I 115th CONGRESS 1st Session H. R. 3922 IN THE HOUSE OF REPRESENTATIVES October 3, 2017 Mr. Walden introduced the following bill; which was referred to the Committee on Energy and Commerce , and in addition to the Committee on Ways and Means , for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To extend funding for certain public health programs, and for other purposes.

1. Short title This Act may be cited as the Community Health And Medical Professionals Improve Our Nation Act of 2017 or the CHAMPION Act . 2. Table of contents The table of contents for this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. Title I—Extension of Public Health Programs Sec. 101. Extension for community health centers and the National Health Service Corps. Sec. 102. Extension for special diabetes programs. Sec. 103. Reauthorization of program of payments to teaching health centers that operate graduate medical education programs. Sec. 104. Extension for family-to-family health information centers. Sec. 105. 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. I Extension of Public Health Programs 101. Extension for community health centers and the National Health Service Corps (a) Community health centers funding Section 10503(b)(1)(E) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 254b–2(b)(1)(E) ) is amended by striking 2017 and inserting 2019 . (b) Other community health centers provisions Section 330 of the Public Health Service Act ( 42 U.S.C. 254b ) is amended— (1) in subsection (b)(1)(A)(ii), by striking abuse and inserting use disorder ; (2) in subsection (b)(2)(A), by striking abuse and inserting use disorder ; (3) in subsection (c)— (A) by striking subparagraphs (B) through (D); (B) by striking (1) In general and all that follows through The Secretary and inserting the following: (1) Centers The Secretary ; and (C) in such paragraph (1), as amended, by redesignating clauses (i) through (v) as subparagraphs (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 centers funded under this section to implement evidence-based models for increasing access to high-quality primary care services, which may include models related to— (A) improving the delivery of care for individuals with multiple chronic conditions; (B) workforce configuration; (C) reducing the cost of care; (D) enhancing care coordination; (E) expanding the use of telehealth and technology enabled collaborative learning and capacity building models; (F) care integration, including integration of behavioral health, mental health, or substance use disorder services; and (G) addressing emerging public health or substance use disorder issues to meet the health needs of the population served by the health center. (2) Sustainability In making supplemental 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 providers and health services relative to the national average. ; (5) in subsection (e)(1)— (A) in subparagraph (B)— (i) by striking 2 years and inserting 1 year ; and (ii) by adding at the end the following: The Secretary shall not make a grant under this paragraph unless the applicant provides assurances to the Secretary that within 120 days of receiving grant funding for the operation of the health center, the applicant will submit, for approval by the Secretary, an implementation plan to meet the requirements of subsection (l)(3). The Secretary may extend such 120-day period for achieving compliance 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 subsection (c)(1)) ; (iii) by striking or plan, including the purchase and inserting the following: “including— (i) the purchase ; (iv) by inserting , which may include data and information systems after of equipment ; (v) by striking the period at the end and inserting a semicolon; and (vi) by adding at the end the following: (ii) the provision of training and technical assistance; and (iii) other activities that— (I) reduce costs associated with the provision of health services; (II) improve access to, and availability of, health services provided to individuals served by the centers; (III) enhance the quality and coordination of health services; or (IV) improve the health status of communities. ; (6) in subsection (e)(5)(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 ; (7) by striking subsection (s); (8) by redesignating subsections (g) through (r) as subsections (h) through (s), respectively; (9) by inserting after subsection (f), the following: (g) New access points and expanded services (1) Approval of new access points (A) In general The Secretary may approve applications for grants under subparagraph (A) or (B) of subsection (e)(1), subsection (h), subsection (i), and subsection (j) to establish new delivery sites. (B) Special consideration In carrying out subparagraph (A), the Secretary may give special consideration to applicants that have demonstrated the new delivery site will be located within a sparsely populated area, or an area which has a level of unmet need that is higher relative to other applicants. (C) Consideration of applications In carrying subparagraph (A), the Secretary shall approve applications for grants under subparagraphs (A) and (B) of subsection (e)(1) 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 involved to the medically underserved populations in urban areas which may be expected to use the services provided by the applicants is not less than two to three or greater than three to two. (D) Service area overlap If in carrying out subparagraph (A) the applicant proposes to serve an area that is currently served by another health center funded under this section, the Secretary may consider whether the award of funding to an additional health center in the area can be justified based on the unmet need for additional services within the catch­ment area. (2) Approval of expanded service applications (A) In general The Secretary may approve applications for grants under subparagraph (A) or (B) of subsection (e)(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). (B) Priority expansion projects In carrying out subparagraph (A), the Secretary may give special consideration to expanded service applications that seek to address emerging public health or behavioral health, mental health, or substance abuse issues through increasing the availability of additional health services described in subsection (b)(2) in an area in which there are significant barriers to accessing care. (C) Consideration of applications In carrying out subparagraph (A), the Secretary shall approve applications for applicants 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 involved to the medically underserved populations in urban areas which may be expected to use the services provided by such applicants is not less than two to three or greater than three to two. ; (10) in subsection (i) (as so redesignated)— (A) in paragraph (1), by striking and children and youth at risk of homelessness and inserting , children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness ; and (B) in paragraph (5)— (i) by striking subparagraph (B); (ii) by redesignating subparagraph (C) as subparagraph (B); and (iii) in subparagraph (B) (as so redesignated)— (I) in the subparagraph heading, by striking abuse and inserting use disorder ; and (II) by striking abuse and inserting use disorder ; (11) in subsection (l) (as so redesignated)— (A) in paragraph (2)— (i) in the paragraph heading, by inserting unmet before need ; (ii) in the matter preceding subparagraph (A), by inserting and an application for a grant under subsection (g) after subsection (e)(1) ; (iii) in subparagraph (A), by inserting unmet before need for health services ; (iv) in subparagraph (B), by striking and at the end; (v) in subparagraph (C), by striking the period at the end and inserting ; and ; and (vi) by adding after subparagraph (C) the following: (D) in the case of an application for a grant pursuant to subsection (g)(1), a demonstration that the applicant has consulted with appropriate State and local government agencies, and health care providers regarding the need for the heath services to be provided at the proposed delivery site. ; (B) in paragraph (3)— (i) in the matter preceding subparagraph (A), by inserting or subsection (g) after subsection (e)(1)(B) ; (ii) in subparagraph (B), by striking in the catchment area of the center and inserting , including other health care providers that provide care within the catchment area, local hospitals, and specialty providers in the catchment area of the center, to provide access to services not available through the health center and to reduce the non-urgent use of hospital emergency departments ; (iii) in subparagraph (H)(ii), by inserting who shall be directly employed by the center after approves the selection of a director for the center ; (iv) in subparagraph (L), by striking and at the end; (v) in subparagraph (M), by striking the period and inserting ; and ; and (vi) by inserting after subparagraph (M), the following: (N) the center has written policies and procedures in place to ensure the appropriate use of Federal funds in compliance with applicable Federal statutes, regulations, and the terms and conditions of the Federal award. ; and (C) by striking paragraph (4); (12) in subsection (m) (as so redesignated), by adding at the end the following: Funds expended to carry out activities under this subsection and operational support activities under subsection (n) shall not exceed three percent of the amount appropriated for this section for the fiscal year involved. ; (13) in subsection (q) (as so redesignated), by striking grants for new health centers under subsections (c) and (e) and inserting operating grants under subsection (e), applications for new access points and expanded service pursuant to subsection (g) ; (14) in subsection (r)(4) (as so redesignated), 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. ; and (15) in subsection (s)(3) (as so redesignated)— (A) by striking appropriate committees of Congress a report concerning the distribution of funds under this section and inserting the following: “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 ; (B) by striking populations. Such report shall include an assessment and inserting the following: “populations; (B) an assessment ; (C) by striking and the rationale for any substantial changes in the distribution of funds. and inserting a semicolon; and (D) by adding at the end the following: (C) the distribution of awards and funding for new or expanded services in each of rural areas and urban areas; (D) the distribution of awards and funding for establishing new access points, and the number of new access points created; (E) the amount of unexpended funding for loan guarantees and loan guarantee authority under title XVI; (F) the rationale for any substantial changes in the distribution of funds; (G) the rate of closures for health centers and access points; (H) the number and reason for any grants awarded pursuant to subsection (e)(1)(B); and (I) the number and reason for any waivers provided pursuant to subsection (r)(4). . (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) 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 ). (e) 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 (2) in paragraph (4), by inserting and section 101(d) of the Community Health And Medical Professionals Improve Our Nation Act of 2017 after section 221(c) of the Medicare Access and CHIP Reauthorization Act of 2015 . 102. Extension for special diabetes programs (a) Special diabetes program for type I diabetes 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 Section 330C(c)(2) of the Public Health Service Act ( 42 U.S.C. 254c–3(c)(2) ) is amended— (1) in subparagraph (C), by striking and at the end; (2) in subparagraph (D), by striking the period at the end and inserting and $112,500,000 for the period consisting of the second, third, and fourth quarters of fiscal year 2018; and ; and (3) by adding at the end the following: (E) $150,000,000 for fiscal year 2019. . 103. Reauthorization of program of payments to teaching health centers that operate graduate medical education programs (a) 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— (A) maintenance of existing approved graduate medical residency training programs; (B) expansion of existing approved graduate medical residency training programs; and (C) establishment of new approved graduate medical residency training programs, as appropriate. (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 (B) are located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act). . (b) Funding Subsection (g) of section 340H of the Public Health Service Act ( 42 U.S.C. 256h ) is amended— (1) by striking To carry out and inserting the following: (1) In general To carry out ; (2) by striking and $15,000,000 for the first quarter of fiscal year 2018 and inserting , $15,000,000 for the first quarter of fiscal year 2018, $111,500,000 for the period consisting of the second, third, and fourth quarters of fiscal year 2018, and $126,500,000 for fiscal year 2019 ; and (3) 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. . (c) Annual reporting Subsection (h)(1) of section 340H of the Public Health Service Act ( 42 U.S.C. 256h ) is amended— (1) by redesignating subparagraph (D) as subparagraph (H); and (2) 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 residents entering primary care practice (meaning any of the areas of practice listed in the definition 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 residents who entered practice at a health care facility— (i) primarily serving a health professional shortage area with a designation in effect under section 332 or a medically underserved community (as defined in section 799B); or (ii) located in a rural area (as defined in section 1886(d)(2)(D) of the Social Security Act). . (d) Report on training costs Not later than March 31, 2019, the Secretary of Health and Human Services shall submit to the Congress a report on the direct graduate expenses of approved graduate medical residency training programs, and the 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 )). (e) Definition Subsection (j) of section 340H of the Public Health Service Act ( 42 U.S.C. 256h ) is amended— (1) by redesignating paragraphs (2) and (3) as paragraphs (3) and (4), respectively; and (2) by inserting after paragraph (1) the following: (2) New approved graduate medical residency training program The term new approved graduate medical residency training program means an approved graduate medical residency training program for which the sponsoring qualified teaching health center has not received a payment under this section for a previous fiscal year (other than pursuant to subsection (a)(1)(C)). . (f) Technical correction Subsection (f) of the section 340H ( 42 U.S.C. 256h ) is amended by striking hospital each place it appears and inserting teaching health center . (g) 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. 104. Extension for family-to-family health information 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 (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 developed in all territories and at least one such center shall be developed for Indian tribes ; and (3) by amending paragraph (5) to read as follows: (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. . 105. Youth empowerment program; personal responsibility education (a) Youth empowerment program (1) In general Section 510 of the Social Security Act ( 42 U.S.C. 710 ) is amended to read as follows: 510. Youth empowerment program (a) In general (1) Allotments to States For the purpose described in subsection (b), the Secretary shall, for each of fiscal years 2018 and 2019, allot to each State which has transmitted an application for the fiscal year under section 505(a) an amount equal to the product of— (A) the amount appropriated pursuant to subsection (e)(1) for the fiscal year, minus the amount reserved under subsection (e)(2) for the fiscal year; and (B) the proportion that the number of low-income children in the State bears to the total of such numbers of children for all the States. (2) Other allotments (A) Other entities For the purpose described in subsection (b), the Secretary shall, for each of fiscal years 2018 and 2019, for any State which has not transmitted an application for the fiscal year under section 505(a), allot to one or more entities in the State the amount that would have been allotted to the State under paragraph (1) if the State had submitted such an application. (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 reporting under paragraph (6), the purpose of an allotment under subsection (a) to a State (or to another entity in the State pursuant to subsection (a)(2)) is to enable the State or other entity to implement education exclusively on sexual risk avoidance (meaning voluntarily refraining from sexual activity). (2) Required components Education on sexual risk avoidance pursuant to an allotment under this section shall— (A) ensure that the unambiguous and primary emphasis and context for each topic described 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 receiving the education. (3) Topics Education on sexual risk avoidance 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 decisionmaking, 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. (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 violence, 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 contraception is medically accurate and ensures that students understand that contraception offers physical risk reduction, but not risk elimination; and (B) the education does not include demonstrations, simulations, or distribution of contraceptive devices. (5) Research (A) In general A State or other entity receiving an allotment pursuant to subsection (a) may use up to 20 percent of such allotment to build the evidence base for sexual risk avoidance education by conducting or supporting research. (B) Requirements Any research conducted or supported pursuant to subparagraph (A) shall be— (i) rigorous; (ii) evidence-based; and (iii) designed and conducted by independent researchers who have experience in conducting and publishing research in peer-reviewed outlets. (6) Information collection and reporting A State or other entity receiving an allotment pursuant to subsection (a) shall, as specified by the Secretary— (A) collect information on the programs and activities funded through the allotment; and (B) submit reports to the Secretary on the data from such programs and activities. (c) National evaluation (1) In general The Secretary shall— (A) in consultation with appropriate State and local agencies, conduct one or more rigorous evaluations of the education funded through this section and associated data; and (B) submit a report to the Congress on the results of such evaluations, together with a summary of the information collected pursuant to subsection (b)(6). (2) Consultation In conducting the evaluations required by paragraph (1), including the establishment of evaluation methodologies, the Secretary shall consult with relevant stakeholders. (d) Applicability of certain provisions (1) Sections 503, 507, and 508 apply to allotments under subsection (a) to the same extent and in the same manner as such sections apply to allotments under section 502(c). (2) Sections 505 and 506 apply to allotments under subsection (a) to the extent determined by the Secretary to be appropriate. (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 reserve, for each of fiscal years 2018 and 2019, not more than 20 percent of the amount appropriated pursuant to paragraph (1) for administering the program under this section, including the conducting of national evaluations and the provision of technical assistance to the recipients of allotments. . (2) Effective date The amendment made by this section 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)— (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 inserting Competitive PREP grants ; and (II) in clause (i), by striking solicit applications to award 3-year grants in each of fiscal years 2012 through 2017 and insert continue through fiscal year 2019 grants awarded for any of fiscal years 2015 through 2017 ; (C) in subsection (c), by inserting after youth with HIV/AIDS, the following: victims 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. II Offsets 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 striking 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 purposes of subparagraph (B)(iv)(II), the grace period 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— (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 premiums before discontinuing coverage that is applicable 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 paragraph (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 payment under paragraph (2)(A). (b) Report on aligning grace periods for Medicaid, Medicare, and Exchange plans Not later than two 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 Medicare 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 Patient Protection and Affordable Care Act, including the extent to which such an alignment of grace periods may help to avoid enrollment status confusion for individuals under such Medicaid program, Medicare 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. 202. Prevention and Public Health Fund Section 4002(b) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 300u–11(b) ) is amended by striking paragraphs (3) through (8) and inserting the following new paragraphs: (3) for fiscal year 2018, $900,000,000; (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. .