C) 
the following: 
‘‘(D) in the case of an application for a 
grant pursuant to subsection (e)(6), a dem-
onstration that the applicant has consulted with 
appropriate State and local government agen-
cies, 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 subpara-
graph (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
328 
inserting ‘‘, including other health care pro-
viders 
that 
provide 
care 
within 
the 
catchment area, local hospitals, and spe-
cialty providers in the catchment area of 
the center, to provide access to services not 
available through the health center and to 
reduce the non-urgent use of hospital emer-
gency departments’’; 
(iii) in subparagraph (H)(ii), by in-
serting ‘‘who shall be directly employed by 
the center’’ after ‘‘approves the selection of 
a director for the center’’; 
(iv) in subparagraph (L), by striking 
‘‘and’’ at the end; 
(v) in subparagraph (M), by striking 
the period and inserting ‘‘; and’’; and 
(vi) by inserting after subparagraph 
(M), the following: 
‘‘(N) the center has written policies and 
procedures in place to ensure the appropriate use 
of Federal funds in compliance with applicable 
Federal statutes, regulations, and the terms and 
conditions of the Federal award.’’; and 
(C) by striking paragraph (4);
329 
(10) in subsection (l), by adding at the end the 
following: ‘‘Funds expended to carry out activities 
under this subsection and operational support activi-
ties under subsection (m) shall not exceed 3 percent 
of the amount appropriated for this section for the fis-
cal 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 fol-
lowing: ‘‘Committee on Health, Education, 
Labor, and Pensions of the Senate, and the Com-
mittee on Energy and Commerce of the House of 
Representatives, a report including, at a min-
imum— 
‘‘(A) the distribution of funds for carrying 
out this section’’;
330 
(B) by striking ‘‘populations. Such report 
shall include an assessment’’ and inserting the 
following: ‘‘populations; 
‘‘(B) an assessment’’; 
(C) by striking ‘‘and the rationale for any 
substantial changes in the distribution of funds.’’ 
and inserting a semicolon; and 
(D) by adding at the end the following: 
‘‘(C) the distribution of awards and funding 
for new or expanded services in each of rural 
areas and urban areas; 
‘‘(D) the distribution of awards and fund-
ing for establishing new access points, and the 
number of new access points created; 
‘‘(E) the amount of unexpended funding for 
loan guarantees and loan guarantee authority 
under title XVI; 
‘‘(F) the rationale for any substantial 
changes in the distribution of funds; 
‘‘(G) the rate of closures for health centers 
and access points; 
‘‘(H) the number and reason for any grants 
awarded pursuant to subsection (e)(1)(B); and 
‘‘(I) the number and reason for any waivers 
provided pursuant to subsection (q)(4).’’;
331 
(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 ad-
dition to any amounts made available pursuant to 
paragraph (1) of this subsection, section 402A of this 
Act, or section 10503 of the Patient Protection and 
Affordable Care Act, there is authorized to be 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 Ini-
tiative under section 498E of this Act.’’; and 
(14) by striking subsection (s). 
(c) NATIONAL HEALTH SERVICE CORPS.—Section 
10503(b)(2) of the Patient Protection and Affordable Care 
Act (42 U.S.C. 254b–2(b)(2)), as amended by section 3101 
of Public Law 115–96, is amended by amending subpara-
graph (F) to read as follows: 
‘‘(F) $310,000,000 for each of fiscal years 
2018 and 2019.’’. 
(d) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.—
332 
(1) PAYMENTS.—Subsection (a) of section 340H 
of the Public Health Service Act (42 U.S.C. 256h) is 
amended to read as follows: 
‘‘(a) PAYMENTS.— 
‘‘(1) IN GENERAL.—Subject to subsection (h)(2), 
the Secretary shall make payments under this section 
for direct expenses and indirect expenses to qualified 
teaching health centers that are listed as sponsoring 
institutions by the relevant accrediting body for, as 
appropriate— 
‘‘(A) maintenance of filled positions at ex-
isting approved graduate medical residency 
training programs; 
‘‘(B) expansion of existing approved grad-
uate medical residency training programs; and 
‘‘(C) establishment of new approved grad-
uate medical residency training programs. 
‘‘(2) PER RESIDENT AMOUNT.—In making pay-
ments under paragraph (1), the Secretary shall con-
sider the cost of training residents at teaching health 
centers and the implications of the per resident 
amount on approved graduate medical residency 
training programs at teaching health centers.
333 
‘‘(3) PRIORITY.—In making payments under 
paragraph (1)(C), the Secretary shall give priority to 
qualified teaching health centers that— 
‘‘(A) serve a health professional shortage 
area with a designation in effect under section 
332 or a medically underserved community (as 
defined in section 799B); or 
‘‘(B) are located in a rural area (as defined 
in section 1886(d)(2)(D) of the Social Security 
Act).’’. 
(2) 
FUNDING.—Paragraph 
(1) 
of 
section 
340H(g) of the Public Health Service Act (42 U.S.C. 
256h(g)), as amended by section 3101 of Public Law 
115–96, is amended by striking ‘‘and $30,000,000 for 
the period of the first and second quarters of fiscal 
year 2018’’ and inserting ‘‘and $126,500,000 for each 
of fiscal years 2018 and 2019’’. 
(3) ANNUAL REPORTING.—Subsection (h)(1) of 
section 340H of the Public Health Service Act (42 
U.S.C. 256h) is amended— 
(A) by redesignating subparagraph (D) as 
subparagraph (H); and 
(B) by inserting after subparagraph (C) the 
following:
334 
‘‘(D) The number of patients treated by 
residents described in paragraph (4). 
‘‘(E) The number of visits by patients treat-
ed by residents described in paragraph (4). 
‘‘(F) Of the number of residents described in 
paragraph (4) who completed their residency 
training at the end of such residency academic 
year, the number and percentage of such resi-
dents entering primary care practice (meaning 
any of the areas of practice listed in the defini-
tion of a primary care residency program in sec-
tion 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 resi-
dents who entered practice at a health care facil-
ity— 
‘‘(i) primarily serving a health profes-
sional shortage area with a designation in 
effect under section 332 or a medically un-
derserved community (as defined in section 
799B); or
335 
‘‘(ii) located in a rural area (as de-
fined 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 indi-
rect expenses associated with the additional costs of 
teaching residents, of qualified teaching health centers 
(as such terms are used or defined in section 340H 
of the Public Health Service Act (42 U.S.C. 256h)). 
(5) DEFINITION.—Subsection (j) of section 340H 
of the Public Health Service Act (42 U.S.C. 256h) is 
amended— 
(A) by redesignating paragraphs (2) and 
(3) as paragraphs (3) and (4), respectively; and 
(B) by inserting after paragraph (1) the fol-
lowing: 
‘‘(2) NEW APPROVED GRADUATE MEDICAL RESI-
DENCY TRAINING PROGRAM.—The term ‘new approved 
graduate medical residency training program’ means 
an approved graduate medical residency training 
program for which the sponsoring qualified teaching 
health center has not received a payment under this
336 
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 strik-
ing ‘‘hospital’’ each place it appears and inserting 
‘‘teaching health center’’. 
(7) PAYMENTS FOR PREVIOUS FISCAL YEARS.— 
The provisions of section 340H of the Public Health 
Service Act (42 U.S.C. 256h), as in effect on the day 
before the date of enactment of Public Law 115–96, 
shall continue to apply with respect to payments 
under such section for fiscal years before fiscal year 
2018. 
(e) APPLICATION.—Amounts appropriated pursuant to 
this section for fiscal year 2018 or 2019 are subject to the 
requirements contained in Public Law 115–31 for funds for 
programs authorized under sections 330 through 340 of the 
Public Health Service Act (42 U.S.C. 254b–256). 
(f) CONFORMING AMENDMENT.—Paragraph (4) of sec-
tion 3014(h) of title 18, United States Code, as amended 
by section 3101 of Public Law 115–96, is amended by strik-
ing ‘‘and section 3101(d) of the CHIP and Public Health 
Funding Extension Act’’ and inserting ‘‘and section 
2501(e) of the SUSTAIN Care Act of 2018’’.
337 
SEC. 2502. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 
(a) SPECIAL DIABETES PROGRAM FOR TYPE I DIABE-
TES.—Subparagraph (D) of section 330B(b)(2) of the Pub-
lic Health Service Act (42 U.S.C. 254c–2(b)(2)), as amend-
ed 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 ex-
pended.’’. 
(b) SPECIAL DIABETES PROGRAM FOR INDIANS.—Sub-
paragraph (D) of section 330C(c)(2) of the Public Health 
Service Act (42 U.S.C. 254c–3(c)(2)), as amended by sec-
tion 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 ex-
pended.’’. 
SEC. 2503. EXTENSION FOR FAMILY-TO-FAMILY HEALTH IN-
FORMATION CENTERS. 
Section 501(c) of the Social Security Act (42 U.S.C. 
701(c)) is amended— 
(1) in paragraph (1)(A)— 
(A) in clause (v), by striking ‘‘and’’ at the 
end; 
(B) in clause (vi), by striking the period at 
the end and inserting ‘‘; and’’; and
338 
(C) by adding at the end the following new 
clause: 
‘‘(vii) $6,000,000 for each of fiscal years 2018 
and 2019.’’; 
(2) in paragraph (3)(C), by inserting before the 
period the following: ‘‘, and with respect to fiscal 
years 2018 and 2019, such centers shall also be devel-
oped in all territories and at least one such center 
shall be developed for Indian Tribes’’; and 
(3) by amending paragraph (5) to read as fol-
lows: 
‘‘(5) For purposes of this subsection— 
‘‘(A) the term ‘Indian Tribe’ has the meaning 
given to the term ‘Indian tribe’ in section 4 of the In-
dian Health Care Improvement Act (25 U.S.C. 1603); 
‘‘(B) the term ‘State’ means each of the 50 States 
and the District of Columbia; and 
‘‘(C) the term ‘territory’ means Puerto Rico, 
Guam, American Samoa, the United States Virgin Is-
lands, and the Northern Mariana Islands.’’. 
SEC. 2504. EXTENSION FOR SEXUAL RISK AVOIDANCE EDU-
CATION. 
(a) IN GENERAL.—Section 510 of the Social Security 
Act (42 U.S.C. 710) is amended to read as follows:
339 
‘‘SEC. 510. SEXUAL RISK AVOIDANCE EDUCATION. 
‘‘(a) IN GENERAL.— 
‘‘(1) ALLOTMENTS TO STATES.—For the purpose 
described in subsection (b), the Secretary shall, for 
each of fiscal years 2018 and 2019, allot to each State 
which has transmitted an application for the fiscal 
year under section 505(a) an amount equal to the 
product of— 
‘‘(A) the amount appropriated pursuant to 
subsection (e)(1) for the fiscal year, minus the 
amount reserved under subsection (e)(2) for the 
fiscal year; and 
‘‘(B) the proportion that the number of low- 
income children in the State bears to the total of 
such numbers of children for all the States. 
‘‘(2) OTHER ALLOTMENTS.— 
‘‘(A) OTHER
ENTITIES.—For the purpose 
described in subsection (b), the Secretary shall, 
for each of fiscal years 2018 and 2019, for any 
State which has not transmitted an application 
for the fiscal year under section 505(a), allot to 
one or more entities in the State the amount that 
would have been allotted to the State under 
paragraph (1) if the State had submitted such 
an application.
340 
‘‘(B) PROCESS.—The Secretary shall select 
the recipients of allotments under subparagraph 
(A) by means of a competitive grant process 
under which— 
‘‘(i) not later than 30 days after the 
deadline for the State involved to submit an 
application for the fiscal year under section 
505(a), the Secretary publishes a notice so-
liciting grant applications; and 
‘‘(ii) not later than 120 days after such 
deadline, all such applications must be sub-
mitted. 
‘‘(b) PURPOSE.— 
‘‘(1) IN GENERAL.—Except for research under 
paragraph (5) and information collection and report-
ing under paragraph (6), the purpose of an allotment 
under subsection (a) to a State (or to another entity 
in the State pursuant to subsection (a)(2)) is to en-
able the State or other entity to implement education 
exclusively on sexual risk avoidance (meaning volun-
tarily refraining from sexual activity). 
‘‘(2) REQUIRED
COMPONENTS.—Education on 
sexual risk avoidance pursuant to an allotment under 
this section shall—
341 
‘‘(A) ensure that the unambiguous and pri-
mary emphasis and context for each topic de-
scribed in paragraph (3) is a message to youth 
that normalizes the optimal health behavior of 
avoiding nonmarital sexual activity; 
‘‘(B) be medically accurate and complete; 
‘‘(C) be age-appropriate; 
‘‘(D) be based on adolescent learning and 
developmental theories for the age group receiv-
ing the education; and 
‘‘(E) be culturally appropriate, recognizing 
the experiences of youth from diverse commu-
nities, backgrounds, and experiences. 
‘‘(3) TOPICS.—Education on sexual risk avoid-
ance pursuant to an allotment under this section 
shall address each of the following topics: 
‘‘(A) The holistic individual and societal 
benefits associated with personal responsibility, 
self-regulation, goal setting, healthy decision-
making, and a focus on the future. 
‘‘(B) The advantage of refraining from non-
marital sexual activity in order to improve the 
future prospects and physical and emotional 
health of youth.
342 
‘‘(C) The increased likelihood of avoiding 
poverty when youth attain self-sufficiency and 
emotional maturity before engaging in sexual ac-
tivity. 
‘‘(D) 
The 
foundational 
components 
of 
healthy relationships and their impact on the 
formation of healthy marriages and safe and sta-
ble families. 
‘‘(E) How other youth risk behaviors, such 
as drug and alcohol usage, increase the risk for 
teen sex. 
‘‘(F) How to resist and avoid, and receive 
help regarding, sexual coercion and dating vio-
lence, recognizing that even with consent teen sex 
remains a youth risk behavior. 
‘‘(4) CONTRACEPTION.—Education on sexual risk 
avoidance pursuant to an allotment under this section 
shall ensure that— 
‘‘(A) any information provided on contra-
ception is medically accurate and complete and 
ensures that students understand that contracep-
tion offers physical risk reduction, but not risk 
elimination; and
343 
‘‘(B) the education does not include dem-
onstrations, simulations, or distribution of con-
traceptive devices. 
‘‘(5) RESEARCH.— 
‘‘(A) IN GENERAL.—A State or other entity 
receiving an allotment pursuant to subsection (a) 
may use up to 20 percent of such allotment to 
build the evidence base for sexual risk avoidance 
education by conducting or supporting research. 
‘‘(B) REQUIREMENTS.—Any research con-
ducted or supported pursuant to subparagraph 
(A) shall be— 
‘‘(i) rigorous; 
‘‘(ii) evidence-based; and 
‘‘(iii) designed and conducted by inde-
pendent researchers who have experience in 
conducting and publishing research in peer- 
reviewed outlets. 
‘‘(6) INFORMATION
COLLECTION
AND
REPORT-
ING.—A State or other entity receiving an allotment 
pursuant to subsection (a) shall, as specified by the 
Secretary— 
‘‘(A) collect information on the programs 
and activities funded through the allotment; and
344 
‘‘(B) submit reports to the Secretary on the 
data from such programs and activities. 
‘‘(c) NATIONAL EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary shall— 
‘‘(A) in consultation with appropriate State 
and local agencies, conduct one or more rigorous 
evaluations of the education funded through this 
section and associated data; and 
‘‘(B) submit a report to the Congress on the 
results of such evaluations, together with a sum-
mary of the information collected pursuant to 
subsection (b)(6). 
‘‘(2) CONSULTATION.—In conducting the evalua-
tions required by paragraph (1), including the estab-
lishment of rigorous evaluation methodologies, the 
Secretary shall consult with relevant stakeholders and 
evaluation experts. 
‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.— 
‘‘(1) Sections 503, 507, and 508 apply to allot-
ments under subsection (a) to the same extent and in 
the same manner as such sections apply to allotments 
under section 502(c). 
‘‘(2) Sections 505 and 506 apply to allotments 
under subsection (a) to the extent determined by the 
Secretary to be appropriate.
345 
‘‘(e) DEFINITIONS.—In this section: 
‘‘(1) The term ‘age-appropriate’ means suitable 
(in terms of topics, messages, and teaching methods) 
to the developmental and social maturity of the par-
ticular age or age group of children or adolescents, 
based on developing cognitive, emotional, and behav-
ioral capacity typical for the age or age group. 
‘‘(2) The term ‘medically accurate and complete’ 
means verified or supported by the weight of research 
conducted in compliance with accepted scientific 
methods and— 
‘‘(A) published in peer-reviewed journals, 
where applicable; or 
‘‘(B) comprising information that leading 
professional organizations and agencies with rel-
evant expertise in the field recognize as accurate, 
objective, and complete. 
‘‘(3) The term ‘rigorous’, with respect to research 
or evaluation, means using— 
‘‘(A) established scientific methods for meas-
uring the impact of an intervention or program 
model in changing behavior (specifically sexual 
activity or other sexual risk behaviors), or reduc-
ing pregnancy, among youth; or
346 
‘‘(B) other evidence-based methodologies es-
tablished by the Secretary for purposes of this 
section. 
‘‘(4) The term ‘youth’ refers to one or more indi-
viduals who have attained age 10 but not age 20. 
‘‘(f) FUNDING.— 
‘‘(1) IN GENERAL.—To carry out this section, 
there is appropriated, out of any money in the Treas-
ury not otherwise appropriated, $75,000,000 for each 
of fiscal years 2018 and 2019. 
‘‘(2) RESERVATION.—The Secretary shall reserve, 
for each of fiscal years 2018 and 2019, not more than 
20 percent of the amount appropriated pursuant to 
paragraph (1) for administering the program under 
this section, including the conducting of national 
evaluations and the provision of technical assistance 
to the recipients of allotments.’’. 
(b) EFFECTIVE DATE.—The amendment made by this 
section takes effect on October 1, 2017. 
SEC. 2505. EXTENSION FOR PERSONAL RESPONSIBILITY 
EDUCATION. 
(a) IN GENERAL.—Section 513 of the Social Security 
Act (42 U.S.C. 713) is amended— 
(1) in subsection (a)(1)(A), by striking ‘‘2017’’ 
and inserting ‘‘2019’’; and
347 
(2) in subsection (a)(4)— 
(A) in subparagraph (A), by striking 
‘‘2017’’ each place it appears and inserting 
‘‘2019’’; and 
(B) in subparagraph (B)— 
(i) in the subparagraph heading, by 
striking ‘‘3-YEAR
GRANTS’’ and inserting 
‘‘COMPETITIVE PREP GRANTS’’; and 
(ii) in clause (i), by striking ‘‘solicit 
applications to award 3-year grants in each 
of fiscal years 2012 through 2017’’ and in-
serting ‘‘continue through fiscal year 2019 
grants awarded for any of fiscal years 2015 
through 2017’’; 
(3) in subsection (c)(1), by inserting after ‘‘youth 
with HIV/AIDS,’’ the following: ‘‘victims of human 
trafficking,’’; and 
(4) in subsection (f), by striking ‘‘2017’’ and in-
serting ‘‘2019’’. 
(b) EFFECTIVE DATE.—The amendments made by this 
section take effect on October 1, 2017.
348 
TITLE VI—CHILD AND FAMILY 
SERVICES AND SUPPORT 
Subtitle A—Family First Prevention 
Services Act 
SEC. 2601. SHORT TITLE. 
This subtitle may be cited as the ‘‘Family First Pre-
vention Services Act’’. 
CHAPTER 1—INVESTING IN PREVENTION 
AND FAMILY SERVICES 
SEC. 2611. PURPOSE. 
The purpose of this chapter is to enable States to use 
Federal funds available under parts B and E of title IV 
of the Social Security Act to provide enhanced support to 
children and families and prevent foster care placements 
through the provision of mental health and substance abuse 
prevention and treatment services, in-home parent skill- 
based programs, and kinship navigator services. 
Subchapter A—Prevention Activities Under 
Title IV–E 
SEC. 2621. FOSTER CARE PREVENTION SERVICES AND PRO-
GRAMS. 
(a) STATE OPTION.—Section 471 of the Social Secu-
rity Act (42 U.S.C. 671) is amended— 
(1) in subsection (a)(1), by striking ‘‘and’’ and 
all that follows through the semicolon and inserting ‘‘,
349 
adoption assistance in accordance with section 473, 
and, at the option of the State, services or programs 
specified in subsection (e)(1) of this section for chil-
dren who are candidates for foster care or who are 
pregnant or parenting foster youth and the parents or 
kin caregivers of the children, in accordance with the 
requirements of that subsection;’’; and 
(2) by adding at the end the following: 
‘‘(e) PREVENTION AND FAMILY SERVICES AND PRO-
GRAMS.— 
‘‘(1) IN
GENERAL.—Subject to the succeeding 
provisions of this subsection, the Secretary may make 
a payment to a State for providing the following serv-
ices or programs for a child described in paragraph 
(2) and the parents or kin caregivers of the child 
when the need of the child, such a parent, or such a 
caregiver for the services or programs are directly re-
lated to the safety, permanence, or well-being of the 
child or to preventing the child from entering foster 
care: 
‘‘(A) MENTAL
HEALTH
AND
SUBSTANCE 
ABUSE
PREVENTION
AND
TREATMENT
SERV-
ICES.—Mental health and substance abuse pre-
vention and treatment services provided by a 
qualified clinician for not more than a 12-month
350 
period that begins on any date described in 
paragraph (3) with respect to the child. 
‘‘(B) IN-HOME PARENT SKILL-BASED PRO-
GRAMS.—In-home parent skill-based programs 
for not more than a 12-month period that begins 
on any date described in paragraph (3) with re-
spect to the child and that include parenting 
skills training, parent education, and individual 
and family counseling. 
‘‘(2) CHILD DESCRIBED.—For purposes of para-
graph (1), a child described in this paragraph is the 
following: 
‘‘(A) A child who is a candidate for foster 
care (as defined in section 475(13)) but can re-
main safely at home or in a kinship placement 
with receipt of services or programs specified in 
paragraph (1). 
‘‘(B) A child in foster care who is a preg-
nant or parenting foster youth. 
‘‘(3) DATE DESCRIBED.—For purposes of para-
graph (1), the dates described in this paragraph are 
the following: 
‘‘(A) The date on which a child is identified 
in a prevention plan maintained under para-
351 
graph (4) as a child who is a candidate for foster 
care (as defined in section 475(13)). 
‘‘(B) The date on which a child is identified 
in a prevention plan maintained under para-
graph (4) as a pregnant or parenting foster 
youth in need of services or programs specified 
in paragraph (1). 
‘‘(4) REQUIREMENTS
RELATED
TO
PROVIDING 
SERVICES AND PROGRAMS.—Services and programs 
specified in paragraph (1) may be provided under 
this subsection only if specified in advance in the 
child’s prevention plan described in subparagraph (A) 
and the requirements in subparagraphs (B) through 
(E) are met: 
‘‘(A) PREVENTION PLAN.—The State main-
tains a written prevention plan for the child that 
meets the following requirements (as applicable): 
‘‘(i) CANDIDATES.—In the case of a 
child who is a candidate for foster care de-
scribed in paragraph (2)(A), the prevention 
plan shall— 
‘‘(I) identify the foster care pre-
vention strategy for the child so that 
the child may remain safely at home, 
live temporarily with a kin caregiver
352 
until 
reunification 
can 
be 
safely 
achieved, or live permanently with a 
kin caregiver; 
‘‘(II) list the services or programs 
to be provided to or on behalf of the 
child to ensure the success of that pre-
vention strategy; and 
‘‘(III) comply with such other re-
quirements as the Secretary shall es-
tablish. 
‘‘(ii) PREGNANT OR PARENTING FOS-
TER YOUTH.—In the case of a child who is 
a pregnant or parenting foster youth de-
scribed in paragraph (2)(B), the prevention 
plan shall— 
‘‘(I) be included in the child’s case 
plan required under section 475(1); 
‘‘(II) list the services or programs 
to be provided to or on behalf of the 
youth to ensure that the youth is pre-
pared (in the case of a pregnant foster 
youth) or able (in the case of a par-
enting foster youth) to be a parent;
353 
‘‘(III) describe the foster care pre-
vention strategy for any child born to 
the youth; and 
‘‘(IV) comply with such other re-
quirements as the Secretary shall es-
tablish. 
‘‘(B) TRAUMA-INFORMED.—The services or 
programs to be provided to or on behalf of a 
child are provided under an organizational 
structure and treatment framework that involves 
understanding, recognizing, and responding to 
the effects of all types of trauma and in accord-
ance with recognized principles of a trauma-in-
formed approach and trauma-specific interven-
tions to address trauma’s consequences and fa-
cilitate healing. 
‘‘(C) ONLY SERVICES AND PROGRAMS PRO-
VIDED IN ACCORDANCE WITH PROMISING, SUP-
PORTED, OR WELL-SUPPORTED PRACTICES PER-
MITTED.— 
‘‘(i) IN GENERAL.—Only State expend-
itures for services or programs specified in 
subparagraph (A) or (B) of paragraph (1) 
that are provided in accordance with prac-
tices that meet the requirements specified in
354 
clause (ii) of this subparagraph and that 
meet the requirements specified in clause 
(iii), (iv), or (v), respectively, for being a 
promising, supported, or well-supported 
practice, shall be eligible for a Federal 
matching 
payment 
under 
section 
474(a)(6)(A). 
‘‘(ii) GENERAL
PRACTICE
REQUIRE-
MENTS.—The general practice requirements 
specified in this clause are the following: 
‘‘(I) The practice has a book, 
manual, or other available writings 
that specify the components of the 
practice protocol and describe how to 
administer the practice. 
‘‘(II) There is no empirical basis 
suggesting that, compared to its likely 
benefits, the practice constitutes a risk 
of harm to those receiving it. 
‘‘(III) If multiple outcome studies 
have been conducted, the overall weight 
of evidence supports the benefits of the 
practice. 
‘‘(IV) Outcome measures are reli-
able and valid, and are administrated
355 
consistently and accurately across all 
those receiving the practice. 
‘‘(V) There is no case data sug-
gesting a risk of harm that was prob-
ably caused by the treatment and that 
was severe or frequent. 
‘‘(iii) PROMISING PRACTICE.—A prac-
tice shall be considered to be a ‘promising 
practice’ if the practice is superior to an 
appropriate comparison practice using con-
ventional standards of statistical signifi-
cance (in terms of demonstrated meaningful 
improvements in validated measures of im-
portant child and parent outcomes, such as 
mental health, substance abuse, and child 
safety and well-being), as established by the 
results or outcomes of at least one study 
that— 
‘‘(I) was rated by an independent 
systematic review for the quality of the 
study design and execution and deter-
mined to be well-designed and well-exe-
cuted; and
356 
‘‘(II) utilized some form of control 
(such as an untreated group, a placebo 
group, or a wait list study). 
‘‘(iv) SUPPORTED PRACTICE.—A prac-
tice shall be considered to be a ‘supported 
practice’ if— 
‘‘(I) the practice is superior to an 
appropriate comparison practice using 
conventional standards of statistical 
significance (in terms of demonstrated 
meaningful improvements in validated 
measures of important child and par-
ent outcomes, such as mental health, 
substance abuse, and child safety and 
well-being), as established by the re-
sults or outcomes of at least one study 
that— 
‘‘(aa) was rated by an inde-
pendent systematic review for the 
quality of the study design and 
execution and determined to be 
well-designed and well-executed; 
‘‘(bb) was a rigorous ran-
dom-controlled trial (or, if not 
available, a study using a rig-
370 
ITURE REQUIREMENT.—A State that elects to provide 
services and programs specified in paragraph (1) 
shall not use any State foster care prevention expend-
itures for a fiscal year for the State share of expendi-
tures under section 474(a)(6) for a fiscal year. 
‘‘(9) ADMINISTRATIVE COSTS.—Expenditures de-
scribed in section 474(a)(6)(B)— 
‘‘(A) shall not be eligible for payment under 
subparagraph (A), (B), or (E) of section 
474(a)(3); and 
‘‘(B) shall be eligible for payment under sec-
tion 474(a)(6)(B) without regard to whether the 
expenditures are incurred on behalf of a child 
who is, or is potentially, eligible for foster care 
maintenance payments under this part. 
‘‘(10) APPLICATION.— 
‘‘(A) IN GENERAL.—The provision of serv-
ices or programs under this subsection to or on 
behalf of a child described in paragraph (2) shall 
not be considered to be receipt of aid or assist-
ance under the State plan under this part for 
purposes of eligibility for any other program es-
tablished under this Act. 
‘‘(B) CANDIDATES
IN
KINSHIP
CARE.—A 
child described in paragraph (2) for whom such