‘‘(ii) VICE
CHAIRPERSON.—The Ad-
ministrator of the Federal Emergency 
Management Agency, or a designee of the 
Administrator, shall serve on the Panel as 
the Vice Chairperson of the Panel. 
‘‘(5) STAFF, EXPERTS, AND CONSULTANTS.— 
The Panel may— 
‘‘(A) appoint such staff as the Panel con-
siders to be appropriate, without regard to the 
provisions of title 5, United States Code, gov-
erning appointments in the competitive service; 
‘‘(B) fix the pay of such staff, without re-
gard to the provisions of chapter 51 and sub-
chapter III of chapter 53 of such title relating 
to classification and General Schedule pay 
rates; and 
‘‘(C) procure the services of experts and 
consultants in accordance with the provisions of 
section 3109(b) of such title. 
‘‘(6) DETAIL OF FEDERAL PERSONNEL.—Upon 
request of the Panel, the head of any Federal agency 
may detail, on a reimbursable basis, any of the per-
sonnel of the agency to the Panel to assist it in car-
rying out the duties under paragraph (3). 
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‘‘(7) FEDERAL
ADVISORY
COMMITTEE
ACT.— 
The Federal Advisory Committee Act (5 U.S.C. 
App.) shall apply to the Panel. 
‘‘(8) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated such sums as 
may be necessary to the Panel for carrying out the 
duties of the panel for each of fiscal years 2018 
through 2023. 
‘‘(h) GUIDANCE RELATING TO AMERICAN INDIANS 
AND ALASKA NATIVES.— 
‘‘(1) IN GENERAL.—The Secretary shall issue 
guidance with respect to applying the provisions of 
this section in a manner consistent with the fol-
lowing: 
‘‘(A) To further the goal that Federal 
health services to maintain and improve the 
health of the Indians are consonant with and 
required by the Federal Government’s historical 
and unique legal relationship with, and result-
ing responsibility to, the American Indian peo-
ple. 
‘‘(B) No enrollment fee, premium, or simi-
lar charge, and no deduction, copayment, cost 
sharing, or similar charge is to be imposed 
against an Indian who is furnished an item or 
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service through a waiver under this section. All 
costs incurred in waiving such charges shall be 
borne by the Federal Government in fulfillment 
of the trust responsibility. 
‘‘(C) A State may not require the enroll-
ment of an individual who is an Indian in 
health insurance offered through a waiver under 
this section. 
‘‘(D) Health insurance issuers offering cov-
erage pursuant to a waiver under this section 
must make good faith efforts to contract with 
Indian Health Care Providers operating within 
the area served by the issuers. 
‘‘(E) Health insurance issuers offering cov-
erage pursuant to a waiver under this section 
shall pay Indian Health Care Providers, wheth-
er such providers are participating or non-
participating providers with respect to the cov-
erage, for covered services provided to those In-
dian enrollees who are eligible to receive serv-
ices from such providers at a rate equal to the 
rate negotiated between such entity and the 
provider involved or, if such a rate has not been 
negotiated, at a rate that is not less than the 
level and amount of payment which the entity 
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would make for the services if the services were 
furnished by a participating provider which is 
not an Indian Health Care Provider. 
‘‘(F) Health insurance issuers offering cov-
erage pursuant to a waiver under this section 
will include a standard contract addendum 
when contracting with Indian Health Care Pro-
viders. The contract addendum will be devel-
oped in consultation with tribes and in con-
ference with Urban Indian Health Programs 
operating within the service area of the State. 
‘‘(G) The treatment of Indians under this 
legislation does not constitute invidious racial 
discrimination in violation of the Due Process 
Clause of the Fifth or Fourteenth Amendments, 
but is reasonable and rationally designed to fur-
ther the health of Indians. 
‘‘(H) In the case of any State in which 1 
or more Indian Health Care Programs fur-
nishes health care services, the State will pro-
vide for a process under which the State seeks 
advice on a regular, ongoing basis from des-
ignees of such Indian Health Care Programs 
and Urban Indian Organizations on matters re-
lating to the application of a waiver under this 
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section that are likely to have a direct effect on 
such Indian Health Programs and that— 
‘‘(i) shall include solicitation of advice 
prior to submission of any plan amend-
ments, waiver requests, and proposals for 
demonstration projects likely to have a di-
rect effect on Indians or Indian Health 
Care Programs; and 
‘‘(ii) may include appointment of an 
advisory committee and of a designee of 
such Indian Health Care Programs to the 
medical care advisory committee advising 
the State on its waiver under this section. 
‘‘(2) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) The term ‘Indian’ has the meaning 
given such term in section 447.50 of title 42 of 
the Code of Federal Regulations (as in effect on 
July 1, 2010). 
‘‘(B) The term ‘Indian Health Care Pro-
vider’ has the meaning given such term in sec-
tion 438.14(a) of title 42 of the Code of Fed-
eral Regulations. 
‘‘(i) DEFINITIONS.—In this section: 
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‘‘(1) HEALTH BENEFITS COVERAGE.—The term 
‘health benefits coverage’— 
‘‘(A) means— 
‘‘(i) health insurance coverage, as 
such term is defined in section 2791(b) of 
the Public Health Service Act (42 U.S.C. 
300gg–91(b)); and 
‘‘(ii) coverage under a group health 
plan, as such term is defined in section 
2791(a) of the Public Health Service Act 
(42 U.S.C. 300gg–91(a)); and 
‘‘(B) includes any medical coverage or 
health benefits provided under any specified 
Federal health program described in subpara-
graphs (A) through (E) of paragraph (4). 
‘‘(2) RESIDENT.—With respect to a State, the 
term ‘resident’ means an individual— 
‘‘(A) who is— 
‘‘(i) a citizen or national of the United 
States; or 
‘‘(ii) an alien lawfully residing in the 
State (including an alien who is granted 
deferred action or who is otherwise author-
ized to remain in the United States); and 
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‘‘(A) The Medicare program under title 
XVIII of the Social Security Act. 
‘‘(B) The Medicaid program under title 
XIX of the Social Security Act. 
‘‘(C) The Children’s Health Insurance Pro-
gram under title XXI of the Social Security 
Act. 
‘‘(D) The Federal Employees Health Bene-
fits Plan under chapter 89 of title 5 of the 
United States Code. 
‘‘(E) Medical coverage under chapter 55 of 
title 10, United States Code, including coverage 
under the TRICARE program. 
‘‘(F) An Exchange established under this 
subtitle. 
‘‘(G) Subsidies under section 1402. 
‘‘(H) Tax credits under sections 36B and 
45R of the Internal Revenue Code of 1986.’’. 
(b) CLERICAL AMENDMENT.—The item in the table 
of contents in section 1(b) of the Patient Protection and 
Affordable Care Act relating to section 1332 is amended 
to read as follows: 
‘‘Sec. 1332. Waiver for State universal health care.’’. 
(c) CONTINUATION OF CURRENT LAW FOR CURRENT 
WAIVERS AND WAIVER APPLICATIONS.— 
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(1) IN GENERAL.—Subject to paragraph (2), in 
the case of a State that has applied to the Secretary 
of Health and Human Services for a waiver under 
section 1332 of the Patient Protection and Afford-
able Care Act (42 U.S.C. 18052), as in effect before 
the enactment of this Act, for plan year 2018, such 
section 1332 shall continue to apply to such applica-
tion and to any waiver under such application for 
subsequent plan years. 
(2) TRANSITION TO NEW WAIVER LAW.—Noth-
ing in paragraph (1) shall be construed as pre-
venting a State described in such paragraph from 
withdrawing an application described in such para-
graph (or requesting the Secretary to terminate an 
approved waiver referred to in such paragraph) for 
plan year 2019 or a subsequent plan year and subse-
quently applying for a waiver under section 1332 of 
the Patient Protection and Affordable Care Act, as 
amended by subsection (a), for such a plan year. 
Æ 
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