In the Senate of the United States, 
December 19, 2018. 
Resolved, That the Senate agree to the amendment of 
the House of Representatives to the amendment of the Sen-
ate to the bill (H.R. 695), entitled ‘‘An Act to amend the Na-
tional Child Protection Act of 1993 to establish a national 
criminal history background check system and criminal his-
tory review program for certain individuals who, related to 
their employment, have access to children, the elderly, or in-
dividuals with disabilities, and for other purposes.’’, with the 
following 
SENATE AMENDMENT TO HOUSE AMENDMENT TO 
SENATE AMENDMENT: 
In lieu of the matter proposed to be inserted by the 
House amendment, insert the following: 
DIVISION A—FURTHER ADDITIONAL 
CONTINUING APPROPRIATIONS ACT, 2019 
SEC. 101. The Continuing Appropriations Act, 2019 
(division C of Public Law 115–245) is further amended— 
(1) by striking the date specified in section 
105(3) and inserting ‘‘February 8, 2019’’; and
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(2) by adding after section 136 the following: 
‘‘SEC. 137. Notwithstanding section 251(a)(1) of the 
Balanced Budget and Emergency Deficit Control Act of 
1985 and the timetable in section 254(a) of such Act, the 
final sequestration report for fiscal year 2019 pursuant to 
section 254(f)(1) of such Act and any order for fiscal year 
2019 pursuant to section 254(f)(5) of such Act shall be 
issued, for the Congressional Budget Office, 10 days after 
the date specified in section 105(3), and for the Office of 
Management and Budget, 15 days after the date specified 
in section 105(3). 
‘‘SEC. 138. The authority provided under title XXI of 
the Homeland Security Act of 2002 (6 U.S.C. 621 et seq.), 
as amended by section 2(a) of the Protecting and Securing 
Chemical Facilities from Terrorist Attacks Act of 2014 
(Public Law 113–254), shall continue in effect through the 
date specified in section 105(3). 
‘‘SEC. 139. Section 319L(e)(1)(A) of the Public Health 
Service Act (42 U.S.C. 247d–7e(e)(1)(A)) shall continue in 
effect through the date specified in section 105(3) of this 
Act. 
‘‘SEC. 140. Section 405(a) of the Pandemic and All- 
Hazards Preparedness Act (42 U.S.C. 247d–6a note) shall 
continue in effect through the date specified in section 
105(3) of this Act.’’.
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This division may be cited as the ‘‘Further Additional 
Continuing Appropriations Act, 2019’’. 
DIVISION B—MEDICAID 
EXTENDERS 
SEC. 101. EXTENSION OF MONEY FOLLOWS THE PERSON RE-
BALANCING DEMONSTRATION. 
(a) GENERAL FUNDING.—Section 6071(h) of the Def-
icit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended— 
(1) in paragraph (1)— 
(A) in subparagraph (D), by striking ‘‘and’’ 
after the semicolon; 
(B) in subparagraph (E), by striking the 
period at the end and inserting ‘‘; and’’; and 
(C) by adding at the end the following: 
‘‘(F) subject to paragraph (3), $112,000,000 
for fiscal year 2019.’’; 
(2) in paragraph (2)— 
(A) by striking ‘‘Amounts made’’ and in-
serting ‘‘Subject to paragraph (3), amounts 
made’’; and 
(B) by striking ‘‘September 30, 2016’’ and 
inserting ‘‘September 30, 2021’’; and 
(3) by adding at the end the following new para-
graph:
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‘‘(3) SPECIAL RULE FOR FY 2019.—Funds ap-
propriated under paragraph (1)(F) shall be made 
available for grants to States only if such States have 
an approved MFP demonstration project under this 
section as of December 31, 2018.’’. 
(b) FUNDING FOR QUALITY ASSURANCE AND IMPROVE-
MENT; TECHNICAL
ASSISTANCE; OVERSIGHT.—Section 
6071(f) of the Deficit Reduction Act of 2005 (42 U.S.C. 
1396a note) is amended by striking paragraph (2) and in-
serting the following: 
‘‘(2) FUNDING.—From the amounts appropriated 
under subsection (h)(1)(F) for fiscal year 2019, 
$500,000 shall be available to the Secretary for such 
fiscal year to carry out this subsection.’’. 
(c) TECHNICAL AMENDMENT.—Section 6071(b) of the 
Deficit Reduction Act of 2005 (42 U.S.C. 1396a note) is 
amended by adding at the end the following: 
‘‘(10) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services.’’. 
SEC. 102. EXTENSION OF PROTECTION FOR MEDICAID RE-
CIPIENTS OF HOME AND COMMUNITY-BASED 
SERVICES AGAINST SPOUSAL IMPOVERISH-
MENT. 
(a) IN GENERAL.—Section 2404 of Public Law 111– 
148 (42 U.S.C. 1396r–5 note) is amended by striking ‘‘the
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5-year period that begins on January 1, 2014,’’ and insert-
ing ‘‘the period beginning on January 1, 2014, and ending 
on March 31, 2019,’’. 
(b) RULE OF CONSTRUCTION.— 
(1) PROTECTING STATE SPOUSAL INCOME AND 
ASSET DISREGARD FLEXIBILITY UNDER WAIVERS AND 
PLAN AMENDMENTS.—Nothing in section 2404 of Pub-
lic Law 111–148 (42 U.S.C. 1396r–5 note) or section 
1924 of the Social Security Act (42 U.S.C. 1396r–5) 
shall be construed as prohibiting a State from dis-
regarding an individual’s spousal income and assets 
under a State waiver or plan amendment described 
in paragraph (2) for purposes of making determina-
tions of eligibility for home and community-based 
services or home and community-based attendant 
services and supports under such waiver or plan 
amendment. 
(2) STATE WAIVER OR PLAN AMENDMENT DE-
SCRIBED.—A State waiver or plan amendment de-
scribed in this paragraph is any of the following: 
(A) A waiver or plan amendment to provide 
medical assistance for home and community- 
based services under a waiver or plan amend-
ment under subsection (c), (d), or (i) of section 
1915 of the Social Security Act (42 U.S.C.
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1396n) or under section 1115 of such Act (42 
U.S.C. 1315). 
(B) A plan amendment to provide medical 
assistance for home and community-based serv-
ices for individuals by reason of being deter-
mined eligible under section 1902(a)(10)(C) of 
such Act (42 U.S.C. 1396a(a)(10)(C)) or by rea-
son of section 1902(f) of such Act (42 U.S.C. 
1396a(f)) or otherwise on the basis of a reduction 
of income based on costs incurred for medical or 
other remedial care under which the State dis-
regarded the income and assets of the individ-
ual’s spouse in determining the initial and ongo-
ing financial eligibility of an individual for such 
services in place of the spousal impoverishment 
provisions applied under section 1924 of such 
Act (42 U.S.C. 1396r–5). 
(C) A plan amendment to provide medical 
assistance for home and community-based at-
tendant services and supports under section 
1915(k) of such Act (42 U.S.C. 1396n(k)).
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SEC. 103. REDUCTION IN FMAP AFTER 2020 FOR STATES 
WITHOUT ASSET VERIFICATION PROGRAM. 
Section 1940 of the Social Security Act (42 U.S.C. 
1396w) is amended by adding at the end the following new 
subsection: 
‘‘(k) REDUCTION IN FMAP AFTER 2020 FOR NON- 
COMPLIANT STATES.— 
‘‘(1) IN GENERAL.—With respect to a calendar 
quarter beginning on or after January 1, 2021, the 
Federal medical assistance percentage otherwise deter-
mined under section 1905(b) for a non-compliant 
State shall be reduced— 
‘‘(A) for calendar quarters in 2021 and 
2022, by 0.12 percentage points; 
‘‘(B) for calendar quarters in 2023, by 0.25 
percentage points; 
‘‘(C) for calendar quarters in 2024, by 0.35 
percentage points; and 
‘‘(D) for calendar quarters in 2025 and 
each year thereafter, by 0.5 percentage points. 
‘‘(2) NON-COMPLIANT
STATE
DEFINED.—For 
purposes of this subsection, the term ‘non-compliant 
State’ means a State— 
‘‘(A) that is one of the 50 States or the Dis-
trict of Columbia;
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‘‘(B) with respect to which the Secretary 
has not approved a State plan amendment sub-
mitted under subsection (a)(2); and 
‘‘(C) that is not operating, on an ongoing 
basis, an asset verification program in accord-
ance with this section.’’. 
SEC. 104. MEDICAID IMPROVEMENT FUND. 
Section 1941(b)(1) of the Social Security Act (42 
U.S.C. 
1396w–1(b)(1)) 
is 
amended 
by 
striking 
‘‘$31,000,000’’ and inserting ‘‘$6,000,000’’. 
SEC. 105. BUDGETARY EFFECTS. 
(a) STATUTORY PAYGO SCORECARDS.—The budgetary 
effects of this division shall not be entered on either PAYGO 
scorecard maintained pursuant to section 4(d) of the Statu-
tory Pay-As-You-Go Act of 2010 (2 U.S.C. 933(d)). 
(b) SENATE PAYGO SCORECARDS.—The budgetary ef-
fects of this division shall not be entered on any PAYGO 
scorecard maintained for purposes of section 4106 of H. 
Con. Res. 71 (115th Congress). 
(c) CLASSIFICATION OF BUDGETARY EFFECTS.—Not-
withstanding Rule 3 of the Budget Scorekeeping Guidelines 
set forth in the joint explanatory statement of the committee 
of conference accompanying Conference Report 105–217 
and section 250(c)(8) of the Balanced Budget and Emer-
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gency Deficit Control Act of 1985, the budgetary effects of 
this division shall not be estimated— 
(1) for purposes of section 251 of such Act; and 
(2) for purposes of paragraph (4)(C) of section 
3 of the Statutory Pay-As-You-Go Act of 2010 as 
being included in an appropriation Act. 
(d) PAYGO ANNUAL REPORT.—For the purposes of 
the annual report issued pursuant to section 5 of the Statu-
tory Pay-As-You-Go Act of 2010 (2 U.S.C. 934) after ad-
journment of the second session of the 115th Congress, and 
for determining whether a sequestration order is necessary 
under such section, the debit for the budget year on the 5- 
year scorecard, if any, and the 10-year scorecard, if any, 
shall be deducted from such scorecard in 2019 and added 
to such scorecard in 2020. 
Attest: 
Secretary.
115TH CONGRESS 
2D SESSION 
H.R. 695 
SENATE AMENDMENT TO 
HOUSE AMENDMENT TO 
SENATE AMENDMENT