IIB 
115TH CONGRESS 
1ST SESSION H. R. 3922 
IN THE SENATE OF THE UNITED STATES 
NOVEMBER 6, 2017 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To extend funding for certain public health programs, and 
for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Continuing Community 
Health And Medical Professional Programs to Improve 
Our Nation, Increase National Gains, and Help Ensure 
Access for Little Ones, Toddlers, and Hopeful Youth by 
Keeping Insurance Delivery Stable Act of 2017’’ or the 
‘‘CHAMPIONING HEALTHY KIDS Act’’. 
SEC. 2. TABLE OF CONTENTS. 
The table of contents for this Act is as follows: 
Sec. 1. Short title. 
Sec. 2. Table of contents. 
DIVISION A—CHAMPION ACT 
Sec. 100. Short title. 
TITLE I—EXTENSION OF PUBLIC HEALTH PROGRAMS 
Sec. 101. Extension for community health centers, the National Health Service 
Corps, and teaching health centers that operate GME pro-
grams. 
Sec. 102. Extension for special diabetes programs. 
Sec. 103. Extension for family-to-family health information centers. 
Sec. 104. Youth empowerment program; personal responsibility education. 
TITLE II—OFFSETS 
Sec. 201. Providing for qualified health plan grace period requirements for 
issuer receipt of advance payments of cost-sharing reductions 
and premium tax credits that are more consistent with State 
law grace period requirements. 
Sec. 202. Prevention and Public Health Fund. 
DIVISION B—HEALTHY KIDS ACT 
Sec. 300. Short title. 
TITLE I—CHIP EXTENSION AND OTHER MEDICAID AND CHIP 
PROVISIONS 
Sec. 301. Five-year funding extension of the Children’s Health Insurance Pro-
gram. 
Sec. 302. Extension of certain programs and demonstration projects. 
Sec. 303. Extension of outreach and enrollment program. 
Sec. 304. Extension and reduction of additional Federal financial participation 
for CHIP. 
Sec. 305. Modifying reductions in Medicaid DSH allotments. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6211
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
Sec. 306. Puerto Rico and the Virgin Islands Medicaid payments. 
TITLE II—OFFSETS 
Sec. 401. Medicaid third party liability provisions. 
Sec. 402. Treatment of lottery winnings and other lump-sum income for pur-
poses of income eligibility under Medicaid. 
Sec. 403. Adjustments to Medicare part B and part D premium subsidies for 
higher income individuals. 
DIVISION A—CHAMPION ACT 
SEC. 100. SHORT TITLE. 
This division may be cited as the ‘‘Community Health 
And Medical Professionals Improve Our Nation Act of 
2017’’ or the ‘‘CHAMPION Act’’. 
TITLE I—EXTENSION OF PUBLIC 
HEALTH PROGRAMS 
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, 
THE NATIONAL HEALTH SERVICE CORPS, 
AND TEACHING HEALTH CENTERS THAT OP-
ERATE GME PROGRAMS. 
(a) COMMUNITY HEALTH CENTERS FUNDING.—Sec-
tion 10503(b)(1)(E) of the Patient Protection and Afford-
able Care Act (42 U.S.C. 254b–2(b)(1)(E)) is amended 
by striking ‘‘2017’’ and inserting ‘‘2019’’. 
(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’’; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 in-
serting the following: 
‘‘(1) CENTERS.—The Secretary’’; and 
(C) in paragraph (1), as amended, by re-
designating 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 evi-
dence-based models for increasing access to high- 
quality primary care services, which may include 
models related to— 
‘‘(A) improving the delivery of care for in-
dividuals with multiple chronic conditions; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(B) workforce configuration; 
‘‘(C) reducing the cost of care; 
‘‘(D) enhancing care coordination; 
‘‘(E) expanding the use of telehealth and 
technology-enabled collaborative learning and 
capacity building models; 
‘‘(F) care integration, including integration 
of behavioral health, mental health, or sub-
stance use disorder services; and 
‘‘(G) addressing emerging public health or 
substance use disorder issues to meet the health 
needs of the population served by the health 
center. 
‘‘(2) 
SUSTAINABILITY.—In 
making 
supple-
mental awards under this subsection, the Secretary 
may consider whether the health center involved has 
submitted a plan for continuing the activities funded 
under this subsection after supplemental funding is 
expended. 
‘‘(3) SPECIAL CONSIDERATION.—The Secretary 
may give special consideration to applications for 
supplemental funding under this subsection that 
seek to address significant barriers to access to care 
in areas with a greater shortage of health care pro-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
viders and health services relative to the national av-
erage.’’; 
(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 fol-
lowing: ‘‘The Secretary shall not make a 
grant under this paragraph unless the ap-
plicant provides assurances to the Sec-
retary that within 120 days of receiving 
grant funding for the operation of the 
health center, the applicant will submit, for 
approval by the Secretary, an implementa-
tion plan to meet the requirements of sub-
section (k)(3). The Secretary may extend 
such 120-day period for achieving compli-
ance upon a demonstration of good cause 
by the health center.’’; and 
(B) in subparagraph (C)— 
(i) in the subparagraph heading, by 
striking ‘‘AND PLANS’’; 
(ii) by striking ‘‘or plan (as described 
in subparagraphs (B) and (C) of sub-
section (c)(1))’’; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 fol-
lowing: 
‘‘(ii) the provision of training and 
technical assistance; and 
‘‘(iii) other activities that— 
‘‘(I) reduce costs associated with 
the provision of health services; 
‘‘(II) improve access to, and 
availability of, health services provided 
to individuals served by the centers; 
‘‘(III) enhance the quality and 
coordination of health services; or 
‘‘(IV) improve the health status 
of communities.’’; 
(6) in subsection (e)(5)(B)— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(A) in the heading of subparagraph (B), by 
striking ‘‘AND PLANS’’; and 
(B) by striking ‘‘and subparagraphs (B) 
and (C) of subsection (c)(1) to a health center 
or to a network or plan’’ and inserting ‘‘to a 
health center or to a network’’; 
(7) in subsection (e), by adding at the end the 
following: 
‘‘(6) NEW
ACCESS
POINTS
AND
EXPANDED 
SERVICES.— 
‘‘(A) 
APPROVAL
OF
NEW
ACCESS 
POINTS.— 
‘‘(i) IN
GENERAL.—The Secretary 
may approve applications for grants under 
subparagraph (A) or (B) of paragraph (1) 
to establish new delivery sites. 
‘‘(ii) SPECIAL
CONSIDERATION.—In 
carrying out clause (i), the Secretary may 
give special consideration to applicants 
that have demonstrated the new delivery 
site will be located within a sparsely popu-
lated area, or an area which has a level of 
unmet need that is higher relative to other 
applicants. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(iii) CONSIDERATION
OF
APPLICA-
TIONS.—In carrying out clause (i), the 
Secretary shall approve applications for 
grants in such a manner that the ratio of 
the medically underserved populations in 
rural areas which may be expected to use 
the services provided by the applicants in-
volved to the medically underserved popu-
lations in urban areas which may be ex-
pected 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 
APPLICATIONS.— 
‘‘(i) IN
GENERAL.—The Secretary 
may approve applications for grants under 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
subparagraph (A) or (B) of paragraph (1) 
to expand the capacity of the applicant to 
provide required primary health services 
described in subsection (b)(1) or additional 
health services described in subsection 
(b)(2). 
‘‘(ii) 
PRIORITY
EXPANSION 
PROJECTS.—In carrying out clause (i), the 
Secretary may give special consideration to 
expanded service applications that seek to 
address emerging public health or 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 
Secretary shall approve applications for 
grants in such a manner that the ratio of 
the medically underserved populations in 
rural areas which may be expected to use 
the services provided by the applicants in-
volved to the medically underserved popu-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 
fiscal year involved.’’; 
(11) in subsection (q)(4), by adding at the end 
the following: ‘‘A waiver provided by the Secretary 
under this paragraph may not remain in effect for 
more than 1 year and may not be extended after 
such period. An entity may not receive more than 
one waiver under this paragraph in consecutive 
years.’’; 
(12) in subsection (r)(3)— 
(A) by striking ‘‘appropriate committees of 
Congress a report concerning the distribution of 
funds under this section’’ and inserting the fol-
lowing: ‘‘Committee on Health, Education, 
Labor, and Pensions of the Senate, and the 
Committee on Energy and Commerce of the 
House of Representatives, a report including, at 
a minimum— 
‘‘(A) the distribution of funds for carrying 
out this section’’; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 fund-
ing 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 author-
ity 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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(I) the number and reason for any waiv-
ers provided pursuant to subsection (q)(4).’’; 
(13) in subsection (r), by adding at the end the 
following new paragraph: 
‘‘(5) FUNDING FOR PARTICIPATION OF HEALTH 
CENTERS IN ALL OF US RESEARCH PROGRAM.—In 
addition to any amounts made available pursuant to 
paragraph (1) of this subsection, section 402A of 
this Act, or section 10503 of the Patient Protection 
and Affordable Care Act, there is authorized to be 
appropriated, and there is appropriated, out of any 
monies in the Treasury not otherwise appropriated, 
to the Secretary $25,000,000 for fiscal year 2018 to 
support the participation of health centers in the All 
of Us Research Program under the Precision Medi-
cine Initiative under section 498E of this Act.’’; and 
(14) by striking subsection (s). 
(c) NATIONAL HEALTH SERVICE CORPS.—Section 
10503(b)(2)(E) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 254b–2(b)(2)(E)) is amended by 
striking ‘‘2017’’ and inserting ‘‘2019’’. 
(d) TEACHING HEALTH CENTERS THAT OPERATE 
GRADUATE MEDICAL EDUCATION PROGRAMS.— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 existing 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) PRIORITY.—In making payments pursuant 
to 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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(B) are located in a rural area (as de-
fined in section 1886(d)(2)(D) of the Social Se-
curity Act).’’. 
(2) FUNDING.—Subsection (g) of section 340H 
of the Public Health Service Act (42 U.S.C. 256h) 
is amended— 
(A) by striking ‘‘To carry out’’ and insert-
ing the following: 
‘‘(1) IN GENERAL.—To carry out’’; 
(B) by striking ‘‘and $15,000,000 for the 
first quarter of fiscal year 2018’’ and inserting 
‘‘and $126,500,000 for each of fiscal years 
2018 and 2019, to remain available until ex-
pended’’; and 
(C) by adding at the end the following: 
‘‘(2) 
ADMINISTRATIVE
EXPENSES.—Of 
the 
amount made available to carry out this section for 
any fiscal year, the Secretary may not use more 
than 5 percent of such amount for the expenses of 
administering this section.’’. 
(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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(B) by inserting after subparagraph (C) 
the following: 
‘‘(D) The number of patients treated by 
residents described in paragraph (4). 
‘‘(E) The number of visits by patients 
treated by residents described in paragraph (4). 
‘‘(F) Of the number of residents described 
in paragraph (4) who completed their residency 
training at the end of such residency academic 
year, the number and percentage of such 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 
section 749A). 
‘‘(G) Of the number of residents described 
in paragraph (4) who completed their residency 
training at the end of such residency academic 
year, the number and percentage of such resi-
dents who entered practice at a health care fa-
cility— 
‘‘(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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(ii) located in a rural area (as de-
fined in section 1886(d)(2)(D) of the So-
cial 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 re-
port on the direct graduate expenses of approved 
graduate medical residency training programs, and 
the indirect expenses associated with the additional 
costs of teaching residents, of qualified teaching 
health centers (as such terms are used or defined in 
section 340H of the Public Health Service Act (42 
U.S.C. 256h)). 
(5) DEFINITION.—Subsection (j) of section 
340H of the Public Health Service Act (42 U.S.C. 
256h) is amended— 
(A) by redesignating paragraphs (2) and 
(3) as paragraphs (3) and (4), respectively; and 
(B) by inserting after paragraph (1) the 
following: 
‘‘(2) NEW
APPROVED
GRADUATE
MEDICAL 
RESIDENCY
TRAINING
PROGRAM.—The term ‘new 
approved graduate medical residency training pro-
gram’ means an approved graduate medical resi-
dency training program for which the sponsoring 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
qualified teaching health center has not received a 
payment under this section for a previous fiscal year 
(other than pursuant to subsection (a)(1)(C)).’’. 
(6) TECHNICAL
CORRECTION.—Subsection (f) 
of section 340H (42 U.S.C. 256h) is amended by 
striking ‘‘hospital’’ each place it appears and insert-
ing ‘‘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 this Act, 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 AMENDMENTS.—Section 3014(h) of 
title 18, United States Code, is amended— 
(1) in paragraph (1), by striking ‘‘, as amended 
by section 221 of the Medicare Access and CHIP 
Reauthorization Act of 2015,’’; and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(2) in paragraph (4), by inserting ‘‘and section 
101(e) of the Community Health And Medical Pro-
fessionals Improve Our Nation Act of 2017’’ after 
‘‘section 221(c) of the Medicare Access and CHIP 
Reauthorization Act of 2015’’. 
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS. 
(a) SPECIAL DIABETES PROGRAM FOR TYPE I DIA-
BETES.—Section 330B(b)(2)(C) of the Public Health 
Service Act (42 U.S.C. 254c–2(b)(2)(C)) is amended by 
striking ‘‘2017’’ and inserting ‘‘2019’’. 
(b) SPECIAL DIABETES PROGRAM FOR INDIANS.— 
Subparagraph (D) of section 330C(c)(2) of the Public 
Health Service Act (42 U.S.C. 254c–3(c)(2)) is amended 
to read as follows: 
‘‘(D) $150,000,000 for each of fiscal years 
2018 and 2019.’’. 
SEC. 103. 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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(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 de-
veloped 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 such term in section 4 of the Indian Health 
Care Improvement Act (25 U.S.C. 1603); 
‘‘(B) the term ‘State’ means each of the 50 
States and the District of Columbia; and 
‘‘(C) the term ‘territory’ means Puerto Rico, 
Guam, American Samoa, the Virgin Islands, and the 
Northern Mariana Islands.’’. 
SEC. 104. YOUTH EMPOWERMENT PROGRAM; PERSONAL 
RESPONSIBILITY EDUCATION. 
(a) YOUTH EMPOWERMENT PROGRAM.— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(1) IN GENERAL.—Section 510 of the Social 
Security Act (42 U.S.C. 710) is amended to read as 
follows: 
‘‘SEC. 510. YOUTH EMPOWERMENT PROGRAM. 
‘‘(a) IN GENERAL.— 
‘‘(1) ALLOTMENTS TO STATES.—For the pur-
pose 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 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
one or more entities in the State the amount 
that would have been allotted to the State 
under paragraph (1) if the State had submitted 
such an application. 
‘‘(B) PROCESS.—The Secretary shall select 
the recipients of allotments under subparagraph 
(A) by means of a competitive grant process 
under which— 
‘‘(i) not later than 30 days after the 
deadline for the State involved to submit 
an application for the fiscal year under 
section 505(a), the Secretary publishes a 
notice soliciting grant applications; and 
‘‘(ii) not later than 120 days after 
such deadline, all such applications must 
be submitted. 
‘‘(b) PURPOSE.— 
‘‘(1) IN GENERAL.—Except for research under 
paragraph (5) and information collection and report-
ing under paragraph (6), the purpose of an allot-
ment under subsection (a) to a State (or to another 
entity in the State pursuant to subsection (a)(2)) is 
to enable the State or other entity to implement edu-
cation exclusively on sexual risk avoidance (meaning 
voluntarily refraining from sexual activity). 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(2) REQUIRED COMPONENTS.—Education on 
sexual risk avoidance pursuant to an allotment 
under this section shall— 
‘‘(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; and 
‘‘(D) be based on adolescent learning and 
developmental theories for the age group receiv-
ing the education. 
‘‘(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 
nonmarital sexual activity in order to improve 
the future prospects and physical and emotional 
health of youth. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(C) The increased likelihood of avoiding 
poverty when youth attain self-sufficiency and 
emotional maturity before engaging in sexual 
activity. 
‘‘(D) The foundational components of 
healthy relationships and their impact on the 
formation of healthy marriages and safe and 
stable families. 
‘‘(E) How other youth risk behaviors, such 
as drug and alcohol usage, increase the risk for 
teen sex. 
‘‘(F) How to resist and avoid, and receive 
help regarding, sexual coercion and dating 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 ensures that 
students understand that contraception offers 
physical risk reduction, but not risk elimination; 
and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00027
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(B) the education does not include dem-
onstrations, simulations, or distribution of con-
traceptive devices. 
‘‘(5) RESEARCH.— 
‘‘(A) IN GENERAL.—A State or other enti-
ty receiving an allotment pursuant to subsection 
(a) may use up to 20 percent of such allotment 
to build the evidence base for sexual risk avoid-
ance education by conducting or supporting re-
search. 
‘‘(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— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(A) collect information on the programs 
and activities funded through the allotment; 
and 
‘‘(B) submit reports to the Secretary on 
the data from such programs and activities. 
‘‘(c) NATIONAL EVALUATION.— 
‘‘(1) IN GENERAL.—The Secretary shall— 
‘‘(A) in consultation with appropriate State 
and local agencies, conduct one or more rig-
orous evaluations of the education funded 
through this section and associated data; and 
‘‘(B) submit a report to the Congress on 
the results of such evaluations, together with a 
summary of the information collected pursuant 
to subsection (b)(6). 
‘‘(2) CONSULTATION.—In conducting the eval-
uations required by paragraph (1), including the es-
tablishment of evaluation methodologies, the Sec-
retary shall consult with relevant stakeholders. 
‘‘(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 allot-
ments under section 502(c). 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(2) Sections 505 and 506 apply to allotments 
under subsection (a) to the extent determined by the 
Secretary to be appropriate. 
‘‘(e) FUNDING.— 
‘‘(1) IN GENERAL.—To carry out this section, 
there is appropriated, out of any money in the 
Treasury not otherwise appropriated, $75,000,000 
for each of fiscal years 2018 and 2019. 
‘‘(2) RESERVATION.—The Secretary shall re-
serve, 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.’’. 
(2) EFFECTIVE DATE.—The amendment made 
by this subsection takes effect on October 1, 2017. 
(b) PERSONAL RESPONSIBILITY EDUCATION.— 
(1) IN GENERAL.—Section 513 of the Social 
Security Act (42 U.S.C. 713) is amended— 
(A) in subsection (a)(1)(A), by striking 
‘‘2017’’ and inserting ‘‘2019’’; and 
(B) in subsection (a)(4)— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(i) in subparagraph (A), by striking 
‘‘2017’’ each place it appears and inserting 
‘‘2019’’; and 
(ii) in subparagraph (B)— 
(I) in the subparagraph heading, 
by striking ‘‘3-YEAR GRANTS’’ and in-
serting 
‘‘COMPETITIVE
PREP 
GRANTS’’; and 
(II) in clause (i), by striking ‘‘so-
licit applications to award 3-year 
grants in each of fiscal years 2012 
through 2017’’ and inserting ‘‘con-
tinue through fiscal year 2019 grants 
awarded for any of fiscal years 2015 
through 2017’’; 
(C) in subsection (c)(1), by inserting after 
‘‘youth with HIV/AIDS,’’ the following: ‘‘vic-
tims of human trafficking,’’; and 
(D) in subsection (f), by striking ‘‘2017’’ 
and inserting ‘‘2019’’. 
(2) EFFECTIVE DATE.—The amendments made 
by this subsection take effect on October 1, 2017. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
TITLE II—OFFSETS 
SEC. 201. PROVIDING FOR QUALIFIED HEALTH PLAN 
GRACE PERIOD REQUIREMENTS FOR ISSUER 
RECEIPT OF ADVANCE PAYMENTS OF COST- 
SHARING REDUCTIONS AND PREMIUM TAX 
CREDITS THAT ARE MORE CONSISTENT WITH 
STATE LAW GRACE PERIOD REQUIREMENTS. 
(a) IN GENERAL.—Section 1412(c) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18082(c)) 
is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (B)(iv)(II), by strik-
ing ‘‘a 3-month grace period’’ and inserting ‘‘a 
grace period specified in subparagraph (C)’’; 
and 
(B) by adding at the end the following new 
subparagraphs: 
‘‘(C) GRACE PERIOD SPECIFIED.—For pur-
poses of subparagraph (B)(iv)(II), the grace pe-
riod specified in this subparagraph is— 
‘‘(i) for plan years beginning before 
January 1, 2018, a 3-month grace period; 
and 
‘‘(ii) for plan years beginning on or 
after January 1, 2018— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00032
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(I) in the case of an Exchange 
operating in a State that has a State 
law grace period in place, such State 
law grace period; and 
‘‘(II) in the case of an Exchange 
operating in a State that does not 
have a State law grace period in 
place, a 1-month grace period. 
‘‘(D) STATE
LAW
GRACE
PERIOD.—For 
purposes of subparagraph (C), the term ‘State 
law grace period’ means, with respect to a 
State, a grace period for nonpayment of pre-
miums before discontinuing coverage that is ap-
plicable under the State law to health insurance 
coverage offered in the individual market of the 
State.’’; and 
(2) in paragraph (3), by adding at the end the 
following new sentence: ‘‘The requirements of para-
graph (2)(B)(iv) apply to an issuer of a qualified 
health plan receiving an advanced payment under 
this paragraph in the same manner and to the same 
extent that such requirements apply to an issuer of 
a qualified health plan receiving an advanced pay-
ment under paragraph (2)(A).’’. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00033
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(b) REPORT
ON ALIGNING GRACE PERIODS
FOR 
MEDICAID, MEDICARE, AND EXCHANGE PLANS.—Not 
later than 2 years after the date of full implementation 
of subsection (a), the Comptroller General of the United 
States shall submit to Congress a report on— 
(1) the effects on consumers of aligning grace 
periods applied under the Medicaid program under 
title XIX of the Social Security Act, under the Medi-
care program under parts C and D of title XVIII of 
such Act, and under qualified health plans offered 
on an Exchange established under title I of the Pa-
tient Protection and Affordable Care Act, including 
the extent to which such an alignment of grace peri-
ods may help to avoid enrollment status confusion 
for individuals under such Medicaid program, Medi-
care program, and qualified health plans; and 
(2) the extent to which such an alignment of 
grace periods may reduce fraud, waste, and abuse 
under the Medicaid program. 
SEC. 202. PREVENTION AND PUBLIC HEALTH FUND. 
Section 4002(b) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 300u–11(b)) is amended by 
striking paragraphs (3) through (8) and inserting the fol-
lowing new paragraphs: 
‘‘(3) for fiscal year 2018, $900,000,000; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00034
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(4) for fiscal year 2019, $500,000,000; 
‘‘(5) for fiscal year 2020, $500,000,000; 
‘‘(6) for fiscal year 2021, $500,000,000; 
‘‘(7) for fiscal year 2022, $500,000,000; 
‘‘(8) for fiscal year 2023, $500,000,000; 
‘‘(9) for fiscal year 2024, $500,000,000; 
‘‘(10) for fiscal year 2025, $750,000,000; 
‘‘(11) for fiscal year 2026, $1,000,000,000; and 
‘‘(12) for fiscal year 2027 and each fiscal year 
thereafter, $2,000,000,000.’’. 
DIVISION B—HEALTHY KIDS ACT 
SEC. 300. SHORT TITLE. 
This division may be cited as the ‘‘Helping Ensure 
Access for Little Ones, Toddlers, and Hopeful Youth by 
Keeping Insurance Delivery Stable Act of 2017’’ or the 
‘‘HEALTHY KIDS Act’’. 
TITLE I—CHIP EXTENSION AND 
OTHER MEDICAID AND CHIP 
PROVISIONS 
SEC. 301. FIVE-YEAR FUNDING EXTENSION OF THE CHIL-
DREN’S HEALTH INSURANCE PROGRAM. 
(a) APPROPRIATION; TOTAL ALLOTMENT.—Section 
2104(a) of the Social Security Act (42 U.S.C. 1397dd(a)) 
is amended— 
(1) in paragraph (19), by striking ‘‘and’’; 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00035
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(2) in paragraph (20), by striking the period at 
the end and inserting a semicolon; and 
(3) by adding at the end the following new 
paragraphs: 
‘‘(21) for fiscal year 2018, $21,500,000,000; 
‘‘(22) for fiscal year 2019, $22,600,000,000; 
‘‘(23) for fiscal year 2020, $23,700,000,000; 
‘‘(24) for fiscal year 2021, $24,800,000,000; 
and 
‘‘(25) for fiscal year 2022, for purposes of mak-
ing two semi-annual allotments— 
‘‘(A) $2,850,000,000 for the period begin-
ning on October 1, 2021, and ending on March 
31, 2022; and 
‘‘(B) $2,850,000,000 for the period begin-
ning on April 1, 2022, and ending on Sep-
tember 30, 2022.’’. 
(b) ALLOTMENTS.— 
(1) IN GENERAL.—Section 2104(m) of the So-
cial Security Act (42 U.S.C. 1397dd(m)) is amend-
ed— 
(A) in paragraph (2)— 
(i) 
in 
the 
heading, 
by 
striking 
‘‘THROUGH
2016’’ 
and 
inserting 
‘‘THROUGH 2022’’; and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00036
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(ii) in subparagraph (B)— 
(I) in the matter preceding clause 
(i), by striking ‘‘(19)’’ and inserting 
‘‘(24)’’; 
(II) in clause (ii), in the matter 
preceding subclause (I), by inserting 
‘‘(other than fiscal year 2022)’’ after 
‘‘even-numbered fiscal year’’; and 
(III) in clause (ii)(I), by inserting 
‘‘(or, in the case of fiscal year 2018, 
under paragraph (4))’’ after ‘‘clause 
(i)’’; 
(B) in paragraph (5)— 
(i) by striking ‘‘or (4)’’ and inserting 
‘‘(4), or (10)’’; and 
(ii) by striking ‘‘or 2017’’ and insert-
ing ‘‘, 2017, or 2022’’; 
(C) in paragraph (7)— 
(i) in subparagraph (A), by striking 
‘‘2017’’ and inserting ‘‘2022’’; 
(ii) in subparagraph (B), in the mat-
ter preceding clause (i), by inserting ‘‘(or, 
in the case of fiscal year 2018, by not later 
than the date that is 60 days after the 
date of the enactment of the HEALTHY 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00037
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(II) the amount made available 
under subsection (a)(25)(B).’’. 
(2) 
TECHNICAL
AMENDMENT.—Section 
2104(m)(2)(A) 
of 
such 
Act 
(42 
U.S.C. 
1397dd(m)(2)(A)) is amended by striking ‘‘the allot-
ment increase factor under paragraph (5)’’ each 
place it appears and inserting ‘‘the allotment in-
crease factor under paragraph (6)’’. 
(3) ONE-TIME
APPROPRIATION
FOR
FISCAL 
YEAR 2022.—There is appropriated to the Secretary 
of Health and Human Services, out of any money in 
the 
Treasury 
not 
otherwise 
appropriated, 
$20,200,000,000 to accompany the allotment made 
for the period beginning on October 1, 2021, and 
ending on March 31, 2022, under paragraph 
(25)(A) of section 2104(a) of the Social Security Act 
(42 U.S.C. 1397dd(a)) (as added by subsection 
(a)(3)), to remain available until expended. Such 
amount shall be used to provide allotments to States 
under paragraph (10) of section 2104(m) of such 
Act (as added by subsection (b)(1)(E)) for the first 
6 months of fiscal year 2022 in the same manner as 
allotments are provided under subsection (a)(25)(A) 
of such section 2104 and subject to the same terms 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00041
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
and conditions as apply to the allotments provided 
from such subsection (a)(25)(A). 
(c) EXTENSION OF THE CHILD ENROLLMENT CON-
TINGENCY FUND.—Section 2104(n) of the Social Security 
Act (42 U.S.C. 1397dd(n)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)(ii)— 
(i) by striking ‘‘2010, 2011, 2012, 
2013, 2014, and 2016’’ and inserting 
‘‘2010 through 2014, 2016, and 2018 
through 2021’’; and 
(ii) by striking ‘‘fiscal year 2015 and 
fiscal year 2017’’ and inserting ‘‘fiscal 
years 2015, 2017, and 2022’’; and 
(B) in subparagraph (B)— 
(i) by striking ‘‘2010, 2011, 2012, 
2013, 2014, and 2016’’ and inserting 
‘‘2010 through 2014, 2016, and 2018 
through 2021’’; and 
(ii) by striking ‘‘fiscal year 2015 and 
fiscal year 2017’’ and inserting ‘‘fiscal 
years 2015, 2017, and 2022’’; and 
(2) in paragraph (3)(A), in the matter pre-
ceding clause (i), by striking ‘‘or a semi-annual allot-
ment period for fiscal year 2015 or 2017’’ and in-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00042
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
serting ‘‘or in any of fiscal years 2018 through 2021 
(or a semi-annual allotment period for fiscal year 
2015, 2017, or 2022)’’. 
(d) EXTENSION OF QUALIFYING STATES OPTION.— 
Section 2105(g)(4) of the Social Security Act (42 U.S.C. 
1397ee(g)(4)) is amended— 
(1) in the heading, by striking ‘‘THROUGH 
2017’’ and inserting ‘‘THROUGH 2022’’; and 
(2) in subparagraph (A), by striking ‘‘2017’’ 
and inserting ‘‘2022’’. 
(e) EXTENSION OF EXPRESS LANE ELIGIBILITY OP-
TION.—Section 1902(e)(13)(I) of the Social Security Act 
(42 U.S.C. 1396a(e)(13)(I)) is amended by striking 
‘‘2017’’ and inserting ‘‘2022’’. 
(f) ASSURANCE OF AFFORDABILITY STANDARD FOR 
CHILDREN AND FAMILIES.— 
(1) IN GENERAL.—Section 2105(d)(3) of the 
Social Security Act (42 U.S.C. 1397ee(d)(3)) is 
amended— 
(A) in the paragraph heading, by striking 
‘‘UNTIL
OCTOBER
1, 2019’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2022’’; and 
(B) in subparagraph (A), in the matter 
preceding clause (i)— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00043
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(i) by striking ‘‘2019’’ and inserting 
‘‘2022’’; and 
(ii) by striking ‘‘The preceding sen-
tence shall not be construed as preventing 
a State during such period’’ and inserting 
‘‘During the period that begins on October 
1, 2019, and ends on September 30, 2022, 
the preceding sentence shall only apply 
with respect to children in families whose 
income does not exceed 300 percent of the 
poverty 
line 
(as 
defined 
in 
section 
2110(c)(5)) applicable to a family of the 
size involved. The preceding sentences shall 
not be construed as preventing a State 
during any such periods’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1902(gg)(2) of the Social Security Act (42 U.S.C. 
1396a(gg)(2)) is amended— 
(A) in the paragraph heading, by striking 
‘‘UNTIL
OCTOBER
1, 2019’’ and inserting 
‘‘THROUGH SEPTEMBER 30, 2022’’; and 
(B) by striking ‘‘September 30, 2019,’’ 
and inserting ‘‘September 30, 2022 (but during 
the period that begins on October 1, 2019, and 
ends on September 30, 2022, only with respect 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00044
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
to children in families whose income does not 
exceed 300 percent of the poverty line (as de-
fined in section 2110(c)(5)) applicable to a fam-
ily of the size involved)’’. 
(g) CHIP LOOK-ALIKE PLANS.— 
(1) BLENDING RISK POOLS.—Section 2107 of 
the Social Security Act (42 U.S.C. 1397gg) is 
amended by adding at the end the following: 
‘‘(g) USE OF BLENDED RISK POOLS.— 
‘‘(1) IN GENERAL.—Nothing in this title (or 
any other provision of Federal law) shall be con-
strued as preventing a State from considering chil-
dren enrolled in a qualified CHIP look-alike pro-
gram and children enrolled in a State child health 
plan under this title (or a waiver of such plan) as 
members of a single risk pool. 
‘‘(2) QUALIFIED CHIP LOOK-ALIKE PROGRAM.— 
In this subsection, the term ‘qualified CHIP look- 
alike program’ means a State program— 
‘‘(A) under which children who are under 
the age of 19 and are not eligible to receive 
medical assistance under title XIX or child 
health assistance under this title may purchase 
coverage through the State that provides bene-
fits that are at least identical to the benefits 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00045
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
provided under the State child health plan 
under this title (or a waiver of such plan); and 
‘‘(B) that is funded exclusively through 
non-Federal funds, including funds received by 
the State in the form of premiums for the pur-
chase of such coverage.’’. 
(2) COVERAGE RULE.— 
(A) IN GENERAL.—Section 5000A(f)(1) of 
the Internal Revenue Code of 1986 is amended 
in subparagraph (A)(iii), by inserting ‘‘or under 
a qualified CHIP look-alike program (as de-
fined in section 2107(g) of the Social Security 
Act)’’ before the comma at the end. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply with re-
spect to taxable years beginning after December 
31, 2017. 
SEC. 302. EXTENSION OF CERTAIN PROGRAMS AND DEM-
ONSTRATION PROJECTS. 
(a) 
CHILDHOOD
OBESITY
DEMONSTRATION 
PROJECT.—Section 1139A(e)(8) of the Social Security 
Act (42 U.S.C. 1320b–9a(e)(8)) is amended— 
(1) by striking ‘‘and $10,000,000’’ and insert-
ing ‘‘, $10,000,000’’; and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00046
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(2) by inserting after ‘‘2017’’ the following: ‘‘, 
and $25,000,000 for the period of fiscal years 2018 
through 2022’’. 
(b) PEDIATRIC QUALITY MEASURES PROGRAM.— 
Section 1139A(i) of the Social Security Act (42 U.S.C. 
1320b–9a(i)) is amended— 
(1) by striking ‘‘Out of any’’ and inserting the 
following: 
‘‘(1) IN GENERAL.—Out of any’’; 
(2) by striking ‘‘there is appropriated for each’’ 
and inserting ‘‘there is appropriated— 
‘‘(A) for each’’; 
(3) by striking ‘‘, and there is appropriated for 
the period’’ and inserting ‘‘; 
‘‘(B) for the period’’; 
(4) by striking ‘‘. Funds appropriated under 
this subsection shall remain available until ex-
pended.’’ and inserting ‘‘; and’’; and 
(5) by adding at the end the following: 
‘‘(C) for the period of fiscal years 2018 
through 2022, $75,000,000 for the purpose of 
carrying out this section (other than sub-
sections (e), (f), and (g)). 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00047
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(2) 
AVAILABILITY.—Funds 
appropriated 
under this subsection shall remain available until ex-
pended.’’. 
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT 
PROGRAM. 
(a) IN GENERAL.—Section 2113 of the Social Secu-
rity Act (42 U.S.C. 1397mm) is amended— 
(1) in subsection (a)(1), by striking ‘‘2017’’ and 
inserting ‘‘2022’’; and 
(2) in subsection (g)— 
(A) by striking ‘‘and $40,000,000’’ and in-
serting ‘‘, $40,000,000’’; and 
(B) by inserting after ‘‘2017’’ the fol-
lowing: ‘‘, and $100,000,000 for the period of 
fiscal years 2018 through 2022’’. 
(b) MAKING ORGANIZATIONS THAT USE PARENT 
MENTORS
ELIGIBLE
TO
RECEIVE
GRANTS.—Section 
2113(f) of the Social Security Act (42 U.S.C. 1397mm(f)) 
is amended— 
(1) in paragraph (1)(E), by striking ‘‘or com-
munity-based doula programs’’ and inserting ‘‘, com-
munity-based doula programs, or parent mentors’’; 
and 
(2) by adding at the end the following new 
paragraph: 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00048
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(5) PARENT
MENTOR.—The term ‘parent 
mentor’ means an individual who— 
‘‘(A) is a parent or guardian of at least 
one child who is an eligible child under this title 
or title XIX; and 
‘‘(B) is trained to assist families with chil-
dren who have no health insurance coverage 
with respect to improving the social deter-
minants of the health of such children, includ-
ing by providing— 
‘‘(i) education about health insurance 
coverage, including, with respect to obtain-
ing such coverage, eligibility criteria and 
application and renewal processes; 
‘‘(ii) assistance with completing and 
submitting applications for health insur-
ance coverage; 
‘‘(iii) a liaison between families and 
representatives of State plans under title 
XIX or State child health plans under this 
title; 
‘‘(iv) guidance on identifying medical 
and dental homes and community phar-
macies for children; and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00049
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(v) assistance and referrals to suc-
cessfully address social determinants of 
children’s health, including poverty, food 
insufficiency, and housing.’’. 
(c) EXCLUSION FROM MODIFIED ADJUSTED GROSS 
INCOME.—Section 1902(e) of the Social Security Act (42 
U.S.C. 1396a(e)) is amended— 
(1) in the first paragraph (14), relating to in-
come determined using modified adjusted gross in-
come, by adding at the end the following new sub-
paragraph: 
‘‘(J) EXCLUSION
OF
PARENT
MENTOR 
COMPENSATION
FROM
INCOME
DETERMINA-
TION.—Any nominal amount received by an in-
dividual as compensation, including a stipend, 
for participation as a parent mentor (as defined 
in paragraph (5) of section 2113(f)) in an activ-
ity or program funded through a grant under 
such section shall be disregarded for purposes 
of determining the income eligibility of such in-
dividual for medical assistance under the State 
plan or any waiver of such plan.’’; and 
(2) by striking ‘‘(14) EXCLUSION’’ and insert-
ing ‘‘(15) EXCLUSION’’. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00050
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
SEC. 304. EXTENSION AND REDUCTION OF ADDITIONAL 
FEDERAL FINANCIAL PARTICIPATION FOR 
CHIP. 
Section 2105(b) of the Social Security Act (42 U.S.C. 
1397ee(b)) is amended in the second sentence by inserting 
‘‘and during the period that begins on October 1, 2019, 
and ends on September 30, 2020, the enhanced FMAP 
determined for a State for a fiscal year (or for any portion 
of a fiscal year occurring during such period) shall be in-
creased by 11.5 percentage points’’ after ‘‘23 percentage 
points,’’. 
SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH AL-
LOTMENTS. 
Section 1923(f)(7)(A) of the Social Security Act (42 
U.S.C. 1396r–4(f)(7)(A)) is amended— 
(1) in clause (i), in the matter preceding sub-
clause (I), by striking ‘‘2018’’ and inserting ‘‘2020’’; 
and 
(2) in clause (ii), by striking subclauses (I) 
through (VIII) and inserting the following: 
‘‘(I) $4,000,000,000 for fiscal 
year 2020; and 
‘‘(II) $8,000,000,000 for each of 
fiscal years 2021 through 2025.’’. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00051
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
SEC. 306. PUERTO RICO AND THE VIRGIN ISLANDS MED-
ICAID PAYMENTS. 
(a) INCREASED CAP.—Section 1108(g) of the Social 
Security Act (42 U.S.C. 1308(g)) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A), by inserting ‘‘(or, 
with respect to fiscal years 2018 and 2019, in-
creased by such percentage increase plus one 
percentage point)’’ after ‘‘beginning of the fis-
cal year’’; and 
(B) in subparagraph (B), by inserting 
‘‘(or, with respect to fiscal years 2018 and 
2019, increased by such percentage increase 
plus one percentage point)’’ after ‘‘percentage 
increase referred to in subparagraph (A)’’; 
(2) in paragraph (5)— 
(A) in subparagraph (A), by striking ‘‘sub-
paragraph (B)’’ and inserting ‘‘subparagraphs 
(B), (C), (D), (E), and (F)’’; and 
(B) by adding at the end the following new 
subparagraphs: 
‘‘(C) The amount of the increase otherwise pro-
vided under subparagraph (A) for Puerto Rico shall 
be further increased by $880,000,000. 
‘‘(D)(i) For the period beginning October 1, 
2017, and ending December 31, 2019, the amount 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00052
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
of the increase otherwise provided under subpara-
graph (A) for Puerto Rico shall be further increased 
by $120,000,000 if the Financial Oversight and 
Management Board for Puerto Rico established 
under section 101 of the Puerto Rico Oversight, 
Management, and Economic Stability Act (48 
U.S.C. 2121) certifies by a majority vote that Puer-
to Rico has taken reasonable and appropriate steps 
during such period to— 
‘‘(I) reduce fraud, waste, and abuse under 
the program under title XIX; 
‘‘(II) implement strategies to reduce un-
necessary, inefficient, or excessive spending 
under title XIX; 
‘‘(III) improve the use and availability of 
Medicaid data for program operation and over-
sight; and 
‘‘(IV) improve the quality of care and pa-
tient experience for individuals enrolled under 
the program under title XIX. 
‘‘(ii) As a condition of any additional increase 
pursuant to clause (i), not later than October 1, 
2018, Puerto Rico shall submit to the Financial 
Oversight and Management Board for Puerto Rico 
a report regarding steps taken to achieve each of the 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00053
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
goals described in subclauses (I) through (IV) of 
clause (i). 
‘‘(E) Payments under section 1903(a)(8) for a 
quarter of a fiscal year shall not be taken into ac-
count in applying subsection (f) (as increased in ac-
cordance with this paragraph and paragraphs (1), 
(2), (3), and (4)) to Puerto Rico or the Virgin Is-
lands for such fiscal year. 
‘‘(F)(i) For the period beginning October 1, 
2017, and ending December 31, 2019, the amount 
of the increase otherwise provided under subpara-
graph (A) for the Virgin Islands shall be further in-
creased by an amount equal to the per capita equiv-
alent of the total amount of the increase provided 
for Puerto Rico under subparagraphs (C) and (D) 
for such period. 
‘‘(ii) For purposes of clause (i), the term ‘per 
capita equivalent’ means the ratio of— 
‘‘(I) the population of the Virgin Islands, 
as determined by the most recent census esti-
mate released by the Bureau of the Census be-
fore September 4, 2017; to 
‘‘(II) the population of Puerto Rico, as so 
determined.’’. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00054
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(b) FEDERAL MATCH
FOR MEDICAL PERSONNEL 
AND FRAUD REDUCTION.—Section 1903(a) of the Social 
Security Act (42 U.S.C. 1396b(a)) is amended— 
(1) in paragraph (2)(A), by inserting ‘‘subject 
to paragraph (8),’’ before ‘‘an amount’’; 
(2) in paragraph (6)— 
(A) in subparagraph (B), by inserting 
‘‘subject to paragraph (8),’’ before ‘‘75 per cen-
tum’’; and 
(B) by striking at the end ‘‘plus’’; 
(3) in paragraph (7), by striking at the end the 
period and inserting ‘‘; plus’’ ; and 
(4) by adding at the end the following new 
paragraph: 
‘‘(8) for quarters during the period beginning 
January 1, 2018, and ending December 31, 2019, 
paragraphs (2)(A) and (6) shall apply with respect 
to Puerto Rico and the Virgin Islands as if— 
‘‘(A) the reference to ‘75 per centum’ in 
paragraph (2)(A) were a reference to ‘90 per 
centum’; and 
‘‘(B) the reference to ‘75 per centum’ in 
paragraph (6)(B) were a reference to ‘90 per 
centum’.’’. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00055
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
TITLE II—OFFSETS 
SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS. 
(a) MEDICAID THIRD PARTY LIABILITY.— 
(1) DELAY
OF
BIPARTISAN
BUDGET
ACT
OF 
2013 THIRD PARTY LIABILITY PROVISIONS.— 
(A) IN GENERAL.—Section 202(c) of the 
Bipartisan Budget Act of 2013 (Public Law 
113–67; 127 Stat. 1177; 42 U.S.C. 1396a 
note), as amended by section 211 of the Pro-
tecting Access to Medicare Act of 2014 (Public 
Law 113–93; 128 Stat. 1047; 42 U.S.C. 1396a 
note) and section 220 of the Medicare Access 
and CHIP Reauthorization Act of 2015 (Public 
Law 114–10), is amended by striking ‘‘2017’’ 
and inserting ‘‘2019’’. 
(B) EFFECTIVE DATE; TREATMENT.—The 
amendment made by subparagraph (A) shall 
take effect on September 30, 2017, and shall 
apply with respect to any open claims, including 
claims generated or filed, after such date. 
(2) CLARIFICATION OF DEFINITIONS APPLICA-
BLE TO THIRD PARTY LIABILITY.— 
(A) IN GENERAL.—Section 1902 of the So-
cial Security Act (42 U.S.C. 1396a) is amended 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00056
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
by adding at the end the following new sub-
section: 
‘‘(nn) RESPONSIBLE THIRD PARTY AND HEALTH IN-
SURER DEFINITIONS.—For purposes of subsection (a)(25) 
and section 1903(d)(2)(B): 
‘‘(1) RESPONSIBLE THIRD PARTY.—The term 
‘responsible third party’ means a health insurer, a 
pharmacy benefit manager to the extent the phar-
macy benefit manager provides information under 
this title for the purpose of coordinating benefits, an 
accountable care organization under section 1899, or 
any other party that is, by statute, contract, or 
agreement, legally responsible for payment of a 
claim for a health care item or service. Such term 
does not include a party if payment by such party 
has been made or can reasonably be expected to be 
made under a workmen’s compensation law or plan 
of the United States or a State, or under an auto-
mobile or liability insurance policy or plan (including 
a self-insured plan), or under no fault insurance. 
‘‘(2) HEALTH INSURER.—The term ‘health in-
surer’ means a group health plan, as defined in sec-
tion 607(1) of the Employee Retirement Income Se-
curity Act of 1974, a self-insured plan, a fully-in-
sured plan, a service benefit plan, a medicaid man-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00057
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
aged care plan under section 1903(m) or 1932, and 
any other health plan determined appropriate by the 
Secretary.’’. 
(B) CONFORMING AMENDMENTS.—Section 
1902(a)(25) of the Social Security Act (42 
U.S.C. 1396a(a)(25)) is amended— 
(i) in subparagraph (A), in the matter 
preceding clause (i), by striking ‘‘third par-
ties’’ and all that follows through ‘‘item or 
service)’’ and inserting ‘‘responsible third 
parties’’; 
(ii) in subparagraph (G), by striking 
‘‘health insurer’’ and all that follows 
through ‘‘item or service)’’ and inserting 
‘‘responsible third party’’; 
(iii) in subparagraph (I), in the mat-
ter preceding clause (i), by striking ‘‘health 
insurers’’ and all that follows through 
‘‘item or service’’ and inserting ‘‘respon-
sible third parties’’; and 
(iv) by inserting ‘‘responsible’’ before 
‘‘third’’ each place it appears in subpara-
graphs (A)(i), (A)(ii), (C), (D), and (H). 
(3) REMOVAL OF SPECIAL TREATMENT OF CER-
TAIN TYPES OF CARE AND PAYMENTS UNDER MED-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00058
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
ICAID
THIRD
PARTY
LIABILITY
RULES.—Section 
1902(a)(25) of the Social Security Act (42 U.S.C. 
1396a(a)(25)), as amended by section 202(c) of the 
Bipartisan Budget Act of 2013 (after application of 
paragraph (1)), is amended— 
(A) in subparagraph (E)— 
(i) in the matter preceding clause (i), 
by striking ‘‘prenatal or preventive’’ and 
all that follows through ‘‘State plan’’ and 
inserting ‘‘items and services provided 
under the program required under the 
State plan pursuant to paragraph (62)’’; 
and 
(ii) in clause (i)— 
(I) by striking ‘‘such service’’ 
and inserting ‘‘such items and serv-
ices’’; and 
(II) by striking each place it ap-
pears ‘‘such services’’ and inserting 
‘‘such items and services’’ each such 
place; and 
(B) by striking subparagraph (F). 
(4) CLARIFICATION OF ROLE OF HEALTH IN-
SURERS WITH RESPECT TO THIRD PARTY LIABIL-
ITY.— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00059
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(A) IN GENERAL.—Section 1902(a)(25) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396a(a)(25)), as amended by paragraph (3), is 
further amended by inserting after subpara-
graph (E) the following new subparagraph: 
‘‘(F) that— 
‘‘(i) in the case of a State that pro-
vides medical assistance under this title 
through a contract with a health insurer, 
such contract shall specify any responsi-
bility of such health insurer (or other enti-
ty) with respect to recovery of payment 
from responsible third parties pursuant to 
the delegation or transfer by the State to 
such insurer (or other entity) of a right de-
scribed in subparagraph (I)(ii); and 
‘‘(ii) in the case of a State that under 
a contract described in clause (i) delegates 
or transfers to a health insurer (or other 
entity) a right described in such clause, the 
State shall provide assurances to the Sec-
retary that the State laws referred to in 
subparagraph (I), with respect to each re-
sponsibility of such health insurer (or other 
entity) specified under such clause, confer 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00060
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
to such health insurer (or other entity) the 
authority of the State with respect to the 
requirements 
specified 
in 
clauses 
(i) 
through (iv) of such subparagraph (I);’’. 
(B) 
TREATMENT
OF
COLLECTED 
AMOUNTS.—Section 1903(d)(2)(B) of the Social 
Security Act (42 U.S.C. 1396b(d)(2)(B)) is 
amended by adding at the end the following: 
‘‘For purposes of this subparagraph, reimburse-
ments made by a responsible third party to 
health insurers (as defined in section 1902(nn)) 
pursuant to section 1902(a)(25)(F)(ii) shall be 
treated in the same manner as reimbursements 
made to a State under the previous sentence.’’. 
(5) INCREASING STATE FLEXIBILITY WITH RE-
SPECT
TO
THIRD
PARTY
LIABILITY.—Section 
1902(a)(25)(I) of the Social Security Act (42 U.S.C. 
1396a(a)(25)(I)) is amended— 
(A) in clause (i), by striking ‘‘medical as-
sistance under the State plan’’ and inserting 
‘‘medical assistance under a State plan (or 
under a waiver of the plan)’’; 
(B) by striking clause (ii) and inserting the 
following new clause: 
‘‘(ii) accept— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00061
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(I) any State’s right of recovery 
and the assignment to any State of 
any right of an individual or other en-
tity to payment from the party for an 
item or service for which payment has 
been 
made 
under 
the 
respective 
State’s plan (or under a waiver of the 
plan); and 
‘‘(II) as a valid authorization of 
the responsible third party for the fur-
nishing of an item or service to an in-
dividual eligible to receive medical as-
sistance under this title, an authoriza-
tion made on behalf of such individual 
under the State plan (or under a 
waiver of such plan) for the fur-
nishing of such item or service to such 
individual;’’; 
(C) in clause (iii)— 
(i) by striking ‘‘respond to’’ and in-
serting ‘‘not later than 60 days after re-
ceiving’’; and 
(ii) by striking ‘‘; and’’ at the end and 
inserting ‘‘, respond to such inquiry; and’’; 
and 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00062
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(D) in clause (iv), by inserting ‘‘a failure 
to obtain a prior authorization,’’ after ‘‘claim 
form,’’. 
(6) STATE
INCENTIVE
TO
PURSUE
THIRD 
PARTY LIABILITY FOR NEWLY ELIGIBLES.—Section 
1903(d)(2)(B) of the Social Security Act (42 U.S.C. 
1396b(d)(2)(B)), as amended by paragraph (4)(B), 
is further amended by adding at the end the fol-
lowing: ‘‘In the case of expenditures for medical as-
sistance provided during 2017 and subsequent years 
for individuals described in subclause (VIII) of sec-
tion 1902(a)(10)(A)(i), in determining the amount, 
if any, of overpayment under this subparagraph with 
respect to such medical assistance, the Secretary 
shall apply the Federal medical assistance percent-
age for the State under section 1905(b), notwith-
standing the application of section 1905(y).’’. 
(b) COMPLIANCE WITH THIRD PARTY INSURANCE 
REPORTING.—Section 1905 of the Social Security Act (42 
U.S.C. 1396d) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(ee) Notwithstanding subsection (b), for any year 
beginning after 2019, if a State fails to comply with the 
requirements of section 1902(a)(25) with respect to each 
calendar quarter in such year, the Secretary may reduce 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00063
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
the Federal medical assistance percentage by 0.1 percent-
age point for calendar quarters in each subsequent year 
in which the State fails to so comply.’’. 
(c) APPLICATION TO CHIP.— 
(1) IN
GENERAL.—Section 2107(e)(1) of the 
Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(A) by redesignating subparagraphs (B) 
through (R) as subparagraphs (C) through (S), 
respectively; and 
(B) by inserting after subparagraph (A) 
the following new subparagraph: 
‘‘(B) Section 1902(a)(25) (relating to third 
party liability).’’. 
(2) 
MANDATORY
REPORTING.—Section 
1902(a)(25)(I)(i) of the Social Security Act (42 
U.S.C. 1396a(a)(25)(I)(i)), as amended by sub-
section (a)(5), is further amended— 
(A) by striking ‘‘(and, at State option, 
child’’ and inserting ‘‘and child’’; and 
(B) by striking ‘‘title XXI)’’ and inserting 
‘‘title XXI’’. 
(d) TRAINING ON THIRD PARTY LIABILITY.—Section 
1936 of the Social Security Act (42 U.S.C. 1396u–6) is 
amended— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00064
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(1) in subsection (b)(4), by striking ‘‘and qual-
ity of care’’ and inserting ‘‘, quality of care, and the 
liability of responsible third parties (as defined in 
section 1902(nn))’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(f) THIRD PARTY LIABILITY TRAINING.—With re-
spect to education or training activities carried out pursu-
ant to subsection (b)(4) with respect to the liability of re-
sponsible third parties (as defined in section 1902(nn) for 
payment for items and services furnished under State 
plans (or under waivers of such plans)) under this title, 
the Secretary shall— 
‘‘(1) publish (and update on an annual basis) 
on the public Internet website of the Centers for 
Medicare & Medicaid Services a dedicated Internet 
page containing best practices to be used in assess-
ing such liability; 
‘‘(2) monitor efforts to assess such liability and 
analyze the challenges posed by that assessment; 
‘‘(3) distribute to State agencies administering 
the State plan under this title information related to 
such efforts and challenges; and 
‘‘(4) provide guidance to such State agencies 
with respect to State oversight of efforts under a 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00065
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
medicaid managed care plan under section 1903(m) 
or 1932 to assess such liability.’’. 
(e) DEVELOPMENT
OF MODEL UNIFORM FIELDS 
FOR STATES TO REPORT THIRD PARTY INFORMATION.— 
Not later than January 1, 2019, the Secretary of Health 
and Human Services shall, in consultation with the States, 
develop and make available to the States a model uniform 
reporting set of reporting fields and accompanying guid-
ance documentation that States shall use for purposes 
of— 
(1) reporting information to the Secretary with-
in the Transformed Medicaid Statistical Information 
System (T–MSIS) (or a successor system); and 
(2) collecting information that identifies respon-
sible third parties (as defined in subsection (nn) of 
section 1902 of the Social Security Act (42 U.S.C. 
1396a), as added by subsection (a)(2)(A)) and other 
relevant information for ascertaining the legal re-
sponsibility of such third parties to pay for care and 
services available under the State plan (or under a 
waiver of the plan) under title XIX of the Social Se-
curity Act (42 U.S.C. 1396 et seq.) or under the 
State child health plan under title XXI of such Act 
(42 U.S.C. 1397 et seq.). 
(f) EFFECTIVE DATE.— 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00066
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
(1) IN GENERAL.—Except as provided in para-
graph (2), this section and the amendments made by 
this section (other than as specified in the preceding 
provisions of this section) shall take effect on Octo-
ber 1, 2019, and shall apply to medical assistance or 
child health assistance provided on or after such 
date. 
(2) EXCEPTION
IF
STATE
LEGISLATION
RE-
QUIRED.—In the case of a State plan for medical as-
sistance under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.), or a State child health 
plan for child health assistance under title XXI of 
such Act (42 U.S.C. 1397aa et seq.), that the Sec-
retary of Health and Human Services determines re-
quires State legislation (other than legislation appro-
priating funds) in order for the plan to meet the ad-
ditional requirement imposed by the amendments 
made under this section, such plan shall not be re-
garded as failing to comply with the requirements of 
such title solely on the basis of its failure to meet 
this additional requirement before the first day of 
the first calendar quarter beginning after the close 
of the first regular session of the State legislature 
that begins after the date of the enactment of this 
Act. For purposes of the previous sentence, in the 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00067
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
case of a State that has a 2-year legislative session, 
each year of such session shall be deemed to be a 
separate regular session of the State legislature. 
SEC. 402. TREATMENT OF LOTTERY WINNINGS AND OTHER 
LUMP-SUM INCOME FOR PURPOSES OF IN-
COME ELIGIBILITY UNDER MEDICAID. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396a) is amended— 
(1) in subsection (a)(17), by striking ‘‘(e)(14), 
(e)(14)’’ and inserting ‘‘(e)(14), (e)(15)’’; and 
(2) in subsection (e)(14), as amended by section 
303(c), by adding at the end the following new sub-
paragraph: 
‘‘(K) TREATMENT OF CERTAIN LOTTERY 
WINNINGS AND INCOME RECEIVED AS A LUMP 
SUM.— 
‘‘(i) IN GENERAL.—In the case of an 
individual who is the recipient of qualified 
lottery winnings (pursuant to lotteries oc-
curring on or after January 1, 2018) or 
qualified lump sum income (received on or 
after such date) and whose eligibility for 
medical assistance is determined based on 
the application of modified adjusted gross 
income under subparagraph (A), a State 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00068
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
shall, in determining such eligibility, in-
clude such winnings or income (as applica-
ble) as income received— 
‘‘(I) in the month in which such 
winnings or income (as applicable) is 
received if the amount of such 
winnings or income is less than 
$80,000; 
‘‘(II) over a period of 2 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal to $80,000 but less than 
$90,000; 
‘‘(III) over a period of 3 months 
if the amount of such winnings or in-
come (as applicable) is greater than or 
equal to $90,000 but less than 
$100,000; and 
‘‘(IV) over a period of 3 months 
plus 1 additional month for each in-
crement of $10,000 of such winnings 
or income (as applicable) received, not 
to exceed a period of 120 months (for 
winnings or income of $1,260,000 or 
more), if the amount of such winnings 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00069
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
or income is greater than or equal to 
$100,000. 
‘‘(ii) COUNTING IN EQUAL INSTALL-
MENTS.—For purposes of subclauses (II), 
(III), and (IV) of clause (i), winnings or 
income to which such subclause applies 
shall be counted in equal monthly install-
ments over the period of months specified 
under such subclause. 
‘‘(iii) HARDSHIP EXEMPTION.—An in-
dividual whose income, by application of 
clause (i), exceeds the applicable eligibility 
threshold established by the State, shall 
continue to be eligible for medical assist-
ance to the extent that the State deter-
mines, under procedures established by the 
State (in accordance with standards speci-
fied by the Secretary), that the denial of 
eligibility of the individual would cause an 
undue medical or financial hardship as de-
termined on the basis of criteria estab-
lished by the Secretary. 
‘‘(iv) NOTIFICATIONS
AND
ASSIST-
ANCE REQUIRED IN CASE OF LOSS OF ELI-
GIBILITY.—A State shall, with respect to 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00070
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
an individual who loses eligibility for med-
ical assistance under the State plan (or a 
waiver of such plan) by reason of clause 
(i)— 
‘‘(I) before the date on which the 
individual loses such eligibility, inform 
the individual— 
‘‘(aa) of the individual’s op-
portunity to enroll in a qualified 
health plan offered through an 
Exchange established under title 
I of the Patient Protection and 
Affordable Care Act during the 
special enrollment period speci-
fied in section 9801(f)(3) of the 
Internal Revenue Code of 1986 
(relating to loss of Medicaid or 
CHIP coverage); and 
‘‘(bb) of the date on which 
the individual would no longer be 
considered ineligible by reason of 
clause (i) to receive medical as-
sistance under the State plan or 
under any waiver of such plan 
and be eligible to reapply to re-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00071
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
ceive such medical assistance; 
and 
‘‘(II) provide technical assistance 
to the individual seeking to enroll in 
such a qualified health plan. 
‘‘(v) QUALIFIED LOTTERY WINNINGS 
DEFINED.—In this subparagraph, the term 
‘qualified lottery winnings’ means winnings 
from a sweepstakes, lottery, or pool de-
scribed in paragraph (3) of section 4402 of 
the Internal Revenue Code of 1986 or a 
lottery operated by a multistate or multi-
jurisdictional lottery association, including 
amounts awarded as a lump sum payment. 
‘‘(vi) QUALIFIED LUMP SUM INCOME 
DEFINED.—In this subparagraph, the term 
‘qualified lump sum income’ means income 
that is received as a lump sum from one 
of the following sources: 
‘‘(I) Monetary winnings from 
gambling (as defined by the Secretary 
and including gambling activities de-
scribed in section 1955(b)(4) of title 
18, United States Code). 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00072
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
‘‘(II) Damages received, whether 
by suit or agreement and whether as 
lump sums or as periodic payments 
(other than monthly payments), on 
account of causes of action other than 
causes of action arising from personal 
physical injuries or physical sickness. 
‘‘(III) Income received as liquid 
assets from the estate (as defined in 
section 1917(b)(4)) of a deceased in-
dividual.’’. 
(b) RULES OF CONSTRUCTION.— 
(1) INTERCEPTION OF LOTTERY WINNINGS AL-
LOWED.—Nothing in the amendment made by sub-
section (a)(2) shall be construed as preventing a 
State from intercepting the State lottery winnings 
awarded to an individual in the State to recover 
amounts paid by the State under the State Medicaid 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) for medical assistance fur-
nished to the individual. 
(2) APPLICABILITY LIMITED TO ELIGIBILITY OF 
RECIPIENT OF LOTTERY WINNINGS OR LUMP SUM 
INCOME.—Nothing in the amendment made by sub-
section (a)(2) shall be construed, with respect to a 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00073
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
determination of household income for purposes of a 
determination of eligibility for medical assistance 
under the State plan under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) (or a waiver 
of such plan) made by applying modified adjusted 
gross income under subparagraph (A) of section 
1902(e)(14) of such Act (42 U.S.C. 1396a(e)(14)), 
as limiting the eligibility for such medical assistance 
of any individual that is a member of the household 
other than the individual who received qualified lot-
tery winnings or qualified lump-sum income (as de-
fined 
in 
subparagraph 
(K) 
of 
such 
section 
1902(e)(14), as added by subsection (a)(2) of this 
section). 
SEC. 403. ADJUSTMENTS TO MEDICARE PART B AND PART 
D PREMIUM SUBSIDIES FOR HIGHER INCOME 
INDIVIDUALS. 
(a) IN GENERAL.—Section 1839(i)(3)(C)(i)(II) of the 
Social Security Act (42 U.S.C. 1395r(i)(3)(C)(i)(II)) is 
amended, in the table, by striking the last row and insert-
ing the following new rows: 
‘‘More than $160,000 but less than $500,000 ..............
80 percent
At least $500,000 ...........................................................
100 percent.’’. 
(b) JOINT RETURNS.—Section 1839(i)(3)(C)(ii) of 
the Social Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is 
amended by inserting before the period the following: ‘‘ex-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00074
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
cept, with respect to the dollar amounts applied in the last 
row of the table under subclause (II) of such clause (and 
the second dollar amount specified in the second to last 
row of such table), clause (i) shall be applied by sub-
stituting dollar amounts which are 175 percent of such 
dollar amounts for the calendar year’’. 
(c) INFLATION ADJUSTMENT.—Section 1839(i) of 
the Social Security Act (42 U.S.C. 1395r(i)) is amended— 
(1) in paragraph (5)— 
(A) in subparagraph (A), by striking ‘‘In 
the case’’ and inserting ‘‘Subject to subpara-
graph (C), in the case’’; 
(B) in subparagraph (B), by striking ‘‘sub-
paragraph (A)’’ and inserting ‘‘subparagraph 
(A) or (C)’’; and 
(C) by adding at the end the following new 
subparagraph: 
‘‘(C) TREATMENT OF ADJUSTMENTS FOR 
CERTAIN HIGHER INCOME INDIVIDUALS.— 
‘‘(i) IN GENERAL.—Subparagraph (A) 
shall not apply with respect to each dollar 
amount in paragraph (3) of $500,000. 
‘‘(ii) ADJUSTMENT BEGINNING 2027.— 
In the case of any calendar year beginning 
after 2026, each dollar amount in para-
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00075
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS
HR 3922 RFS
graph (3) of $500,000 shall be increased 
by an amount equal to— 
‘‘(I) such dollar amount, multi-
plied by 
‘‘(II) the percentage (if any) by 
which the average of the Consumer 
Price Index for all urban consumers 
(United States city average) for the 
12-month period ending with August 
of the preceding calendar year exceeds 
such average for the 12-month period 
ending with August 2025.’’; and 
(2) in paragraph (6)(B), by inserting ‘‘(other 
than $500,000)’’ after ‘‘the dollar amounts’’. 
Passed the House of Representatives November 3, 
2017. 
Attest: 
KAREN L. HAAS, 
Clerk. 
VerDate Sep 11 2014 
01:21 Nov 07, 2017
Jkt 079200
PO 00000
Frm 00076
Fmt 6652
Sfmt 6201
E:\BILLS\H3922.RFS
H3922
dlhill on DSK3GLQ082PROD with BILLS